Disparities| Volume 29, ISSUE 5, P392-399, September 2019

“Make the Call, Don't Miss a Beat” Campaign: Effect on Emergency Medical Services Use in Women with Heart Attack Signs



      Our objective was to evaluate the relationship between the “Make The Call, Don't Miss a Beat” national mass media campaign and emergency medical services (EMS) use among women with possible heart attack symptoms.


      We linked campaign TV public service advertisement data with national EMS activation data for 2010 to 2014. We identified EMS activations (i.e., responses) for possible heart attack symptoms and for unintentional injuries for both women and men. We estimated the impact of the campaign on the fraction of the 1.7 to 15.9 million activations of women with possible heart attack symptoms compared with 1.9 million female activations for unintentional injuries within each EMS agency and month using quasi-binomial logistic regression controlling for time and state.


      Of the 3,175 U S. counties, 90% were exposed to the campaign. However, less than 2% of U.S. counties reached moderate TV exposure (≥300 gross rating points) during the entire campaign period. We did not observe an increase in the fraction of female activations for possible heart attack during periods or in counties with higher campaign exposure.


      This mass media campaign that relied heavily on TV public service advertisements was not associated with increased EMS use by women with possible heart attack symptoms, even among counties that were more highly exposed to the campaign advertisements.
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        • Barbagelata A.
        • Perna E.R.
        • Clemmensen P.
        • Uretsky B.F.
        • Canella J.P.
        • Califf R.M.
        • Birnbaum Y.
        Time to reperfusion in acute myocardial infarction. It is time to reduce it!.
        Journal of Electrocardiology. 2007; 40: 257-264
        • Canto J.G.
        • Canto E.A.
        • Goldberg R.J.
        Time to standardize and broaden the criteria for acute coronary symptom presentations in women.
        Canadian Journal of Cardiology. 2014; 30: 721-728
        • Centers for Disease Control and Prevention
        Interactive atlas of heart disease and stroke: a county-level mapping tool.
        Date: 2014
        Date accessed: September 4, 2015
        • Durkin S.J.
        • Biener L.
        • Wakefield M.A.
        Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups.
        American Journal of Public Health. 2009; 99: 2217-2223
        • Enoch G.
        The Nielsen total audience report.
        • Eppler E.
        • Eisenberg M.J.
        • Schaeffer S.
        • Meischke H.
        • Larson M.P.
        911 and emergency department use for chest pain: Results of a media campaign.
        Annals of Emergency Medicine. 1994; 94: 202-208
        • Farrelly M.C.
        • Davis K.C.
        • Haviland M.L.
        • Messeri P.
        • Healton C.G.
        Evidence of a dose-response relationship between "truth" antismoking ads and youth smoking prevalence.
        American Journal of Public Health. 2005; 95: 425-431
        • Ford E.S.
        • Capewell S.
        Proportion of the decline in cardiovascular mortality disease due to prevention versus treatment: public health versus clinical care.
        Annual Review of Public Health. 2011; 32: 5-22
        • Freimuth V.
        • Cole G.
        • Kirby S.D.
        Issues in evaluating mass-media health communication campaigns.
        WHO Regional Publications, European Series2001: 475-492
        • Goff D.C.
        • Mitchell P.
        • Finnegan J.
        • Pandey D.
        • Bittner V.
        • Feldman H.
        • Group R.S.
        Knowledge of heart attack symptoms in 20 U.S. communities. Results from the rapid early action for coronary treatment community trial.
        Preventive Medicine. 2004; 38: 85-93
        • Health Resources and Services Administration
        Data warehouse area health resource files.
        Date: 2010
        Date accessed: March 27, 2015
        • Healy B.
        The Yentl syndrome.
        New England Journal of Medicine. 1991; 325: 274-276
        • Ho M.T.
        • Eisenberg M.J.
        • Litwin P.E.
        • Schaeffer S.M.
        • Doman S.K.
        Delay between onset of chest pain and seeking medical care: the effect of public education.
        Annals of Emergency Medicine. 1989; 18: 727-731
        • Huhman M.
        • Potter L.D.
        • Wong F.L.
        • Banspach S.W.
        • Duke J.C.
        • Heitzler C.D.
        Effects of a mass media campaign to increase physical activity among children: year-1 results of the VERB campaign.
        Pediatrics. 2005; 116: e277-e284
        • Long T.
        • Taubenheim A.
        • Wayman J.
        • Temple S.
        • Ruoff B.
        "The Heart Truth:" Using the power of branding and social marketing to increase awareness of heart disease in women.
        Social Marketing Quarterly. 2008; 14: 3-29
        • Luepker R.V.
        • Raczynski J.M.
        • Osganian S.
        • Goldberg R.J.
        • Hedges J.R.
        • Goff D.C.
        • Simons-Morton D.G.
        Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: the rapid early action for coronary treatment (REACT) trial.
        JAMA. 2000; 284: 60-67
        • Mann N.C.
        • Kane L.
        • Dai M.
        • Jacobson K.
        Description of the 2012 NEMSIS public-release research dataset.
        Prehospital Emergency Care. 2015; 19: 232-240
        • McAfee T.
        • Davis K.C.
        • Alexander Jr., R.L.
        • Pechacek T.F.
        • Bunnell R.
        Effect of the first federally funded US antismoking national media campaign.
        Lancet. 2013; 382: 2003-2011
        • Meischke H.
        • Dulberg E.M.
        • Schaeffer S.S.
        • Henwood D.K.
        • Larsen M.P.
        • Eisenberg M.S.
        ‘Call Fast, Call 911': a direct mail campaign to reduce patient delay in acute myocardial infarction.
        American Journal of Public Health. 1997; 87: 1705-1709
        • Metsch L.
        • Lalota M.
        • Phillips G.
        • Cardenas G.
        • Castel A.D.
        • et al.
        Willingness to take daily pre-exposure prophylaxis (PrEP) among MSM in two HIV epicenters in the United States.
        in: Paper presented at the XIX International AIDS Conference, Washington, DC. 2012
        • Mosca L.
        • Jones W.K.
        • King K.B.
        • Ouyang P.
        • Redberg R.F.
        • Hill M.N.
        Awareness, perception, and knowledge of heart disease risk and prevention among women in the United States: American heart association women's heart disease and stroke campaign task force.
        Archives of Family Medicine. 2000; 9: 506-515
        • Mosca L.
        • Mochari-Greenberger H.
        • Dolor R.J.
        • Newby L.K.
        • Robb K.J.
        Twelve-year follow-up of American women's awareness of cardiovascular disease risk factors and barriers to heart health.
        Circulation: Cardiovascular Quality and Outcomes. 2010; 3: 120-127
        • Moses H.W.
        • Engelking N.
        • Taylor G.T.
        • Prabhakar C.
        • Vallala M.
        • Colliver J.A.
        • Schneider J.A.
        Effect of a two-year public education campaign on reducing response times of patients with symptoms of acute myocardial infarction.
        American Journal of Cardiology. 1991; 68: 249-251
        • Mozaffarian D.
        • Benjamin E.J.
        • Go A.S.
        • Arnett D.K.
        • Blaha M.J.
        • Cushman M.
        • American Heart Association Statistics Committee and Stroke Statistics Subcommittee
        Heart disease and stroke statistics--2015 update: a report from the American Heart Association.
        Circulation. 2015; 131: e29-e322
        • Nichols J.L.
        • Solomon M.G.
        Click it or ticket evaluation, 2011 (DOT HS 811 779).
        U.S. Department of Transportation, National Highway Traffic Safety Administration, Washington, DC2013
        • Rampell C.
        The old and uneducated watch the most TV.
        New York Times, 2012 (Available:)
        • Randolph W.
        • Viswanath K.
        Lessons learned from public health mass media campaigns: marketing health in a crowded media world.
        Annual Review of Public Health. 2004; 25: 419-437
        • Reger B.
        • Cooper L.
        • Booth-Butterfield S.
        • Smith H.
        • Bauman A.
        • Wootan M.
        • Greer F.
        Wheeling Walks: a community campaign using paid media to encourage walking among sedentary older adults.
        Preventive Medicine. 2002; 35: 285-292
        • Sidney S.
        • Quesenberry Jr., C.P.
        • Jaffe M.G.
        • Sorel M.
        • Nguyen-Huynh M.N.
        • Kushi L.H.
        • Rana J.S.
        Recent trends in cardiovascular mortality in the united states and public health goals.
        JAMA Cardiology. 2016; 1: 594-599
        • Wakefield M.A.
        • Spittal M.J.
        • Yong H.H.
        • Durkin S.J.
        • Borland R.
        Effects of mass media campaign exposure intensity and durability on quit attempts in a population-based cohort study.
        Health Education and Research. 2011; 26: 988-997


      Melissa L. McCarthy, ScD, is a health services researcher and Professor at the George Washington University Milken Institute School of Public Health with research expertise in emergency care.


      Suzanne Haynes, PhD, is an epidemiologist with research expertise in women's health.


      Ximin Li, MS, is a biostatistician at the Johns Hopkins University Bloomberg School of Public Health. Her research expertise is the analysis of large datasets.


      N. Clay Mann, PhD, MS, is a health services researcher and Professor at the University of Utah with research expertise in prehospital care.


      Craig D. Newgard, MD, MPH, is an emergency medicine physician and Professor at the Oregon Health & Sciences University with research expertise in cardiac arrest, trauma, and prehospital care.


      Jannet F. Lewis, MD, is a cardiologist and Professor at the George Washington University School of Medicine and Health Sciences. Her research expertise is heart disease in women and the use of echocardiographic techniques to assess heart disease.


      Alan E. Simon, MD, is a pediatrician, presently at the National Institutes of Health, with research expertise in women's health.


      Susan F. Wood, PhD, is a biologist and Professor at the George Washington University Milken Institute School of Public Health with research expertise in women's health.


      Scott L. Zeger, PhD, is a biostatistician and Professor at the Johns Hopkins University Bloomberg School of Public Health. His research expertise is the analysis of correlated data.