University of Southern California Dissertations and Theses

Rallying for children's rights: a media campaign for social change

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Rallying for children's rights: a media campaign for social change

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Content 1

Rallying
for
Children’s
Rights:

A
Media
Campaign
for
Social
Change

ChrisAnna M. Mink M.D.
May 2015

A Thesis Presented to the
FACULTY OF USC GRADUTE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTERS OF ARTS, SPECIALIZED JOURNALISM
2

This proposed campaign has not been endorsed by the American Academy of Pediatrics.

TABLE OF CONTENTS
1. Campaign Summary 3
2. Background 3
3. Campaign Design 5
4. Why is This Campaign Important? 7
5. Sponsoring Organization 9
6. Partner Organization 9
7. Funding Model 9
8. Previous Efforts Related to the Campaign 10
9. Intended Audiences 11
10. Media to Be Used in the Campaign 13
11. Innovative Element 16
12. Campaign Evaluations 16
13. Challenges 19
14. Ethical Considerations 20
15. Timeline 21
16. Bibliography 23
17. Appendix 1. Media and Survey Summary 25
18. Appendix 2. Opinion Article 36
19. Appendix 3. Aaron Emmel Interview 40

LIST OF TABLES
Table 1. “Rally for Children’s Rights” Campaign Goals 6
and Objectives
Table 2. Mean Summary Score for Campaign Media for 17
Survey Groups And For All Participants

LIST OF FIGURES
Figure 1. UNICEF Report of Poverty Rates of Children 8
in Developed Nations
3

ABSTRACT
Rally for Children’s Rights is a media campaign for social change designed to motivate
pediatricians to contact elected officials to support ratification of the United Nations Convention
for the Rights of the Child. The United States is the only country in the world that has not
ratified this treaty. Ratification by the US could benefit American children, as well as children
worldwide. The intended audience for the campaign is pediatricians who are members of the
American Academy of Pediatrics (AAP.)

BACKGROUND
Statement of the Problem (Hypothesis)
Pediatricians in the United States have limited knowledge about the United Nations Convention
on the Rights of the Child. Because of this lack of knowledge, US pediatricians have not taken
action to campaign for its ratification by the United States. Ratification of the CRC is essential
for assuring the well being of our nation’s and the world’s children.

The United Nations Convention for the Rights of the Child
The United Nations Declaration for the Rights of the Child (CRC) was first adopted by all 78
members of the UN General Assembly in 1959, though with little impact upon the world’s
governments. On the 30
th
anniversary of the Declaration in 1989, the UN General Assembly
adopted the CRC, which was viewed as a landmark document for children.
19
Until this year, the
CRC had been ratified or accepted (with interpretations or reservations) by all members of the
UN, except the US and Somalia.
24, 28
Then on January 20, 2015, despite a tenuous government,
Somalia ratified the CRC, making the US the only country in the world that has not ratified the
treaty. The US contributed to the drafting of the CRC, signed the treaty in 1995, and has ratified
both of the subsequent Optional Protocols.
15
The first protocol related to the involvement of
children in armed conflict and the second addressed the sale of children, child prostitution and
child pornography.

The CRC is a human rights document that calls for child-specific protections. The document
requires that countries act in the “best interest of the child,” as compared to thinking of children
as possessions. The CRC is composed of 54 articles, which identify essential rights for children
regardless of their location on Earth.
12
The CRC has been summarized into 10 principles, as
follows:

1. The right to equality, without any exception whatsoever, on account of race, color,
gender, language, religion, national or social origin or any other status of the child or his
or her family.
2. The right to special protection to enable the child’s physical, mental, moral, spiritual and
social development in conditions of freedom and dignity.
3. The right from birth to a name and a nationality.
4

4. The right to social security, to grow and develop in health and to have adequate nutrition,
housing and healthcare.
5. The right to special education and treatment when a child is physically, mentally or
socially disabled.
6. The right to grow up with love and understanding to nurture development of the child’s
full and harmonious personality. Whenever possible, the child should grow up in the care
of parent, but in any case, in an atmosphere of affection with moral and material security.
7. The right to play and recreation and to have free education.
8. The right, under all circumstances, to be among the first to receive relief.
9. The right to protection against all forms of neglect, cruelty and exploitation.
10. The right to be brought up in a spirit of understanding, tolerance, friendship among
peoples, peace and universal brotherhood.

The American Academy of Pediatrics (AAP)
The AAP is a national organization of pediatricians and related child specialists, such as
pediatric surgeons, neurologists and pediatric residents. The headquarters are located in Elk
Grove Village IL and the Federal Affairs office is in Washington DC. Approximately 62,000
pediatric specialists are members and all 50 states are represented. As self-reported on the
AAP’s work force survey in 2007 (last date for posted data,) the majority (nearly 56%) of
members are female, the median age is 44.3 years (including pediatric trainees,) and they are
ethnically diverse (approximately 35% Asian, 9% Hispanic, 8.7% black, and 47 % white.)
2

AAP Governance
The AAP is governed by a Board of Directors consisting of ten members who are elected by
members in their regional districts and who also serve as district chairpersons. Members vote
each year for a national president-elect. The Executive Committee, which conducts AAP
business on a daily basis, consists of the president, president-elect, immediate past president, and
executive director as an ex-officio member.
2

Members also elect officers for their chapters, which serve states and territories in the United
States and provinces in Canada. There are 59 chapters in the United States and seven chapters in
Canada. The US chapters generally are drawn along state lines, but two states with large
populations (New York and California) constitute more than one chapter. Chapters are
individually incorporated, have their own bylaws, and work in local priorities, as well as further
the aims of the national organization.
3
Chapters or districts send monthly electronic
communications to their members, which often include a column from the local president.

Interestingly, not all AAP national members are members of their local (district or state)
chapters. With this in mind, additional segmentations of the AAP were sought to identify
5

influential members of the Academy. AAP members can elect to join one or more of 57 sections
within the AAP, and section memberships more likely reflect an individual’s interests.
4

An AAP section is comprised of members who are interested in and/or trained in a pediatric
subspecialty, such as infectious diseases, international child health and child maltreatment,
among others. A chairperson, who is elected by the members, leads each section. The
chairperson of each section communicates with the AAP Executive Board, and they are also
influential upon their section members. Each section has a newsletter that is distributed
electronically with regular periodicity, most are monthly and some are quarterly. The
chairperson usually has a column in their section’s newsletter.

AAP Mission
According to the AAP website at www.aap.org, their mission is achieving the overall health and
well-being of all youth, infants to young adults, while supporting members to attain this goal.
Although primarily an organization of North American pediatricians, the mission statement does
not include limitations to serving only American children. Often the goals of the AAP are
global, such as eliminating vaccine-preventable diseases worldwide and addressing the safety of
immigrant children. The AAP individual members, as well as the national organization, have a
well-deserved reputation as child advocates. The members have a long record of successful
lobbying for children’s issues at the local, state and federal government levels, such as gun
control, eliminating childhood toxic stress, and funding for children’s nutrition programs.

The AAP often solicits members for lobbying activities, such as requesting that they send
correspondences to elected representatives or give donations for special programs and
campaigns. Because of this history of advocacy, AAP members are an obvious group to call to
action to support ratifying the CRC.

President Obama said that it is “embarrassing” that the US has not ratified the CRC and he
claims ratification is on his agenda. In the last two years of his presidency, he will have some
political freedom to push his priorities. With this in mind, the AAP Leadership Forum (the
major goal setting assembly for the AAP) has made ratification of CRC as one of its top 10
priorities for 2014-2015.
22
Now is the time to act.

CAMPAIGN DESIGN
This campaign will primarily follow the Communication-Persuasion Matrix, also called input-
output model.
23
The input variables include the message, media channels and intended audience.
The output process includes the audiences’ responses to the campaign messages. In this model,
the audience proceeds through the stages of exposure (receiving and attending to the message)
and processing (mental comprehension and emotional interpretations of the message.) These
stages must occur before learning, yielding and behavior changes can occur.
6

A social cause marketing campaign always has a behavior objective and most also have
knowledge and/or belief objectives. Target goals should be SMART; that is specific, measurable,
attainable, relevant and time-sensitive.
20

Goals and Objectives
Goal
The primary goal of the Rally for Children’s Rights campaign is to motivate pediatricians to
contact elected officials to support ratification of the United Nations CRC. The intended primary
audience for the campaign is pediatricians who are members of the AAP. The target goal is that
10% of the 62,000 AAP members will contact at least one elected official.

Objectives (Summarized on Table 1)
Knowledge Objectives
• The first knowledge objective is gaining information about the rights afforded by the
CRC.
• The second knowledge objective is gaining awareness about the relevance of the CRC to
US children.

Behavior Objectives
The primary behavior objective is an action by pediatricians to contact their elected officials.
Possible actions:
• Sign an on-line petition to President Obama
• Sign an in-person petition to President Obama
• Send an email to senators from their home state, the senators in leadership positions, e.g.
McConnell from Kentucky (current Majority Leader) and Reid from Nevada (current
Minority Leader) and those in opposition (e.g. Graham from South Carolina, CRC
opposition leader).

Belief Objectives
For the pediatricians to be motivated to action, they need to believe their actions will influence
elected officials favorably and that their actions ultimately serve children.

7

Table 1. “Rally for Children’s Rights” Campaign Goals and Objectives
Purpose Behavior Knowledge Belief
Contact elected
officials to support
ratification of CRC*
What I want them
to do?
What I need them
to know?
What they may need
to believe to act
Objective Send email
(on-line form or
unique)

Sign a petition
(on-line or in-person)
Content of CRC

Relevance to the well-
being of US children
Action can be
influential

Ultimately serving
children
Target Goal 6,200 AAP members
(10%) contact at least
one senator or sign
petition for President
Obama
Increase knowledge
for 10% of AAP
members about the
articles of CRC
Increase belief by
10% of AAP
members that their
actions have influence
*CRC = UN Convention for the Rights of the Child

WHY IS THIS CAMPAIGN IMPORTANT?
Ratification of the CRC is needed to ensure that US children are viewed as full “rights-bearing”
citizens. This could lead to important reforms in a multitude of programs for US children, such
as those targeting childhood poverty, education and healthcare.

Although many believe that all children in the US have these rights, the facts lead to different
conclusions. Many youth younger than 18 years of age have limited access to quality education,
health care and safe neighborhoods and nearly 25 percent live in poverty.

A study by UNICEF reported that US children fall at 34
th
out of 35

developed nations for overall
well-being. The graphic is excerpted from The Washington Post based upon the UNICEF report
by Peter Adamson.
1, 25
As a nation, we have not yet provided full protection to our children.

8

Figure 1. UNICEF Report of Poverty Rates of Children in Developed Nations
Source: Max Fisher, The Washington Post, April 15, 2013 @
http://www.washingtonpost.com/blogs/worldviews/wp/2013/04/15/map-how-35-countries-compare-on-child-
poverty-the-u-s-is-ranked-34th/, accessed October 18, 2014.

In addition, the United States serves as a human rights role model for other countries and we
have a global responsibility to children outside of our borders. With our failure to ratify the
CRC, the United States’ voice for protecting children in other countries is tempered.

Simmons in 2009 examined the impact of the CRC in other countries where it has been ratified
and found that the CRC had significant impact upon child labor and child health.
25
Although
child labor may not directly impact US children, improvement in child health is definitely
needed. Understanding the principles captured in the articles of the CRC can facilitate
development of “child-focused” policies for pediatric healthcare.
21
Streuli et al identified that
18 of the 54 rights in the CRC are relevant to clinical care of children. Examples include
assuring availability and access to care for disabled children, assuring protection from emotional
and physical harm, and for addressing (and ideally eliminating) health disparities among
different communities in the United States.
27

In addition, ratification of the CRC has motivated some countries to establish child law
commissions, new government offices, and coalitions of private-public organizations to promote
children’s rights.
25
All of these steps would be welcomed for improving the well-being of US
children.

9

Bartholet summarizes the positive impact of the CRC on US children as the three Ps:
participation, provision and protection. Participation rights give children the right to participate
in decision-making that affects them. Provision rights afford children the right to assistance with
preserving their well-being as related to health, education and accessing social services.
Protection rights provide for children’s rights for protection against maltreatment and includes
that the nation and states have a duty to provide this protection.
6

Countries that ratify the CRC are required to provide annual updates to the UN General
Assembly and they are bound to the treaty by international law. Although enforcement is
difficult, exposure of the deficits in an international forum may help to hold the United States
accountable for protection of our children.

SPONSORING ORGANIZATION
The proposed sponsoring agency for this campaign is the AAP. The Rally for Children’s Rights
campaign will be part of a larger campaign planned by the AAP. The tactics for the larger
campaigns are still under development according to Aaron Emmel, Manager of Global Programs
in the AAP Department of Federal Affairs (DOFA) in Washington DC. (Aaron Emmel in an
interview with the author on October 31, 2014, Appendix 3.) Emmel also reported that the
outcomes of the mid-term election would likely affect the AAP’s approach in the campaign.

PARTNER ORGANIZATION
The AAP has joined in a national coalition called Children’s Rights Campaign whose goal is to
rally President Obama’s and the US Senate’s support for ratification of CRC, described at
http://childrightscampaign.org/about/partners. Approximately 120 national organizations have
joined to plan this effort. Members include frequent AAP advocacy partners, such as UNICEF,
Save the Children and The Children’s Defense Fund, and novel partnerships with other groups
such as the American Bar Association and the American Association of Retired Persons.

The benefits of joining with other organizations include increasing the resources, having more
workers to divide the tasks, broadening the support base, which increases access to additional
contact lists and wielding more influence. Receipt of an email or information from a group of
which an individual is already a member is more likely to get attention and stimulate the desired
behavior than an email from an unfamiliar group.
23
Thinking one step further, the more
solicitations received by elected officials, i.e. President Obama and US senators, the more likely
that they will be influenced to prioritize ratification of the CRC.

FUNDING MODEL
The primary funding source for this campaign is the AAP; however, the AAP often solicits its
members for additional donations for special causes, such as this campaign. For soliciting extra
funding for AAP members, I propose use of the heartfelt connector model, as described by
10

Foster, Kim and Christiansen.
14
Promoting and protecting children’s rights is likely an altruistic
cause that most pediatricians would consider to be important, meriting their donations.
Soliciting funds from philanthropic individuals or groups outside of the AAP would be
advantageous. Donations from corporate sponsors have also been solicited for previous AAP
campaigns, for example diaper manufactures provided support for the “Back to Sleep” campaign
to help prevent sudden infant death syndrome. Outside funding will likely be incorporated into
the AAP federal campaign.

Additional resources are needed for some elements of this campaign, including website
development and maintenance, exhibition booths at two national meetings, campaign swag (e.g.
logo buttons, reusable bags and posters,) for the execution of the children’s art campaign and for
lobbying activities on Capitol Hill.

PREVIOUS EFFORTS RELATED TO THE CAMPAIGN
UN Treaty Ratifications by the US
The procedure for ratification of an international treaty is stated in the US Constitution. The
treaty has to be signed by the president and approved by a two-thirds majority vote in the senate
to permit final ratification. After the president signs the treaty, it is given to the Justice
Department for evaluation by the lawyers to be sure nothing in the treaty is more restrictive (or
“more protective” for human rights treaties) than existing US laws. The lawyers assessment can
lead to “a reservation, declaration, or understanding” to negate any additional rights protections
that may be in the treaty. These qualifications are submitted to the senate as part of the
ratification package. The United States has not ratified a full UN treaty since 1994, when it
passed the UN Convention on the Law of the Sea. Historically, US ratification of a full human
rights treaty has been unusual.
24

In the 1990s, the AAP considered advocating for ratification of the CRC but the political climate
in Washington DC was such that failure was expected, and a formal lobbying campaign was not
pursued. President Reagan whose administration had participated in drafting the document
signed the treaty but did not forward it to the US Senate (as required by the Constitution.)
President Clinton also did not forward the treaty to the US Senate, because he perceived he did
not have the needed two-thirds majority. The rights listed in the CRC are basic human rights of
children, which are not objectionable to most rationale individuals.

Why has CRC Ratification Not Occurred?
The US has not ratified the full CRC reportedly for a few reasons; many of these have been
attributed to religious and political conservatives. Some objections to the CRC have been
framed with “anti-UN” sentiment, similar to opposition to other UN treaties in recent years, such
as the Convention on Discrimination against Women and the UN Framework on Climate
Control. For some US citizens, anti-UN sentiment is rooted in fears of the UN presenting a threat
11

to the autonomy of US government and individual freedoms, and for others it stems from a
perceived lack of efficacy by the UN. This style of opposition is difficult to overcome, but
seems to be held by a vocal minority.

Other objections to CRC are concerns that it may permit international law to overtake national
laws, but these are unfounded. Cohen and DeBenedet in their 2012 article in Time magazine
stated “…the supposed danger of loss of national sovereignty is also a false alarm. In fact, no
international treaty has the power to override the US Constitution, as put forth in the landmark
Supreme Court ruling in Reid v. Covert (1957.)”
10

Some parental rights groups have opposed ratification because of the misperception that
affording rights to a child will deter from their parental rights. In actuality, the CRC provides
protection for a child within the context of their family and their community. Other objections
have come from The Home School Defense League.
18
This group is strongly opposed because
they perceive the CRC as a threat to homeschooling, though this is not stated in the treaty.

Some opponents, including elected representatives, believe that the rights of US children are
protected by the Constitution. Unfortunately in practicality, the Constitution does not afford the
full rights to all children living in our borders. A prime example of this is the growing rate of
poverty and its detrimental health effects, which afflicts many American children.

AAP Campaigns
Although AAP members have not yet attempted advocating for the CRC, they have been
successful with other lobbying activities. The AAP has successfully participated in or developed
several campaigns in recent years, including “Back to Sleep” to help reduce the rate of sudden
infant death, second hand smoke campaigns, and child safety seat legislation, among others.
Most recently, the AAP rallied its members to support successfully the Children’s Health
Insurance Program (CHIP), which provides insurance for nearly 8 million children from families
with low incomes but too high to qualify for Medicaid. Funding for CHIP has been threatened in
previous federal budgets, and is in danger again in 2015. The AAP has already begun soliciting
senators to support CHIP’s funding (Senate Bill 2461.)
5

INTENDED AUDIENCES
Primary Audience
The primary audience is pediatricians who are members of the AAP.

The results of the intercept survey are consistent with my hypothesis that pediatricians may not
have sufficient knowledge about the CRC or the implications of ratification, which may affect
the change in their behavior to act. However, because they have participated in previous calls to
action on behalf of children’s rights, this group may be more receptive to the campaign message.
12

In the stages of change model, also called the transtheoretical model, Prochaska et al describe six
stages that people go through to change their behavior.
20
With limited knowledge, the AAP
members are likely to be in the pre-contemplation stage, the first of the six stages. Ideally,
acquisition of knowledge about the CRC will facilitate the intended audience’s progression
through the stages of change to the action stage, and then they will perform the desired behaviors
of contacting elected officials. The latter two stages of change for individual behavior are
maintenance and termination, which may not be as relevant for this campaign.

Campaigns that include an emotional appeal are more successful at influencing the behaviors of
the target audience.
20
However, few data are available about emotional appeals to physicians.
Nearly all of the existing data are from advertising campaigns from pharmaceutical companies
marketing new products to physicians, primarily those who care for adults. Larry Star, a
pharmaceutical executive, citing the example of Sanofi’s early marketing of taxotere for treating
terminal breast cancer, reported the enhanced success of medication advertisements that included
an emotional appeal, in addition to scientific information. However he also noted, that
understanding doctors’ emotional viewpoints is challenging, because they are are trained to
suppress their emotions.
26

Because so little is known about including an emotional appeal in a social change campaign
targeting doctors, an assessment of different emotional elements for the campaign will be
included in the planned formative research. One element to be tested is the impact of narratives
about real US children deprived of basic human rights and how ratifying the CRC should help.
If effective (either by improving knowledge or motivating one of the desired actions), the
narratives will be incorporated into the campaign. An example narrative will expand the story
about Marilyn, the little girl with food insecurity described in the opinion piece. (Appendix 3)

In addition, AAP members who take the on-line survey planned for the campaign will be given
the opportunity to provide a narrative about one of their own patients who has been deprived of
basic rights, such as limited access to medical specialists. Any narratives contributed may be
posted on the campaign’s Facebook page. This may provide additional social proof for
encouraging participation of other pediatricians.

Segmentation of the primary intended audience
Segmentation of the AAP members was not planned initially, because of my lack of familiarity
with the structure of the AAP. However, at the AAP National Conference and Exhibit (NCE) in
San Diego in October, I gained a better understanding about how sections operate and
segmentation is now planned.

From my experience at the NCE and lessons learned from my intercept survey, I hypothesize that
section membership may be an important factor for pre-existing knowledge about the CRC. In
13

my intercept survey, all five of 16 (31 percent) respondents who were familiar with the CRC
were specialists in child maltreatment. This specialty includes child trafficking, which requires
more global awareness. At The NCE, the Section on International Child Health (SOICH,) also a
more globally aware section, convened a meeting to develop strategies for advocating for CRC
ratification.

These observations suggest that segmenting the AAP by section may identify individuals who
may be innovators or early adopters of change, as described in the Diffusion of Innovation theory
as described by Kotler and Roberto based upon the original work of Rogers and Shoemaker.
20
In
addition, these section members may serve as influentials for other sections by talking about
their actions and by their example, following social proof as described by Cialdini.
8

To test my hypothesis of section as a useful tool for segmentation, I plan to include questions
about section membership and level of activity in an on-line survey using
www.surveymonkey.com. I shall also query about participation in state and district chapters to
see if this segmentation would be useful.

Secondary Audience - Influentials
AAP members can join as many of the 57 sections as they wish. Sections are based upon
individual interests and not necessarily by specialty. For example, I am a specialist in Pediatric
Infectious Diseases, and I am a member of three sections; SOICH, the Section on Infectious
Diseases and the Council Foster Care, Adoption and Kinship Care (called council because they
can also generate policy.) Until I worked on this campaign, I thought of section membership as
belonging to a group with similar interests and did not appreciate the sections’ political clout.

The AAP does not reveal data, if it is collected, about political affiliations of its members; thus,
this is not an option for segmentation.

MEDIA TO BE USED IN THE CAMPAIGN
This campaign will involve multiple media outlets, which has proven critical for dissemination
of social change campaigns.
23
This campaign will employ at least seven media modalities, but
changes in the media may be made as suggested by the planned formative or process research.

Logo Items
The campaign logo, chosen based upon formative research, will be displayed on traditional
media (e.g. posters, flyers and reusable bags) and wearable media (e.g. buttons and lanyards.)
The wearable items will be given to individuals who sign the in-person petitions at the pediatric
meetings. Logo items help to deliver the campaign message and when worn by supporters will
help diffuse the message. Having a logo contributes to “branding” of the campaign, which helps
promote the messages.
20

14

Electronic Communications
AAP members receive regular email updates and newsletters from the national headquarters,
sections and regional chapters of the AAP. The campaign will capitalize on these electronic
communications, and link to this campaign’s website. Debut of the website will occur in the
spring of 2015. An additional, freestanding email about the Rally for Children’s Rights
campaign will be distributed to all AAP members.

Podcasts providing educational content about the CRC will be developed and posted on the
campaigns website, and they will also be available through links from the AAP homepage.
Experts in child rights who are members of the AAP will be asked to volunteer to create the
podcasts. The first podcast speaker will be Dr. Bronwen Anders, a senior member of SOICH,
and she will discuss the articles of the CRC.

Campaign Website (planned for early spring 2015)
A website at www.childrightsdoc.com was developed as part of this campaign. The final site will
include the following elements:
• Attractive design with “eye-catching” features to stimulate the visitors to explore the site,
including a video of a diverse group of pediatricians (e.g. different ages, ethnicities,
attires and locations) saying, “I signed” or “I rallied for children’s rights,” adding social
proof
22

• The campaign logo prominently displayed, to advance branding
• The articles of the CRC and their relevance to US children
• A weekly blog about a different article in the CRC
• A petition to sign electronically for President Obama
• Draft email formats for members to click and personalize for forwarding to US senators.
Email addresses for each senator will be included (available at www.senate.gov.)

In-person Interactions
I am a member of the Advocacy and Policy Committee (APC) of SOICH, and one of our charges
is to assist with campaigning for CRC ratification. With this in mind, SOICH is planning to have
a booth, as part of the AAP exhibit, in the Exhibit Hall at the NCE national meeting in
Washington DC in October 2015. The Exhibit Hall is a popular destination at these professional
meetings. APC members, who can provide information (verbal and print) about the CRC, will
staff the booth. A petition calling for ratification, which will be sent to President Obama, will be
available to sign. Anyone who signs the petition will be given wearable media bearing the
campaign’s logo. The booth will be colorfully decorated with articles from the CRC using
children’s art submissions from an art contest. The booth will also have candy, perhaps not the
healthiest choice but an effective attractor for visitors.

15

Previously a booth was also planned for the Pediatric Academic Societies (PAS) meeting in San
Diego, CA in May 2015; however, the AAP DOFA has decided to delay initiation of their
campaign.

Social Media
The national AAP and a few of the AAP sections, including SOICH, have Facebook accounts
and the national organization also has a Twitter account. However, the use of these media outlets
has not yet been maximized. AAP does not have Instagram or Pinterest accounts. Followers will
be recruited through links from the AAP Facebook and Twitter accounts, the SOICH Facebook
account and personal connections with colleagues.

This campaign will have its own Facebook and Twitter accounts with the logo prominently
displayed, as branding.
20
The initial use will be for announcing campaign updates, news updates
about the CRC and provide educational snippets about the CRC. Similar to their peers, young
pediatricians, i.e. those younger than 35 years of age, are frequent users of social media and they
use it for connecting with colleagues and patients, as well as for accessing news and information.
Analytics will be monitored including the number of followers, the frequency of visits and the
number of re-tweets of the campaign posts.

In addition, the followers will be asked to use their Facebook and Twitter accounts to advertise
the children’s art contest to their patients. Use of social media for communicating with patients,
especially adolescents is a growing trend among pediatricians.

In the additional formative research, participants will be asked about their preference for
receiving communications via social media or email, and messages will be tailored based upon
these results.

Educational Symposia
At the PAS and NCE national meetings, educational seminars will be convened about the articles
of the CRC and potential impact upon US policies and programs for children. Sections,
including SOICH and the section on child abuse and neglect, will be asked to host these
symposia.

Keynote Speaker
Every year at the NCE, an internationally recognized individual is invited to give the keynote
address. At the 2014 meeting Former Secretary of State Hillary Clinton was the speaker, and she
discussed childhood literacy, a priority of the Clinton Foundation.

For 2015, I shall recommend that the AAP invite Malala Yousafzai, the 16 –year-old Pakistani
girl who won the Nobel Peace Prize for her advocacy work for the educational rights for girls.
16

She gained international recognition for standing up to the Taliban to defend her beliefs, and they
tried to shoot her to death when she was 13 years old. She survived and subsequently became
even more vocal. She has presented before the UN General Assembly and is a charming and
articulate speaker. I cannot think of a more credible messenger to motivate pediatricians to rally
for children’s rights. The credibility, engaging qualities and trustworthiness of a messenger are
important factors for the effectiveness of message delivery, as supported by the heuristic of
“liking” described by Cialdini and as reported by Lee and Kotler.
8, 20

In addition, during the NCE especially depending upon the celebrity of the keynote speaker,
traditional news media, such as television and newspapers, are often present. This type of media
attention is free and in this setting is usually without inadvertent negative consequences, which
can occur with journalists’ coverage of an event.

INNOVATIVE ELEMENT
Children’s Art Contest
An art contest for children, ages 5 through 18 years, illustrating the rights in the CRC will be
held. Posters about the art contest will be mailed to AAP members to display in their offices to
recruit young artists. Contestants will be evaluated by age group (5- 9 years, 10-14 years, 15- 18
years,) and winners will have their art on the cover of an AAP publication and receive $500
scholarship sponsored by the AAP.

The SOICH Advocacy and Policy Committee members will be the judges and winners will have
their art displayed on the campaigns website and on one of the AAP’s publications. All entries
will be displayed at the 2015 NCE exhibition booth.

CAMPAIGN EVALUATIONS
Pre-test Results
Formative Research – Completed
Intercept survey – full results are in Appendix 1
Sixteen pediatricians from Harbor-UCLA Medical Center participated in intercept survey.
Participants were queried for their opinions about two possible campaign media, including a
circle logo design and a square logo design. The logo design will be included on all campaign
messaging, including posters, website and wearable media such as buttons. Both preliminary
logos were designed with the concepts from Andy Goodman’s, When Bad Ads Happen to Good
Causes. The intent was for logos to be “eye-catching,” using colorful designs, and they were
simple with large lettering. Also, the circle logo had children and made an emotional appeal.
17

The tested logo designs are attached in Appendix 1:
• Square design with flags and the saying, “Rally for Children’s Rights,” and
• Circle design with children and the saying, “Our Rights are in Your Hands.”
17

Media Evaluation Questions
A Likert scale with five categories (gradient of strongly agree to strongly disagree) was used for
evaluation of the two media, and a value for each category was provided in descending order, i.e.
5, 4, 3, 2 and 1. Each evaluation had 6 statements about the media, permitting a maximum
possible score of 30 points. A summary score was calculated for each media for each
participant, and the means for each group and all participants are shown on Table 1.

Table 2. Mean Summary Score for Campaign Media for Survey Groups
And For All Participants
Mean Summary Score
Group 1
(Square 1
st
)
n=8
Group 2
(Circle 1
st
)
n=8
All
(Groups 1+2)
n=16
Poster 14.6 21.9 21
Circle logo button 20.8 21.8 21.3
Square logo button 14.6 15 14.8

The poster was designed with the same text and the only variation was display of the two
different media. Interestingly, the poster with the circle logo design was rated more highly than
the poster with the square logo design likely reflecting the respondents’ preference for the circle
logo.
The circle logo design was preferred; however, it did not score highly enough to proceed without
modifications. Invaluable information was gathered using the survey tool, including that only 31
percent of pediatrician-respondents were familiar with CRC. This suggests that providing
education (or at least an assessment of knowledge in a larger sample size) about the CRC will be
needed in the campaign. The results also showed that 93% of the respondents were familiar
with the AAP advocacy campaigns, which is encouraging for interest in future campaigns, such
as “Rallying for Children’s Rights.”

As discussed above, specialists in child maltreatment accounted for all five of the 16 respondents
who were familiar with the CRC. This serendipitous finding contributed to the planned
segmentation of the primary intended audience by participation in AAP sections.

Formative Research - Planned
Additional testing - The information gained from the intercept survey suggested that additional
information is needed about pediatricians’ knowledge of CRC, which may impact upon their
readiness for change. The next stage for the pre-testing will include a survey of larger subset of
pediatricians and at least two focus groups.

Focus Groups – At least two focus groups of 8-12 pediatricians in the Los Angeles area will be
convened to assess revised campaign logos for their appeal and effectiveness for conveying the
18

campaign message. The focus groups will be also be queried about their preferred methods for
communications about the campaign, e.g. part of the regular monthly emails, separate email
notifications or social media (Facebook and Twitter.) They will also be queried about their
preferred method for contacting their elected officials, e.g. email, on-line petition or signing in-
person petitions.

On-line survey - Using www.surveymonkey.com, a random sample of 300 AAP pediatricians
throughout the US will be solicited to assess their knowledge and beliefs related to the CRC and
their perceptions about rights of children in the US. This aspect of the campaign was planned for
winter 2015 but will be postponed until after the PAS meeting in May.

This testing is planned because of the disappointing performance of the media tested in the
intercept survey. Comments from the open-ended question in the intercept survey will be used to
revise the logo design.

Process Research (Monitoring)
Process research is conducted to monitor how well the program implementation matched the
intended delivery. For this campaign, the monitoring planned will include analytics for use of
social media and frequency of visits to the website. Data will also be collected for the number of
clicks through to the sample letters to elected representatives and the to the email addresses for
the president and senators.

If the ongoing monitoring suggests difficulties with navigation to the destinies, revisions in the
website design will be performed.

Summative Research
Generally, evaluation research belongs in one of the following categories; inputs, outputs,
outcomes, impacts and return of investment.
20
Ideally, the evaluation parameters for a social
change campaign should be identified before implementing the campaign, though modifications
may be needed during the campaign.

Inputs are the resources, including staffing and materials, needed to develop, implement and
evaluate the campaign. Outputs are activities that can be quantified, and are outlined below for
this campaign. Outcomes are the assessments by participants to the campaigns outputs, and in
this campaign are the numbers of correspondences sent to elected officials, i.e. the change in
behaviors. Outcomes will also include measurement (and ideally an increase) in knowledge and
belief objectives tested in seminar attendees. Impact has one primary measure in this campaign,
and that will be the ratification of the CRC by the United States. It is possible to measure the
number of senators who are influenced by the campaign, by measuring the numbers who change
19

their perspective about the CRC from negative to favorable. However, this is of secondary
importance if the CRC is not ratified and it may not only be due to the campaign.

Knowledge and Beliefs Objectives
Evaluation of the knowledge about the articles of the CRC will involve baseline assessment of
the focus groups and with the on-line survey. Baseline assessment about beliefs of the
pediatricians will be performed in a similar manner using both the focus groups and the on-line
survey.

At the educational sessions at the PAS and NCE meetings, pre- and post-assessments of
knowledge and beliefs will be performed with the seminar attendees.

Behavior Objectives
Evaluation of the behavior change of pediatrician will be measured by
• Number of signatures on the on-line petition
• Number of signatures on the in-person petition
• Total number of “clicks” and successful “sends” for the pre-formatted emails to the US
senators

Return of Investment (ROI)
ROI is essentially the cost per behavior influenced, i.e. a calculation of the gain from the
campaign (benefit per behavior change) compared to the resources (usually money for resources
and personnel time) expended. This involves three calculations:
• Number of behaviors influenced
• Net benefit (Gross economic benefit minus the cost spent)
• The net benefit divided by the investment costs times 100 equals the ROI
10

Because the values of the variables are not known, a ROI calculation for this campaign is not
permissible at this time.

CHALLENGES
The biggest challenge is getting pediatricians to deem ratification of the CRC as a priority that
merits their time. This challenge will be addressed by providing information about the content of
the CRC and its potential benefits to children, especially as related to healthcare.
16
Steps will be
incorporated into the campaign to make it easy for pediatricians to perform the action, for
example, providing draft email formats and senators’ email addresses will facilitate actions and
minimizes the time commitment. The worst thing that could happen with the campaign with
rallying pediatricians is nothing. Fortunately, this would not be immediately harmful to others.

20

The larger challenge, which will primarily be tackled in the AAP national level campaign, is
motivating elected representatives to ratify the CRC. Solicitation of President Obama and US
senators by AAP members is only one component of the AAP’s federal campaign, which has not
yet been fully developed. This challenge will also be addressed by the multi-organization
collaborative, Children’s Rights Campaign. Importantly, political positioning seems to be the
biggest barrier for elected officials to move forward with ratification. Identifying and
dismantling the opposing forces, especially political forces, will be critical for moving forward.

What could go wrong?
A potential problem is that AAP members may not value the CRC as a priority and thus, not be
motivated to perform any of the desired behaviors.

The next possible problem is that this campaign may be successful in garnering member support
but have no impact upon elected officials. This could also occur for the AAP federal level
campaign. Thus, President Obama or the senate may still not move forward with CRC
ratification. Of note, according to a survey of congressional staff members performed by the
Congressional Management Foundation, over 90% considered email or postal letters to have
“some to a lot of influence” over lawmakers.
11

The worst-case scenario is that the CRC is ratified and unforeseen consequences cause loss of
rights to children or compromise the caregivers providing for them. For example, a teen in foster
care may be provided rights to speak on his or her own behalf, but does not fully appreciate the
wisdom of adult experience or the applicable laws and is prematurely given responsibility
(possibly inadvertently or punitively) for his or her own well-being. This has not been reported
in other nations worldwide, so hopefully will not occur here either. Bartholet raised a possible
concern that the CRC may inadvertently limit international adoption by US citizens because of
the article providing for children’s right to nationality and home country.
6

ETHICAL CONSIDERATIONS
This consideration must be undertaken for rallying pediatricians, as well as the ultimate goal of
having the CRC ratified. For the former, it is possible that pediatricians who show support for a
political issue, such as the CRC, may suffer consequences such as being judged by patients,
families or their communities. Of note, only about 22% of pediatricians who contribute to
political campaigns contribute to Republican candidates, and as a group are generally known to
the public to be supportive of children’s rights and more “liberal-leaning issues.”
7
However, not
all pediatricians are liberally aligned politically or even politically active. These individuals
could be impacted by the political activity of the AAP that is not consistent with their beliefs,
and they could feel disenfranchised from colleagues, patients or their community.

21

Another ethical consideration is the potential for pediatricians to lose their sense of
empowerment if no actions are taken for ratification of the CRC after they have devoted time and
energy to the campaign.

TIMELINE
Campaigns generally run in a circular format, not a linear one. The elements include 1) planning
and strategy, developing and pre-testing concepts, 3) Implementation with intended audiences, 4)
assessing effectiveness and revising and 5) evaluating outcomes.
23

In my timeline, I present a linear format of the first round of the campaign over the course of one
year. If the CRC has not been ratified by the end of 2015, then a new cycle will begin, though
the president and possibly some senators will be different and different strategies may be needed.

2015
Jan-Feb → Develop campaign website. www.childrightsdoc.com was launched on 2-25-15.

Feb - Mar → continued development of campaign elements, including website and its contents,
logo design, and multi-media (including video and Facebook and Twitter accounts, launched 2-
25-15 but not publicized yet). Begin weekly blogs about articles of the CRC.

April 11-14 → attend AAP Legislative Advocacy Conference with other members of SOICH;

May 1 –→ publicize the campaign including website, emails and petitions at the PAS meeting

May 15 → forward in-person petition signed at PAS to President Obama. Develop and execute
the survey on www.surveymonkey.com and convene focus groups for completion of additional
formative research.

June-Sept → blog on the campaign website about the CRC articles; write and distribute
campaign updates in section and national monthly newsletters

Aug 1 → distribution of art contest posters to pediatricians’ offices and clinics; entries will be
submitted electronically

Sept 15 → judging of art contest entries and announcement of winners in each age group

Oct 24-27 –→AAP National Convention in Washington DC

Oct 28 → With the AAP Federal Office meet with senators on Capitol Hill to deliver petitions
with signatures collected in person at the NCE meetings.
22

Nov-Dec → Outcome evaluation including counting number of emails sent to elected officials
and number of signatures from in-person surveys at PAS and NCE. Count number of senators
who changed their perspective to favorable for CRC ratification and monitor if President Obama
forwards the CRC to the senate.

23

BIBLIOGRAPHY

1. Adamson Peter. 2012 Innocenti Report Card 10: Measuring Child Poverty @
http://www.unicef-irc.org/publications/pdf/rc10_eng.pdf, accessed October 18, 2014.
2. American Academy of Pediatrics at www.aap.org, accessed on 11-28-14.
3. American Academy of Pediatrics, Chapters and Districts @ http://www.aap.org/en-
us/about-the-aap/chapters-and-districts/pages/chapters-and-districts.aspx, accessed
12-4-14.
4. American Academy of Pediatrics, Committees, Sections and Councils @
http://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/Pages/AAP-
Sections.aspx#sthash.hgrZHwf9.dpuf, accessed 11-28-14.
5. American Academy of Pediatrics. Keeping CHIP Strong for Children. AAP
Advocacy Campaigns at www.aap.org/en-us/advocacy–and-policy/federal-
advocacy/pages/CHIP.aspx, accessed September 15, 2014.
6. Bartholet E. Ratification of the United States of the Convention on the Rights of the
Child: Pros and Cons from a Child’s Rights Perspective. 2011 Annals of American
Academy of Political and Social Science, 633; 1-22.
7. Bonica A, Rosenthal H and Rothman DJ. The Political Polarization of Physicians in
the United States. An Analysis of Campaign Contributions to Federal Elections, 1991
through 2012. 2014 JAMA Intern Med 174 (8): 1308-1317, published on line on June
2, 2014.
8. Cialdini Robert. Influence Science and Practice, 5
th
edition. Pearson Education Inc.
2009
9. Clarke, Peter and Susan Evans. Chapter 5: Protecting Your Choices in Critical Care
in Surviving Modern Medicine: How to Get the Best From Doctors, Family, and
Friends. Rutgers University Press, 1998.
10. Cohen LJ and Debendete AT. Why Doesn’t the U.S. Adopt the U.N. Convention on
the Rights of the Child? Jan 24, 2012 Time Magazine at www.time.com.
11. Communicating with Congress: Perceptions of Citizen Advocacy on Capitol Hill at
http://www.congressfoundation.org/storage/documents/CMF_Pubs/cwc-perceptions-
of-citizen-advocacy.pdf, accessed on October 6, 2014.
12. Declaration of the Rights of the Child at
http://www.un.org/cyberschoolbus/humanrights/resources/child.asp, accessed
September 15, 2014.
13. Max Fisher, The Washington Post, April 15, 2013 @
http://www.washingtonpost.com/blogs/worldviews/wp/2013/04/15/map-how-35-
countries-compare-on-child-poverty-the-u-s-is-ranked-34th/, accessed October 18,
2014.
14. Foster William, Peter Kim and Barbara Christiansen. Ten Nonprofit Funding Models.
Stanford Social Innovation Review. 33-29, 2009.
24

15. Global Policy Forum. US Position on International Treaties at
https://www.globalpolicy.org/empire/26665-us-position-on-international-treaties.html
accessed 10-6-2014.
16. Goldhagen J. Children’s Rights and the United Nations Convention of the Rights of
the Child. Pediatrics 2003 Sep; 112 (3 Part 2): 742-45.
17. Goodman Andy and Cause Communications. Why Bad Ads Happen to Good Causes
and How to Ensure They Won’t Happen to Yours, 2002.
18. Home School Defense League @ http://www.hslda.org/LandingPages/national-
advocacy.asp, accessed 12-4-14
19. Kasper J. The Relevance of U.S. Ratification of the Convention on the Rights of the
Child for Child Health: A Matter of Equity and Social Justice. 2010 Child Welfare 89
(5): 21-36.
20. Lee, Nancy and Phillip Kotler. Social Marketing: Influencing Behaviors for Good,
4
th
edition. Sage Publications, 2011.
21. Oberg CN. Embracing International Children’s Rights. Clin Pediatr (Philadelphia)
2012 Jul; 51 (7): 619-24.
22. O’Connell PM. “Annual Leadership Forum Attendees Vote on Top 10 Resolutions.”
AAP News March 20, 2014, www.aapnews.org.
23. Rice Ronald and Charles Atkin. Public Communication Campaigns, 4
th
edition. Sage
Publications, Inc., Thousand Oaks CA, 2013.
24. Roth K. The Charade of US Ratification of International Human Rights Treaties,
Global Policy Forum in 2000 at
https://www.globalpolicy.org/component/content/article/157/26883.html accessed 10-
6-201
25. Simmons, Beth. 2009 Mobilizing for Human Rights: International Law vs. Domestic
Policies. Cambridge UK: Cambridge University Press.] Congressional Management
Foundation.
26. Star Larry. 2005 Marketing to Professionals: Appealing to Doctor's Emotions,
Pharmaceutical Executive at
http://www.pharmexec.com/node/234667?id=&pageID=1&sk=&date
27. Streuli JC, M Michel and E Vayena. Children’s Rights in Pediatrics. Eur J Pediatr
2011 Jan; 170 (1): 9-14.
28. United Nations News Centre. UN Lauds Somalia as Country Ratifies Landmark
Children Rights Treaty at
http://www.un.org/apps/news/story.asp?NewsID=49845#.VPPifFPF-nQ

25

APPENDIX 1.

CONTENTS:
Media – Tested logos
Survey Questionnaire
Survey Results Summary

26

The US and Somalia are the only 2 countries in the world that have
NOT ratified the United Nations Rights for the Child (CRC).

WHAT IS THE UN CRC?
The CRC has 54 articles that specify basic rights for all children, including the right to an
education and to grow up in secure, healthy, nurturing and equitable environment,
as provided by family, community and country.

WHY DO WE NEED RATIFICATION?
25% of US children live in poverty, and many do not have access to good schools,
safe neighborhoods or quality healthcare.

WHAT CAN PEDIATRICIANS DO?
You can show your support for children by asking your elected representatives
to ratify the CRC by:
• Signing the AAP petition to President Obama
• Sending an email to your senator
• Visit our website for more action steps at
www.aap.org/ratifyUNCRC

27

The US and Somalia are the only 2 countries in the world that have
NOT ratified the United Nations Rights for the Child (CRC).

WHAT IS THE UN CRC?
The CRC has 54 articles that specify basic rights for all children, including the right to an
education and to grow up in secure, healthy, nurturing and equitable environment,
as provided by family, community and country.

WHY DO WE NEED RATIFICATION?
25% of US children live in poverty, and many do not have access to good schools,
safe neighborhoods or quality healthcare.

WHAT CAN PEDIATRICIANS DO?
You can show your support for children by asking your elected representatives
to ratify the CRC by:
• Signing the AAP petition to President Obama
• Sending an email to your senator
• Visit our website for more action steps at
www.aap.org/ratifyUNCRC

28

Questionnaire - Revised
Chris Mink

Introduction
Hello. My name is Chris Mink, and I am a graduate student from the University of Southern
California. We’re doing an important study about Rallying for the Rights of Children. Please
can I ask you a couple of questions, just to make certain that you are in the group we need to
interview? It will only take a couple of minutes. Your answers are strictly confidential.

Qualifying Questions:
1. Are you a pediatrician?
a. Yes
b. No
2. Are you a member of the American Academy of Pediatrics?
a. Yes
b. No

Response, if answered “no” to either questions and thus, don’t qualify:
I’m sorry. We have already interviewed enough people with your background, we won’t need to
continue. Thanks for taking the time to talk to me today. I really appreciate it.

Response, if answered “yes” to both questions and thus, qualify:
We are evaluating some materials about rallying for children’s rights that other organizations
have designed. We want to get your feelings, positive or negative, about the materials. Please
be as candid as you can, because it is important for us to learn how people really feel. That way,
organizations can design the best materials possible.

29

Group__________ Subject #________

Set-up

First, I have a few short questions to get us started:

1. Have you heard of the United Nations Convention for the Rights of the Child (called the
UN CRC) or has this not come to your attention?
a. Yes → If yes, proceed to Question #2
b. No

2. How familiar are you with the UN CRC? Please give only one response:
a. Very familiar
b. Somewhat familiar
c. A little familiar
d. Heard of it, but not familiar

3. Have you heard of any of the advocacy campaigns of the AAP or have these not come to
your attention?
a. Yes → If yes, proceed to Question #4
b. No

4. Are you able to name a topic of an AAP advocacy campaign?
a. Yes → If yes, please state the topic____________________
b. No

Transition

Now, I have a few different questions:
I want to show you posters with two designs for rallying for children’s rights. The logo on the
poster will also be used as the campaign button.

Group 1:
First, Version A Poster – circle button and then Version B Poster – square button

Group 2:
First, Version B Poster – square button and then Version A Poster – circle button

30

Group__________ Subject #________

Now that you have viewed the materials, tell me how the following statements reflect how you
feel about the whole poster, using the scale: strongly agree, agree, neither agree or disagree,
disagree or strongly disagree.

1. Poster

The
Poster

Strongly

agree

Agree
Neither

agree
or

disagree

Disagree
Strongly

disagree

The
message
about
UN
Rights

for
the
Child
is
clearly
conveyed

The
message
about
US

ratification
of
the
UN
Rights
is

clearly
conveyed

The
message
about
what
I
can

do

for
children’s
rights
is

clearly
conveyed

The
poster
has
too
many
words

Having
a
logo
on
the
poster

helps
deliver
the
message

The
poster
is
appealing

Next, please tell me tell me how the following statements reflect how you feel about the circle
button, using the same scale: strongly agree, agree, neither agree or disagree, disagree or
strongly disagree.

2. Reaction to the logo designs for circle button

The
circle
button

Strongly

agree

Agree
Neither

agree
or

disagree

Disagree
Strongly

disagree

The
message
about
children’s

rights
is
clearly
conveyed

The
message
about
my
role
in

children’s
rights
is
clearly

conveyed

I
would
wear
this
button
in
a

clinical
setting,
such
as
my

office
or
hospital

I
would
wear
this
button
in

non-‐clinical
public
settings,

such
as
shopping

I
like
the
shape
of
the
logo

The
logo
is
appealing

31

Group__________ Subject #________

Next, please tell me tell me how the following statements reflect how you feel about the square
button, using the same scale: strongly agree, agree, neither agree or disagree, disagree, strongly
disagree.

3. Reaction to the logo designs for square button

The
square
button

Strongly

agree

Agree
Neither

agree
or

disagree

Disagree
Strongly

disagree

The
message
about
children’s

rights
is
clearly
conveyed

The
message
about
my
role
in

children’s
rights
is
clearly

conveyed

I
would
wear
this
button
in
a

clinical
setting,
such
as
my

office
or
hospital

I
would
wear
this
button
in

non-‐clinical
public
settings,

such
as
shopping

I
like
the
shape
of
the
logo

The
logo
is
appealing

4. Please tell me the logo button design you think best reflects the campaign.
Square button Circle button

5. In your own words, please tell me why you chose that logo button.

Demographics
6. What is your gender?
a. Female
b. Male

7. Were you born in the US?
a. Yes
b. No

32

Group__________ Subject #________

8. Please tell me your age range:
Years of Age
24 - 30
31-40
41-50
51-60
61-70
71 and over

9. What best describes your race/ethnicity? Please respond with only one choice.
Race/Ethnicity Mark “x”
White, non-Latino
Latino
African American
Asian/Pacific Islander
Native American
Multi-ethnic
Other (specify)

10. How long have you been a pediatrician?
Years (including residency) Mark “x”
1-3
4-10
11-20
21-30
31-40
41 or more

11. Did you vote in the last statewide or presidential election?
a. Yes
b. No

12. Did you vote in the last AAP presidential election?
a. Yes
b. No

33

Survey Results Summary
ChrisAnna Mink

Campaign
“Rally for Children’s Rights” is an advocacy campaign that has the primary goal of motivating
pediatricians to contact their elected officials to encourage them to ratify the United Nations
Convention for the Rights of the Child (UN CRC.)

Survey Venue
Pediatricians were solicited to participate in the survey at pediatric conferences, including Grand
Rounds, at Harbor-UCLA Medical Center. The initial plan was to do all 16 surveys at Grand
Rounds; however, this venue did not permit enough time, so recruitment was performed at
additional weekly pediatric conferences.

Survey Methods
Conference attendees were approached and first asked the qualifying questions. If a volunteer
responded that he or she was a pediatrician and a member of the AAP, then the survey was
conducted. A total of 17 people were approached, and only one could not participate due to time
constraints.

Two posters with different media were presented as follows: Group 1 was shown Poster A
(square logo button) first and then Poster B (circle logo button) and Group 2 was shown the
posters in reverse order, B then A. Each group had 8 members, and data from all 16 participants
were evaluable.

Survey Results
Set-Up Questions
1. Of the 16 respondents, only 5 (31%) had heard of the UN CRC, and all 5 were specialists
in child maltreatment. Specialty of the pediatricians was NOT queried in the survey but
these participants were recruited by the Child Abuse conference, so their specialty was
known.
2. Of the 16 respondents, 14 (87.5%) were familiar with the advocacy campaigns of the
AAP; 13/14 (~93%) could name a specific campaign supporting that they were familiar.

Media Evaluation Questions
A Likert scale with five categories (gradient of strongly agree to strongly disagree) was used for
evaluation of the two media, and a value for each category was provided in descending order, i.e.
5, 4, 3, 2 and 1. Each evaluation had 6 statements about the media, permitting a maximum
possible score of 30 points. A summary score was calculated for each media for each
participant, and the means for each group and all participants are shown on Table 1.
34

Table 1: Mean Summary Score for Campaign Media for Survey Groups
and For All Participants
Mean Summary Score
Group 1
(Square 1
st
)
n=8
Group 2
(Circle 1
st
)
n=8
All
(Groups 1+2)
n=16
Poster 14.6 21.9 21
Circle logo button 20.8 21.8 21.3
Square logo button 14.6 15 14.8

The poster was designed with the same text and the only variation was display of the two
different media. Interestingly, the poster with the circle media was rated more highly than the
poster with the square media likely reflecting the respondents’ preference for the circle logo.

Additional Results:
1. Survey question #4 asked respondents which logo button design they thought best
reflected the campaign. Only one respondent preferred the square logo and 13/16
(81.3%) preferred the circle logo design. Interestingly, two (12.5%) stated that they
didn’t “like” either logo. No common traits were identified for the 3 respondents who did
not prefer the circle logo.

Because of the imbalance in preference of logo designs, no analyses of media
comparisons using a co-variable were permissible. No common demographic features
were noted for the 13 participants who preferred the circle logo. No correlations of
familiarity with the UN CRC and demographic data or voting history were noted (except
as discussed in #2 below.)

2. One open-ended question about the logo buttons was included. For the circle logo, 24
comments were provided and 22 (91.7 %) were positive. The most common themes of
the comments were: 1) liked the children, colors and design and 2) conveyed the
campaign message better (than the square logo.) For the square logo, 10 of the 12
(83.3%) comments were negative. The most common themes were: 1) distaste for the
flags because they seemed to reflect aggression, government or “nationalistic” and 2) the
campaign message was not clearly conveyed.

Demographic Results
In summary: 13 respondents were female; 12 were born in the US, the age range was 24 to 70
years (50% were 31-40 years of age); 13 were practicing pediatricians for 1-20 years and 3 had
practiced for over 31 years. Political activity was queried with recent voting behaviors, which
showed 12 (75%) had voted in the recent statewide or presidential election but only 5 (31.3%)
had voted in the recent AAP presidential election (which occurred one week prior to the survey.)
35

Conclusions
A clear preference for the circle logo design and a clear dislike of the flag design were found.
The demographic data collected did not seem to have an impact upon the media design
preference, especially since over 80% preferred the circle logo design. Most respondents were
female, consistent with the female majority of the AAP membership.

Although the sample size is small, limiting generalizations, the results showed that the majority
of pediatricians were not familiar with the UN CRC. This suggests that providing education (or
at least assessment of knowledge in a larger sample size) about the UN CRC will be needed in
the campaign. The results also showed that 93% of the respondents were familiar with the AAP
advocacy campaigns, which is encouraging for interest in future campaigns, such as “Rallying
for Children’s Rights.”

Lessons Learned
Media. Although the circle logo was preferred, it still did not score as highly as desired and an
improved design for the logo and button will be needed before launching the campaign. The
liked features of the circle logo (i.e. colorful, visually appealing, including children and
conveying the message) identified in the open-ended question should be elements in the
improved design.

Survey Execution. More time was needed to recruit respondents than initially planned, but this
was easily resolved by adding more times for recruitment. The pediatricians were very vocal
about their likes and dislikes, which is beneficial, and with this in mind; inclusion of more open-
ended questions may be advantageous for future evaluations.

Better Next Time. The survey did not include a question about sub-specialty of the respondents,
which may have provided useful information. While performing the survey, I noticed that
familiarity with the UN CRC seemed related to sub-specialty; for example, the respondents who
were specialists in child maltreatment were most familiar with the UN CRC. Child maltreatment
specialty includes child trafficking, so perhaps there is more global awareness for this
subspecialty. I had a glimpse that sub-specialty may be important during the AAP national
conference in late October when the international child health specialists held a session about
UN CRC ratification by the US. I had already considered using AAP Section membership for
segmentation of the intended audience, and the survey results support trying this approach.

36

APPENDIX 2.

CONTENTS:
Opinion article, submitted for publication.

37

Child Rights, So Wrong.

ChrisAnna M. Mink MD
K.C. Cole, Professor of Journalism
USC Annenberg School for Journalism and Communication

It’s President’s Day, no school so no lunch. Nine-year-old Marilyn and her mom, Maria, are
cleaning their cluttered cement patio adjacent to their tiny apartment and discussing what to cook
for their only meal today. Rice and beans? No meat, no veggies.

Marilyn’s sparkling brown eyes turn away when asked about her favorite foods, its fruit,
especially apples and bananas. She hesitates to respond, as these items are rare treats, not
routine.

Marilyn, a sprite, courteous girl with uncombed hair and a shy smile isn’t homeless or unloved;
she’s food insecure. The government’s euphemistic term for hunger.

Hunger doesn’t affect only bloated-bellied children in developing nations, it’s here. Nearly 15
million US kids live in poverty and their punishment for being poor is going to bed without
supper.

US children are not full rights-bearing citizens, so some go hungry or homeless or without
quality schools or medical care, or hope. Having enough to eat, a place to live and healthcare are
three of the basic child rights in the United Nations Convention on the Rights of the Child
(CRC).

Nothing objectionable.

But the US government has objected. Actually, we are the only country on Earth that has not
ratified the CRC. Somalia had kept us company until January 20, when their dysfunctional
government ratified the treaty. But not us.

The CRC is a human rights document calling for countries to act in “the best interests of the
child.” It identifies basic universal rights for children, regardless of their location in the world,
religion, gender, economic status, or skin color. It protects children’s rights to physical and moral
growth, a name, a place to live, enough to eat, access to healthcare, recreation and education,
dignity, tolerance and freedom from cruelty and exploitation.

38

It’s not as if some people in the government haven’t tried. Under the Reagan administration, the
US contributed to the drafting of the CRC, signed the treaty in 1995, and has ratified both of the
subsequent Optional Protocols. The first protocol condemned the involvement of children in
armed conflict and the second prohibited the sale of children and child pornography. Only the
amoral or heartless could not protest child prostitutes and kid soldiers.

Although Presidents Reagan, Clinton and Obama all supported the treaty, not one of them
forwarded it to the senate, fearing it would not receive the necessary two-thirds votes. It was
considered politically unwise. Obama called US inaction “embarrassing,” but still failed to pass
it on.

Some oppose the CRC simply because they are against the United Nations on principle—the
same sentiment that’s prevented the U.S. from joining the rest of the world in the treaty
condemning discrimination against women, or accepting global frameworks to mitigate effects of
climate change.

Some parental rights groups have opposed ratification because they fear that granting rights to a
child takes away rights from parents. In fact, the CRC takes pains to protect children within the
context of their family and their community.

Still others fear the CRC could allow international law to overtake national laws, ignoring the
landmark Supreme Court ruling in Reid v. Covert (1957) stating that no international treaty has
the power to override the US Constitution.

Lindsay Graham, Republican senator from South Carolina, opposes the CRC because he believes
our Constitution already provides sufficient protection for children. In his home state, 27% of
children live in poverty and more than half of those kids don’t have enough food. Only 68% of
his Carolina kids graduate from high school.

If the hungry kids in South Carolina could vote, it’s unlikely they’d cast theirs for Senator
Graham.

The Constitution, a grand and time-enduring document, unfortunately is not enough. Too many
US children—especially African American and Latino children—have a quality of life similar to
kids in poorest third world countries.

UNICEF reported that US children rank 34
th
out of 35 among

developed nations for overall well-
being, ahead of only Romania.

39

In countries that have ratified the treaty, the CRC has had significant impact upon child labor and
child health. Some nations have established child law commissions and private-public coalitions
to promote children’s rights.

The treaty could do the same for American children. Harvard Law Professor Elizabeth Bartholet
distilled the potential benefit of ratifying the CRC into three Ps: participation, provision and
protection. Participation rights give children the right to participate in decision-making that
affects them. Provision rights afford children the right to assistance with preserving their well-
being as related to health, education and accessing social services. Protection rights provide for
children’s rights for protection against maltreatment and includes that the nation and states have
a duty to provide this protection.

The US prides itself as being the pillar of human rights. Without assuring protection of children
inside our borders, we negate our global responsibility to children outside of our borders. They
need us too.

At age 13, Malala Yousafzai stood up to the Taliban and was shot in the head for insisting that
girls had the right to an education. Both Malala and Obama won Nobel peace prizes for fighting
injustices. Despite significant adversity, Malala has continued to be a leader for children’s rights.
Obama has been mute.

Marilyn, truly no US kid, should ever go hungry. Can not the Leader of the Free World stand up
for American children?

Mr. President, what is there to fear?

40

APPENDIX 3.

CONTENTS:
My interview with Aaron Emmel, AAP Department of Federal Affairs, conducted 10-31-14.
41

Interview
Aaron Emmel, AAP Dept. of Federal Affairs

10/31/14 – Phone (202)-724-3305

Background
• AAP has policies and advocacy is based on these; convey message bases on these too
• Take public position, reviewed by Ex Committee (made up of CEO, past-president,
president and in-coming president)
• Policies are generated b committees and counsels, not usually by sections, SOICH
(Section of International Child Health) is unique
• Noted CRC articles in Pediatrics journal

How develop strategies?
• Develop strategies to address government policies, from child health perspective
• Global Health strategies are little different
o Have lots of [AAP] policies by questions are 1) how does research translate into
international settings? 2)what are the needs? 3) are other groups promoting the
issue?

How do you set Global Office priorities?
• Rank our priorities to determine advocacies, start with:
o Landscape analysis, what’s in policy?, what are AAP resources? Are there
members already involved? Where are the gaps?
• Partnerships – e.g. USAID, NIH, HBB, IPA
• Have some global health experiences with Helping Babies Breath (HBB), and AAP is the
lead for Strive to Thrive
• Develop partnerships with professional associations in target countries

Who do you approach once prioritize an issue?
• Ask – is something already happening?
o Tiers of engagement
• Assess “center of gravity” – ask what is needed to approach them
• Foreign affairs and Foreign Relations Committee
• What’s going on in The Administration? E.g. with CDC, HHS, USDA, DoD
• WHO, UN General Assembly

How do you generate a “Call to Action”?
• 2 sources for generating ‘call to action” solicitation: Global Champions List and Key
Contact List

How does this happen?
• If something is AAP priority, usually there’s a Key member involved with the priority
42

• Membership voice can make a difference
• Ask who are influentials, blockers, supporters

What about the CRC?
• Asking the president to send CRC to the senate is in the Top 10 Resolutions, though not
all of these become a policy
• Specifics will be done in context of a national campaign. Working with multiple groups
(volunteer driven), including UNICEF, religious orgs, Covenant House, Am. Bar Assoc.
and bunch of others. Have website, think name is www.childrightscampaign.org
• AAP signed the letter that the campaign sent to President Obama.
• He thinks there will likely be a congressional briefing, social media campaign, and other
elements to campaign.
• Nov 20 is Universal Day of the Child, so may have activity then.

Abstract (if available)

Abstract Rally for Children’s Rights is a media campaign for social change designed to motivate pediatricians to contact elected officials to support ratification of the United Nations Convention for the Rights of the Child. The United States is the only country in the world that has not ratified this treaty. Ratification by the US could benefit American children, as well as children worldwide. The intended audience for the campaign is pediatricians who are members of the American Academy of Pediatrics (AAP).

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Asset Metadata

Creator Mink, ChrisAnna M. (author)

Core Title Rallying for children's rights: a media campaign for social change

School Annenberg School for Communication

Degree Master of Arts

Degree Program Specialized Journalism

Publication Date 04/17/2015

Defense Date 04/15/2015

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag child rights,media campaign,OAI-PMH Harvest,pediatricians,United Nations Convention for the Rights of the Child

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Cole, K. C. (committee chair), Bustamante, Peggy (committee member), Mayer, Doe (committee member)

Creator Email cmink@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c3-551798

Unique identifier UC11298261

Identifier etd-MinkChrisA-3324.pdf (filename),usctheses-c3-551798 (legacy record id)

Legacy Identifier etd-MinkChrisA-3324.pdf

Dmrecord 551798

Document Type Thesis

Format application/pdf (imt)

Rights Mink, ChrisAnna M.

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

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