Improving understanding, promoting social inclusion, and fostering empowerment related to epilepsy: Epilepsy Foundation public awareness campaigns — 2001 through 2013

Abstract

It is a significant public health concern that epilepsy, the fourth most common neurological disorder in the United States, is generally poorly understood by both the public and those living with the condition. Lack of understanding may magnify the challenges faced by those with epilepsy, including limiting treatment opportunities, effective management of symptoms, and full participation in daily life activities. Insufficient awareness of epilepsy and appropriate seizure first aid among the public and professionals can result in insufficient treatment, inappropriate seizure response, physical restraint, social exclusion, or other negative consequences. To address the need for increased public education and awareness about epilepsy, the national Epilepsy Foundation, supported by the Centers for Disease Control and Prevention, has conducted yearly multifaceted public education and awareness campaigns designed to reach the broad population and targeted segments of the population including youth, young adults, racial/ethnic groups (i.e., African-, Hispanic-, and Asian-Americans), and people with epilepsy and their caregivers. Campaign channels have included traditional media, social media, and community opinion leaders and celebrity spokespersons. The key activities of these campaigns, conducted from 2001 to 2013, are summarized in this report.

1. Introduction

While people may readily recognize seizure activity associated with epilepsy when they see it in real life or on the screen, epilepsy — the fourth most common neurological disorder in the United States [1] —is generally poorly understood by the public, even among people who know someone with the disorder [2–4]. This raises a significant public health concern given that epilepsy is not rare: about 1 in 26 people will develop epilepsy at some point in their lives [5]. In addition, research has shown that people who have epilepsy themselves often do not have an adequate understanding of their condition, including their diagnosis, the nature of seizures that they experience, what precipitates or triggers their seizures, the possible side effects of the treatment that they receive, the safety issues that they face, and the risks and potential consequences of their condition [6]. This lack of understanding may also intensify the challenges faced by those with epilepsy, especially in regard to managing medication schedules, symptoms, disability, lifestyle limitations, emotional stress, and stigma [7,8].

Misunderstanding, misinformation, and misperceptions about epilepsy and seizures, passed down through the centuries, have resulted in stigma — negative attitudes and beliefs related to those living with the disorder that can result in social-distancing behaviors, social exclusion, and discrimination. This has appeared in the workplace, in schools, and in the community because of the public’s inexperience with appropriate seizure response, persistent myths about epilepsy, and their lack of understanding about the abilities of people with epilepsy [4,5]. In addition, people with epilepsy may experience “felt” stigma, being ashamed of their condition and afraid to be open about it because of the fear of prejudice and discrimination [9].

Over the years, studies have supported the belief that education and awareness campaigns can influence large numbers of people to change or avoid behavior that leads to disability and stigmatization [10,11]. In addition, participants from the epilepsy community, health care, public health, and organized systems of care have come together to address optimal health for people with epilepsy. These meetings have resulted in recommendations related to programs, services, and communication strategies for epilepsy stakeholders and the public health community to better support people with epilepsy [4,12,13]. As a result of these recommendations, as well as contributions from the Living with Epilepsy Task Force [14] and the Vision 20–20 coalition [5], the Institute of Medicine (IOM) was asked to address the public health dimensions of epilepsy. The consensus report that followed, Epilepsy across the Spectrum, has further clarified the complex nature of epilepsy and the role of public health in addressing this disorder, and underlined the importance of comprehensive educational efforts for people with epilepsy and their families, including health literacy and cultural considerations, and the need to eliminate the stigma of epilepsy [4,5]. In this overview, we summarize select public awareness activities on epilepsy to highlight target populations, themes, communication channels, and impacts.

2. Epilepsy Foundation awareness campaigns: 2001–2013

To address the gap in public awareness, the national Epilepsy Foundation (EF), supported by the Centers for Disease Control and Prevention (CDC), has conducted yearly multifaceted public education and awareness campaigns about epilepsy for more than a decade. Campaigns have been tailored to reach targeted segments of the population including youth, young adults, African-Americans, Hispanic-Americans, and Asian-Americans. Communication of key campaign messages has evolved over the years to include not only mass media channels such as television, radio, and print but also other media including DVDs, the Internet, and, most recently, a full array of social media. In addition, public personalities, celebrities, and trusted medical professionals have been recruited to increase understanding and promote greater acceptance of epilepsy by serving as advocates for those with the disorder. Partnerships have grown to include, in addition to affiliates of the national Epilepsy Foundation, companies and corporations; churches; community centers; clinics; local community groups; and national associations, networks, forums, councils, and academic institutions. Table 1 provides a brief outline of the yearly campaigns. Key activities composing each campaign year are described below. With the exception of one year (2004/2005), measurement of campaign effects was limited to estimated audience reach and, later, audience involvement via social media.

Table 1.

Summary of Epilepsy Foundation awareness campaigns: 2001–2013.

Year	Target group	Theme	Methods	Key partners
2001–2002	Teens	Entitled to Respect	Celebrity endorsement, Internet, radio PSAs, audio and video news releases, newspapers, posters, brochures	*NSYNC, epilepsy clinical specialists
2002–2003	Tweens	Entitled to Respect	Celebrity endorsement; Internet; PSAs; ads to youth magazines, high school newspapers, local and national print media	Ashton Kutcher, Triple Image, Clear Channel affiliates
2003–2004	African-American youth	Entitled to Respect/Get the Word Out	Celebrity endorsement, Internet, contest, PSAs, news releases, brochure, posters, campaign microsite	Monica (Arnold), EF affiliates, Clear Channel Worldwide, National Peer Helpers Association, National Association of Police Athletic Leagues
2004–2005	African-American community	Get the Word Out	Celebrity endorsement, audio and video PSAs, radio media tours, Internet, print media, broadcasts, brochures, seizure first aid bookmarks, fact sheets, planned events	Garcelle Beauvais-Nilon, EF affiliates, beauty salons, churches, community centers, health clinics
2005–2006	Hispanic-American community	Epilepsy: It’s More Common Than You Think	Radio interviews and PSAs, celebrity endorsement, magazine and newspaper articles, exhibits, handouts, community health worker in-home visits	“Prevenir es Salud” with Dr. Elmer Huerta, EF affiliates, National Association of Hispanic Journalists, National Council of La Raza, Lay Health Workers National Network
2006–2007	Hispanic-American community	Not Another Moment Lost to Seizures	Radio PSAs, newspaper articles, Internet, curriculum development, community workshops, conference exhibits and presentations, telephone information service line	Hispanic Leadership Council, EF affiliates, National Council of La Raza, Lay Health Workers National Network, United States Hispanic Chamber of Commerce
2007–2008	Hispanic-American community, African-American community	Not Another Moment Lost to Seizures, Know the Difference	Radio PSAs, newspaper articles, Internet, curriculum pilot, magazine ads, educational materials, community workshops, forums, conference exhibits	EF affiliates, Community Health Workers — Promotores, East Coast Migrant Stream Forum, Midwest Stream Farmworker Health Forum, NAACP, National Urban League, Congressional Black Caucus
2008–2009	Hispanic-American community, African-American community	No More Seizures, Know the Difference	Radio PSAs, Internet, magazine ads, curriculum, toll-free telephone, educational materials, community presentations, conferences, forums	EF affiliates, Promotores National Network Association, National Center for Farmworker Health, Urban League affiliates, EEOC
2009–2010	Hispanic community, African-American community	Know the Difference	Radio PSAs, Internet, magazine ads, toll-free telephone, educational materials, community presentations, social media	EF affiliates, Promotores National Network Association, National Center for Farmworker Health, historically black colleges and universities
2010–2011	Hispanic-American community, African-American community	Get Seizure Smart, Know the Difference	Internet, videos, curriculum, toll-free telephone, social media, brochures, ads, flyers, posters, bookmarks, hangers	International Medical Interpreters Association, EF affiliates, National Center for Farmworker Health, historically black colleges and universities, predominantly black institutions
2011–2012	Hispanic-American community, African-American community	Get Seizure Smart	Internet, social media, community events, educational materials, ads, video, DVD	EF affiliates, National Center for Farmworker Health, historically black colleges universities, Predominantly Black Institutions, Hispanic Serving Institutions
2012–2013	Asian-American youth and young adults	26 Days of Epilepsy Awareness and Action	Internet, video, social media, community events, physician outreach, celebrity endorsement	Richard Lui and James Kyson, EF affiliates, Asian-American physicians

Before the first national epilepsy public awareness campaign launched in November 2001, a survey on attitudes and beliefs about epilepsy was distributed to high school students in multiple states. Baseline data from 20,000 students revealed that about half of youth were not sure whether seizures were contagious, and about two-thirds would not know what to do in the presence of someone having a seizure [15]. This led to the launch of the 2001 Entitled to Respect (E2R) campaign, which focused on outreach through teen media channels and the support of the popular musical group *NSYNC. The main objectives of this campaign were to increase teens’ awareness of epilepsy and increase self-esteem among teens with epilepsy. The message was straightforward: youth with epilepsy are entitled to respect just like everybody else. Through the Internet and radio stations and by television, newspapers, posters, and brochures, E2R campaign messages were disseminated. Keys to the campaign were public service radio messages recorded by *NSYNC that included music from the group’s recently released CD. Internet outreach was achieved by linking the Epilepsy Foundation’s tailored EntitledToRespect.org webpage to the *NSYNC website as well as to six other Internet sites popular with teens [16].

The second year of the Entitled to Respect campaign, launched in November 2002, built on the strategies and tactics of the first year. The campaign target expanded to include tweens (ages 10 to 12) in addition to teens. The goals were to increase understanding of epilepsy and provide seizure first aid guidance in order to increase respect for those with the disorder and reduce fear of seizures among tweens. Celebrity public service announcements were delivered by Ashton Kutcher and the musical group Triple Image. In addition, a partnership with Clear Channel Worldwide, a large national media and entertainment company, to produce and distribute the announcements and with EF affiliates to advertise the campaign were established. Public service ads (PSAs) were also distributed to youth magazines, high school newspapers, and local and national print media.

Building on the success of the 2001 and 2002 Entitled to Respect campaigns, the 2003 E2R campaign primarily focused on increasing awareness of epilepsy and respect for people with epilepsy among African-American youth. Campaign tactics included a Get the Word Out contest in which local community youth submitted entries, in a variety of formats, expressing their thoughts on the issue of respect; production and distribution of a celebrity PSA by Monica (Arnold) to reach selected markets with campaign messages; production of a campaign toolkit and other media materials including a brochure, posters, and presentation slides for local EF affiliate campaigns; continued partnership with Clear Channel Worldwide for media coverage; and new partnerships to support local campaign implementation.

The 2004 campaign, which began in November (the national epilepsy awareness month), focused on increasing awareness of epilepsy and respect for people with epilepsy among key partners within the African-American (AA) community. As in 2003, the campaign theme was Get the Word Out. Primary goals were to build and strengthen sustainable relationships with AA community organizations, businesses, and opinion leaders; raise epilepsy and seizure first aid awareness and increase understanding; encourage acceptance, tolerance, and respect for people with epilepsy; reduce the stigma associated with epilepsy; and generate favorable media coverage. Multilevel campaign strategies that were employed included the following: production and distribution of audio PSAs featuring celebrity spokesperson Garcelle Beauvais-Nilon; video PSAs tailored to air in beauty salons nationwide; media outreach through placements in AA and general market print, broadcast, and online media; radio media tours with Garcelle Beauvais-Nilon and a clinician specializing in epilepsy treatment; distribution of epilepsy literature including brochures, seizure first aid bookmarks, and fact sheets to churches and beauty salons nationwide; partnership with the Urban Beauty Collective to deliver key messages and materials to AA beauty salon audiences; and scheduled epilepsy awareness month events at mega churches, community centers, health clinics, and hair salons. Pre-campaign and post-campaign telephone interviews were conducted with AA respondents (n = 200) in five cities throughout the country in order to aid in tracking the effectiveness of the awareness month campaign. When asked if they had heard, read, or seen anything recently about epilepsy, 37% of the post-campaign respondents answered “yes” versus 15% of the pre-campaign respondents.

In November 2005, the EF campaign strategy changed from emphasizing themed activities primarily conducted during national epilepsy month to a year-round theme-related program. Conducted throughout 2006, the campaign theme, Epilepsy: It’s More Common Than You Think, reached out to the Hispanic-American community through national and local partnerships. A 2004 survey on cultural beliefs about epilepsy in the Hispanic community [3], focus group research, and the data from a pilot campaign involving several EF affiliates informed the development of campaign objectives and key messages. Objectives included promoting awareness, providing accurate basic information about the condition, and providing EF affiliates with tools and resources to reach out to their local Hispanic communities. Messages were aired on Spanish-language radio stations. Articles about epilepsy were distributed among Spanish-speaking and bilingual newspapers nationwide. The radio program “Prevenir es Salud” addressed epilepsy issues through interviews with doctors, people with epilepsy, and providers. Materials were exhibited and distributed at the National Association of Hispanic Journalists annual conference. In addition, epilepsy information was widely distributed to attendees of the National Council of La Raza (NCLR), which comprised more than 300 community organizations involved in providing health information to Hispanics during English as a second language (ESL) classes, vocational classes, and community meetings. Epilepsy messages were also brought to Hispanic families in their own homes around the country with the support of the Lay Health Workers National Network (Community Health Workers —Promotores program).

The theme for the 2007 awareness campaign, which began in November 2006 and extended throughout the next year, was Not Another Moment Lost to Seizures. Components of the campaign included special initiatives, once again focusing on education and outreach to Hispanic audiences. A council of prominent Hispanic leaders guided the continuation of the campaign, outlining goals, target audiences, and strategies for moving the campaign forward. The council assisted with the development of a Spanish-language website and developed a draft curriculum for Community Health Workers — Promotores. Epilepsy Foundation affiliates conducted epilepsy awareness workshops in Hispanic communities or through Hispanic community-based organizations. Exhibits and presentations were conducted at Hispanic forums and conferences throughout the country.

The 2008 national awareness campaign, which began in November 2007 and extended throughout the next year, began a yearly focus on the needs of both Hispanic- and African-Americans. The theme of Not Another Moment Lost to Seizures was continued in the Hispanic community. As part of the campaign, selected EF affiliates pilot tested the training curriculum developed for Community Health Workers —Promotores. In addition, trainings and exhibits were conducted at a number of national Hispanic conferences including the Community Health Workers — Promotores annual conference, the annual East Coast Migrant Stream Forum, and the annual Midwest Stream Farmworker Health Forum. In collaboration with the Hispanic Communications Network (HCN), epilepsy PSAs were developed and distributed nationally to radio stations. The HCN also developed and distributed a Spanish article for publication in Hispanic newspapers. Banner ads were created for the Spanish-language website, and PSAs and an article in Spanish were provided in e-mail format for immediate download and use by affiliates and media outlets.

The 2008 campaign also promoted a campaign theme of Know the Difference in local African-American communities. Ads that underscored this theme and provided readers with a link to the Know the Difference page on the EF website ran in Heart & Soul, a magazine that focuses on healthy living for African-Americans. Epilepsy Foundation affiliates developed new ways of distributing epilepsy educational materials at community events. One affiliate provided low-income families with epilepsy education materials packaged with free school supplies. Another affiliate collaborated with a local university to conduct a half-day “Epilepsy Empowerment Forum.” A third affiliate shared epilepsy materials at events hosted by local faith-based organizations. Epilepsy education materials were distributed at numerous national conferences including the Black Women’s Health Imperative, the NAACP Convention, the National Urban League Conference, the Congressional Black Caucus, and the Black Family Reunion.

The 2008–2009 epilepsy awareness campaign, with a theme of No More Seizures, focused on people with epilepsy. The goal was to increase the number of people with epilepsy who achieve optimum control of their condition — no seizures or treatment side effects. A new online resource, www.NoMoreSeizures.org, allowed people with epilepsy to partner with the EF and others in managing their treatment for the condition. However, to sustain prior educational efforts, during National Epilepsy Awareness Month, a month-long radio and online outreach campaign was conducted to dispel myths, increase general awareness of epilepsy among U.S. Hispanics, and direct them to the Foundation’s Spanish-language website and toll-free telephone number. Radio PSAs were distributed on HCN’s affiliate radio network, and web banners were placed on targeted health and lifestyle channels. The training curriculum developed for Community Health Workers — Promotores was made available online after additional testing and revision. Assistance was provided to Hispanic families dealing with epilepsy through a toll-free Spanish-language telephone line. Within the African-American community, the Know the Difference campaign continued, with ads running in Heart & Soul magazine. The Know the Difference page on the EF website was updated to include a new feature, the testimonial page, which allowed readers to post their personal stories about living with epilepsy.

As part of the 2009–2010 epilepsy awareness campaign, Atlanta Falcons football star Jason Snelling, an Epilepsy Foundation spokesperson who has epilepsy, was featured in an article run by online media outlets throughout the country. A Know the Difference campaign ad was published in Heart & Soul magazine. A PSA that featured a well-known radio DJ and past host of the 1980s’ primetime music video show Video Soul focused on the stigma of epilepsy and the importance of raising epilepsy awareness in the African-American community. Campus–community partnerships were created with historically black colleges and universities (HBCUs) in order to raise awareness of epilepsy in local African-American communities. Within the Hispanic community, a radio and online outreach campaign was implemented that was designed to dispel myths, increase general awareness of epilepsy among U.S. Hispanics, and direct Hispanics to the EF’s Spanish-language website and toll-free telephone number. Spanish-language PSAs were disseminated for national broadcast, and web banners were placed on targeted health and lifestyle channels to direct Hispanics to the EF’s Spanish website. Partnerships with the Promotores National Network Association and the National Center for Farmworker Health continued to provide information and referrals to Hispanic families dealing with epilepsy through a toll-free Spanish-language telephone line.

Get Seizure Smart, the theme for 2010–2011 campaign, focused on the importance of seizure recognition and first aid. The Epilepsy Foundation launched an interactive website (www.getseizuresmart.org) that provided educational materials and other resources to support this effort. Partnership with the Hispanic Communications Network (HCN) expanded. Videos promoting epilepsy awareness were posted on social media and made available on the updated Spanish-language website. The EF, in partnership with the International Medical Interpreters Association (IMIA), electronically promoted an online self-study program for Spanish-language interpreters through ads, website banners, web links, brochures, and flyers. This program educated medical interpreters about epilepsy, seizures, and first aid and improved their ability to accurately interpret medical information regarding the disorder. The National Center for Farmworker Health continued to provide information and referrals to individuals and Hispanic families dealing with epilepsy through a toll-free Spanish-language telephone line. Additionally, advertorials and brochures were distributed to raise awareness about epilepsy and provide access to more information. African-American outreach continued to build on the Know the Difference theme. Campus–community partnerships with HBCUs and predominantly black institutions (PBIs) were expanded, providing culturally appropriate outreach to African-American students. The EF’s African-American website was updated with new content and interactive features. In addition, advertorials, brochures, and a text message campaign were used to raise awareness about epilepsy and provide individuals and families in African-American communities with a way to access more information.

The 2011–2012 campaign continued the previous year’s Get Seizure Smart theme, focusing on national distribution of information about seizure recognition and first aid through affiliate-hosted awareness events in local communities and, calling for action through social media and the EF website. In addition, a “1 in 26” video was developed as the first phase of a multimedia campaign targeting young adults 18–26 years of age. The purpose of the campaign was to break down stereotypes surrounding people with epilepsy in schools and professional career settings, and within newly started families. Expanding Hispanic outreach efforts, videos on DVDs, developed and promoted in partnership with the Hispanic Communications Network during earlier campaigns, were made available at no cost to requestors through the National Center for Farmworker Health for use in waiting rooms at migrant health clinics, community centers, health fairs, and other Hispanic venues. African-American outreach included placing advertorials in Heart & Soul and in Ebony, an African-American magazine that provides cultural insight, news, and perspective. An African-American and Hispanic-American transition-age youth and young adult outreach effort was launched to leverage the influence that HBCUs, PBIs, and Hispanic-serving institutions have in their neighborhoods in order to promote understanding and awareness of epilepsy and seizures in those communities. The EF also began developing the first phase of an educational program for Asian-Americans by conducting an environmental scan to determine the national needs for Asian-American outreach, awareness raising, and education on epilepsy.

Social media was an important focus of the 2012–2013 EF awareness campaign. People with epilepsy, their families, their caregivers, and their communities were invited to share their perspectives through creation of a video that answered the question, “When it comes to epilepsy, what do you know now that you wish you knew sooner?” Nationally submitted videos ranged from carefully edited slide shows to impromptu video testimonials. The videos receiving the most votes, cast by visitors to the EF’s Facebook page, were selected as winners and were featured online and honored at the National Walk for Epilepsy. With the goal of raising epilepsy awareness and combating stigma in the Asian-American community, the EF implemented a strategy that focused on Asian-American youth and young adults. Using the “1 in 26” video developed previously, the 26 Days of Epilepsy Awareness and Action media campaign was launched. Asian-Americans living with epilepsy were recruited to share their experiences through postings on Facebook and Twitter as part of the campaign. The campaign also included the #1in26 Could be YOU Thunderclap effort. This effort involved the aggregation and tracking of a series of coordinated social media actions, allowing a single message about the campaign to be mass-shared across multiple social media networks simultaneously on a desired date. The EF also launched a traditional media campaign. Epilepsy Foundation affiliates conducted outreach efforts in their communities and through social media channels. To serve as campaign ambassadors to connect to Asian-American communities on social media and generate community interest, NBC anchor Richard Lui and actor James Kyson were recruited. Because health professionals play a prominent role in Asian-American communities and are viewed as trusted sources of information, Asian-American physicians serving the local community were recruited to participate in the campaign through contact with patients and through sharing messages on Twitter.

3. Conclusion

Over the course of more than a decade of collaborative campaign effort, substantial results have been achieved during and immediately following these campaigns, including increased demand for information on all aspects of epilepsy and seizures; increased visits to the Epilepsy Foundation’s webpages, both directly and through linkages with other partner sites; increased interest in the issues surrounding epilepsy and the discussion generated through social media, celebrity endorsement, the support of medical experts, and grassroots support; and increased attendance at trainings and other educational events (Table 2). Most of the collected outcome data, however, have focused on process outcomes such as campaign reach, including print placements, media counts, attendance at events, and website visits.

Table 2.

Epilepsy Foundation awareness campaign channels and reach: 2001–2013.

Year	Theme	Epilepsy Foundation reported outreach measures
2001–2002	Entitled to Respect	Video news release — 1,552,000 audience impressions, 54 broadcasts, 16 television stations
		Audio news release — 2,551,400 audience impressions, 347 broadcasts, 271 radio stations
		Public service radio message — 40,728,296 audience impressions, 9452 broadcasts, 127 radio stations
		Online banner placements — Bolt.com: 500,000 impressions, IGN.com: 3,000,000 impressions
		News stories — ReutersHealth.com: 2,600,000 impressions, Health News Digest: 1,700,000 impressions
		Print placements — TeenFX Newsletter: 150,000 impressions, Wisconsin State Journal: 88,245 impressions, Pittsburgh
		Post-Gazette: 243,410 impressions, Detroit News: 298,221 impressions, Dayton Daily News: 152,300 impressions, Knoxville News Sentinel: 124,421 impressions
		Educational brochures distributed — 90,000
		Posters distributed — 10,700
2002–2003	Entitled to Respect	Public service radio and video messages — 128 million impressions, 200+ radio stations
		Print placements — 97 community newspapers, over 1.7 million impressions
		Audio news release — ~900 broadcasts, over 5 million listeners
		Celebrity public service radio messages — over 48,000 broadcasts, over 101 million listeners
		Online media outreach — ~6 million impressions
2003–2004	Entitled to Respect/Get the Word Out	Celebrity public service radio messages — over 16,000 broadcasts
		Print, broadcast, and online media impressions — over 175 million
		Get the Word Out contest — ~500 entries
2004–2005	Get the Word Out	Print, broadcast, and online media impressions — over 59 million
		Celebrity public service radio messages — distributed to over 2000 radio stations
		Celebrity video public service messages — aired in over 10,000 beauty salons
		Print materials — over 20,000 pieces
		Telephone precampaign and postcampaign survey of African-Americans — 37% of postcampaign respondents versus 15% of precampaign respondents indicated that they had heard, read, or seen anything recently about epilepsy
2005–2006	Epilepsy: It’s More Common Than You Think	Radio messages — more than 13,000 times, more than 210 Spanish-language radio stations
		Print placements — 97 Spanish-speaking and bilingual newspapers
		“Prevenir es Salud” radio program series — interviews with doctors, people with epilepsy, and providers
		Print materials — to 5000 attendees at the National Association of Hispanic Journalists annual conference, distributed to attendees of the National Council of La Raza
2006–2007	Not Another Moment Lost to Seizures	Public service radio messages — more than 9030 times; to more than 210 Spanish-language radio stations
		Hispanic conference/forum/expo exhibits and trainings — 6 locations, ~170 people trained, ~7500 attendees
		Print placements — 97 Spanish-speaking and bilingual newspapers
2007–2008	Not Another Moment Lost to Seizures, Know the Difference	Community Health Workers — Promotores curriculum — more than 1800 people trained
		Public service radio messages — to 245 radio stations
		Print placements — over 100 Hispanic newspapers
		Print material distribution — 10,000 conference attendees
2008–2009	No More Seizures, Know the Difference	Public service radio messages — 16 national broadcasts, over 19 million impressions
		Online banner placements — over 1.5 million impressions
		Community Health Workers — Promotores curriculum — more than 10,000 people trained
		Spanish-language telephone line — 785 incoming calls
		Heart & Soul magazine ads — circulation of 300,000, readership of more than 1.5 million
		Community presentations/trainings — over 1000 participants
2009–2010	Know the Difference	Public service radio messages — 19.5 million impressions
		Online banner placements — click-through rate of 0.19% to the EF Spanish website
		Spanish-language telephone line — over 1100 incoming calls
		Heart & Soul magazine ads — circulation of 300,000, readership of more than 1.5 million
		Radio PSA (Donnie Simpson) — 266 airings, total audience of approximately 1.5 million
2010–2011	Get Seizure Smart, Know the Difference	Online media outreach — more than 2.25 million copies of a Get Seizure Smart quiz distributed through the campaign site
2011–2012	Get Seizure Smart	Print ads — contributed to a 50% increase in EF website visits (752,044 overall views) over two months
2012–2013	26 Days of Epilepsy Awareness and Action	Online media outreach — 4250 page views (www.1in26.org), 1766 page views (Asian-American landing page), total of more than 3 million reached, including more than 1.9 million Asian-Americans
		Thunderclap media coordination — postings on Facebook walls and Twitter feeds of 457 people, generated a combined reach of more than 250,000 people

A limitation of these efforts includes the limited capacity to study the efficacy of these educational campaigns in changing knowledge, attitudes, and behavior that result in a more socially inclusive and accepting environment for people with epilepsy. Data collection throughout the duration of the campaign, especially collection of pre-campaign and post-campaign data on attitudes and behavior, will help determine the long-term impact of these campaigns and assist in the effective allocation of future resources [5]. Conducting another nationally representative survey of the U.S. public might also demonstrate the impact of these various campaigns [2,17,18]. Including brief questions on attitudes toward epilepsy on public health surveillance systems, similar to efforts to assess effects of a national mental illness antistigma campaign, might provide evidence on epilepsy campaigns’ effectiveness relative to individual level, campaign-specific, and social factors (e.g., per capita expenditure on campaign exposure) [19]. A limitation of this overview is the exclusive focus on broad, themed educational campaigns. A future report will describe CDC-supported EF educational programs targeting specific groups such as school nurses, child and adult day care providers, middle and high school students, and first responders. Some of these latter programs have demonstrated promising results in improving knowledge about and attitudes toward epilepsy [4,20]. In 2012, the Institute of Medicine, addressing the public health spectrum of epilepsy, has emphasized the importance of sustained educational efforts to eliminate the stigma associated with epilepsy and highlighted priority messages about epilepsy warranting dissemination [4,5].