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A report published in the Journal of the American Medical Association paints a bleak picture of life in the United States: life expectancy rates have declined for the third year in a row because of drug overdoses, suicide, liver disease and dozens of other causes.

Particularly alarming is that this decline in life expectancy is striking people who should be in the prime of their lives: those age 25 to 64.

What can be done to reverse this trend? There are no easy answers, but ORAU has been working with the Centers for Disease Control and Prevention, the Appalachian Regional Commission and other agencies on communication about two major health issues: opioid misuse and cancer.

Combating opioid overdose through social media

Appalachia is an area hit hard by the opioid epidemic. According to a 2017 report titled “Appalachian Diseases of Despair,” the overdose mortality rate among individuals ages 25 to 44 was 70 percent higher there than in the rest of the nation. This rate is fueled in part by economic downturns and what researchers cite as increased despair because of lack of opportunities. ORAU Health Communication and Marketing Project Manager Kristin Mattson led two opioid-focused projects for the Appalachian Regional Commission (ARC). The first project involved helping agencies responding directly to the opioid crisis build their communication capacities and skills. The second project helped build similar skills among agencies focused on strengthening the economy as part of a long-term solution.

“We’re doing some incredibly important work,” said Mattson. “This is why public health practitioners go into public health. It’s so fulfilling to know that we’re making a difference in the lives of people suffering from an opioid use disorder and those who love them.”

With funding from CDC’s Injury Center, Mattson and ORAU Health Communication and Marketing Section Manager Jennifer Reynolds traveled to six Appalachian states to provide training. Representatives from more than 30 anti-drug coalitions, not-for-profit organizations, local health departments, emergency response organizations and law enforcement agencies learned how to more effectively reach target audiences through social media.

Carla Blanton, from Operation UNITE in London, Kentucky, reported that the training helped her organization garner “more than 40 percent growth in Facebook followers, a 700 percent increase in monthly Facebook posts, a 378 percent increase in Facebook reach and a nearly seven-fold increase in impressions on Twitter.”

After a year of providing training, Mattson and Reynolds saw an opportunity to more formally identify best practices specific to communicating about opioids in Appalachia. They, along with ORAU Health Communication Specialist Ben Wilburn, conducted in-depth interviews with subject matter experts and focus groups with community members, including those in recovery from opioid addiction. The goal was to identify effective content and messaging strategies for community-based campaigns about opioids.

Results were published in 2018 in a report titled, “Communicating about Opioids in Appalachia: Challenges, Opportunities, and Best Practices.” The report was featured in news media and included as part of ARC testimony to the House Subcommittee on Economic Development, Public Buildings, and Emergency Management.

Improving perceptions, improving communities

ARC granted $94 million through the Partnerships for Opportunity and Workforce and Economic Revitalization (POWER) Initiative to help coal-impacted communities throughout Appalachia grow their economies.

ORAU led a program to equip POWER grantees with strategic communication skills to successfully promote their work to target audiences, the general public and the media. These efforts were an opportunity to replace the often negative and stereotypical narratives of Appalachia with more balanced and hopeful success stories. Joining Mattson and Reynolds, ORAU Education Project Manager Betsy Smither and ORAU Health Communication Specialist Casey Thomas worked with grantees to develop strategic communication and community outreach plans through a series of workshops and technical assistance webinars.

“Strategic communication skill building was something grantees identified as a need to make their programs more effective. We were honored to teach them these skills,” Mattson said. “Ultimately, communities, families and individuals that are economically healthy are better positioned to curb the crippling morbidity and mortality of the opioid epidemic.”

Breast cancer education and survivor support

While cancer is the second leading cause of death in the United States, according to the American Cancer Society (ACS), the death rate has declined steadily over the past two decades. In January 2018, ACS reported the cancer death rate for men and women combined had fallen 26 percent from its peak in 1991. More specifically, breast cancer deaths have declined by 39 percent since 1989. Progress is being attributed to improvements in early detection.

For almost a decade, ORAU has provided support to CDC’s Division of Cancer Prevention and Control (DCPC) in further education and awareness campaigns geared toward young women at risk for hereditary breast cancer, as well as health care providers and the general public. While most cases of breast cancer occur in older women, more than one in 10 new cases are diagnosed in women under the age of 45. These cancers are usually more aggressive, have lower survival rates and higher rates of secondary malignancy, and present unique physical and emotional challenges for these young women. However, many young women do not know that they are at increased risk for breast cancer or how to manage their risk.

“Educating young women about their breast cancer risks leads to more conversations with doctors, increased early screening when appropriate and, ultimately, early detection that saves lives,” Reynolds said.

ORAU led research for DCPC to inform the Bring Your Brave social and digital media campaign, including focus groups with young women and families with a shared history of breast and ovarian cancer, as well as in-depth interviews with medical professionals. This research resulted in the development of a series of testimonial videos.

ORAU also designed and implemented the Know:BRCA Education Campaign and risk assessment tool to promote awareness of family cancer history and BRCA gene mutations as they relate to breast and ovarian cancer risk. The campaign used infographic videos, social media, email blasts and digital advertising to drive traffic to the CDC’s Know:BRCA web pages.

Most recently, ORAU helped evaluate the CDC’s Living Beyond Breast Cancer (LBBC) pilot program. LBBC trains nurses about the unique survivorship issues faced by young women diagnosed with breast cancer and equips them to lead a Survivorship Series educational program at their own cancer centers. This evaluation will help LBBC make informed decisions about the direction of the program and help CDC better understand existing resources for health care providers.

Turning the tide through commitment and consistency

These initiatives have had positive impacts, but unfortunately, there is no single solution to reversing the decline in United States life expectancy. The leading causes of death in the U.S. require multipronged, coordinated approaches and appropriate funding. These issues are ever-evolving, and addressing them effectively requires timely understanding of how to leverage new communication channels and continued research to appropriately inform ongoing communication and education efforts. ORAU health communication and marketing experts remain committed to helping agency customers stay informed with the latest research and strategies to improve public health. With a consistent and well-informed strategy, we may ultimately help turn the tide on the decline in U.S. life expectancy.

Contact us

For information about ORAU’s health communication, preparedness and response solutions, contact Freddy Gray, director, Health Communication and Preparedness programs, at 865.576.0029 or