A Critique of Texas’ Current Youth Tobacco Smoking Intervention- Madeline McClure

The importance of youth smoking interventions is not to be understated. These interventions consistently reduce the numbers of youth who smoke (1). With thousands of American teens beginning to smoke each year, these programs are critical in keeping these numbers low. The most widely cited estimate of teen smoking suggests that 3,000 teens become smokers each day (2). A more current estimate suggests that this number might be closer to about 1,000 youth each day (3). This number, while a significant reduction, still indicates a huge problem—365,000 youth become smokers every year. This breaks down into more than 7,000 new smokers under the age of 18 per state in a given year. In Texas, as with most states, the rates of youth smoking have decreased since 2001, but have stalled over the last several years (4) and continue to be higher than the national average.

While interventions are important in reducing teen tobacco use, it is not sufficient that they exist; they must also be effective in persuading teens not to smoke or to quit smoking. Some interventions achieve this goal. Others are less successful. One example of a not-so-wonderful intervention is the DUCK Texas campaign (ducktexas.org). This campaign began in 2000 and is supposed to target Texas teens. Perhaps it did reach this segment in its early years (data on the website suggests as much), but today there are numerous weaknesses of this campaign. One such problem is the very essence of the campaign itself—DUCK and the other characters delivering the message that “smoking is foul.” Another important failure of the campaign is the fact that it is now nearly 12 years old and is beginning to show its age. A third failure of the campaign is its strategy—that is, its use of animation and media.

DUCK

The campaign centers around a character named DUCK, who seems to be interested in the “cool” associated with hip-hop culture and clothing. DUCK delivers his message that, “Smoking is foul,” a pun likely to be lost on many of the kids seeing and hearing the videos and radio spots (not to mention the irony in the fact that one is expected to associate good with “fowl” but bad with “foul”). DUCK also has a cohort of animated teens who help him deliver his message. These teens are supposed to reflect teen culture to make them more identifiable; however, there is little that appeals about them; they all seem flat and unrealistic. These characters find themselves in situations in which DUCK must enlighten them as to whether smoking will increase their “cool factor.” DUCK, however, is the primary messenger. As far as messengers go, DUCK is a poor one to have selected. He is not similar to the audience he is trying to reach, and studies have shown that this can be problematic when trying to increase effectiveness of programs (5). Further diminishing his relevance is the fact that his voice is provided by a black man. This was a poor choice, considering that at the time this campaign was begun, smoking rates were higher among both whites and Hispanics than among blacks (6). DUCK also fails to exhibit any sort of celebrity status or physical attractiveness. All of these are qualities that an effective messenger might possess; a messenger without any of these qualities is of questionable utility (5). DUCK, as a simple animation, and his posse of youth are too far removed from the teens they are trying to target to be effective.

Age

At 12 years old, the DUCK Texas campaign is outdated. The DUCK Texas website touts the success rate of the program in its first year, and it is remarkable—a 40 percent reduction in youth smoking; however, no other data are provided, and it is not unreasonable to think that the success of this program has diminished. The portrayal of the characters may have been relevant in 2000, but in 2011, extreme crop-tops and baggy pants are not indicators of one’s cool status. Even the animation on the website dates the page. There is very little on the page that has great appeal. The character of DUCK is vaguely reminiscent of Disney’s Darkwing Duck, a character with which most teens in 2000 would have been familiar. This might provide insight as to why this character was chosen. Ten years later, however, it would be surprising if many teens made this connection. To them, DUCK is simply a duck.

While it would be unusual, it is not inconceivable that a campaign might exist for over a decade; but if it is going to still be effective, it needs to evolve and mature (7). When a campaign has been around for 12 years, even if it is still pertinent to the culture (which is dubious), it will lose some of its potency by virtue of being too familiar unless it has been evolving over time (8). This is not the case with the DUCK campaign. There is no evidence to suggest that the intervention is any different now than it was when it was first developed in 2000. The website looks as though it has not been updated since it was designed. The demographic currently being targeted has been hearing the same message practically since birth—they have heard it for so long, it is questionable as to whether they are not yet deaf to the message. If they saw DUCK on television when they were six, seven and eight, he may of seemed cool or fun; but now that he is still on screen at 12 and 13, he likely seems simple and childish.

Strategy

DUCK Texas claims to be targeting teens who might begin to smoke, but the whole strategy of the campaign seems unlikely to reach this demographic. The developers had a good idea when they convened a group of teens to form a focus group for the purpose of discussing how to reach teens. The problem with this, however, is that the teens attending an anti-smoking conference are not the target demographic—they already are against the behavior; the true target consists of teens who currently smoke or who are deciding whether to begin smoking. The group that designed this intervention is going to find it more effective because of its current attitudes than is the group that is actually the target of the message (8). An important thing for people developing interventions to remember is that just because an idea works in a controlled setting does not mean that it will work in the larger market (7). Mid to late adolescents think most PSA’s are silly (9). If this is the case with most public service announcements, which tend to be live-action and depict plausible scenarios, it is a bit unnerving to imagine how teens might respond to the DUCK website and television and radio spots. “Too many campaigns geared to young people have offered only simplistic short-term assistance that leaves children who are seeking effective solutions to difficult problems to lose hope of finding real help” (9)

The ads used in the campaign are very simple, and this makes them easy to discredit. The scenarios show kids easily rejecting an offer to smoke. Those who are smoking are typically alone and look uncool. This is seldom the case, and it is not always so simple to refuse. When one’s peers all smoke, refusing a cigarette can be difficult. Turning down a cigarette can greatly affect one’s social standing, which can limit one’s ability to say no. When a teen feels that he or she does not know how to refuse without compromising his or her status, he or she is not likely to adopt the behavior (10).

The use of animated characters is more relevant to pre-teens in the 8-11 age range, rather than those in the 13-17 age group; even among the pre-teens animation might be losing its appeal given the recent decline in animated television series, and the surge in live-action children’s programming. While animation might appeal to the younger segment, it tends to be less effective than live-action because it is difficult to make animation very emotionally charged. Studies have found that increased sensation—sight and emotion, for instance—makes an intervention more effective (11). The animated characters are all assigned biographical information, which may have been done to make them at least somewhat relatable; however, it appears to do little good, and may actually cause more harm than good. The main issue with this information is that the smokers are all from towns in Texas that already have negative associations. Ascribing these as points of origin for these characters does nothing but affirm the negative ideas that children and teens have about these cities while reinforcing the positive ideas they have about their own cities. It also affirms the negative ideas that children from Midland, for example, might have about their environment. Labeling theory holds that this can lead to internalization about their identities—as being from towns that produce smokers—increasing the likelihood of their smoking; that is, it becomes a self-fulfilling prophecy (12). Another problem with this labeling is that the cities associated with smokers are all in west Texas, and the primary location of implementation for the campaign is east Texas. This seems to be a bit of a disconnect.

Further, the games provided as entertainment are more similar to those that 6-9 year olds would play than those that even 11 year olds, the uppermost age of those actually being reached by these messages, would play. The “Gag-out” game in particular is quite puzzling. The whole premise of the game is to build a tobacco executive, and one’s choices are limited to incredibly unattractive and demeaning attributes. This is problematic because it encourages kids to stereotype smokers as unkempt, disgusting people. While it is understandable that the program wants to portray smoking as unattractive, reinforcing such negative stereotypes in this manner is not the best way to achieve this goal. In addition, this game has the potential to create disdain for people who look like these caricatures—overweight, dirty, et cetera—who are not necessarily smokers. Creating ill will toward other groups of people (even toward smokers) is a very dangerous, and perhaps unethical, thing to do.

Another shortcoming of the intervention’s strategy is that it has a very limited internet presence, especially for a program that has been around for 11 years. A Google search of “duck texas” returns only one hit that is not about duck hunting, and it is the website of the organization (which is a plus). While the DUCK website is the first returned hit, it is not the first link on the page—it is preceded by two advertisements for duck hunting. These advertisements minimize the fact that ducktexas.org is the first returned website. A search on bing.com is a little bit better—there are no ads before the two hits related to the DUCK campaign. An image search on either engine returns only two images; and a video search provides no videos, nor does a YouTube search. Even some of the television ads fail to link to the DUCK website. This is damaging for a campaign whose primary form of reaching kids is through video.

Another fault of the campaign’s strategy is the very limited scope of its website, particularly with regard to providing resources. The internet is an invaluable resource for public health interventions because it allows for mass dissemination of information. It also serves as a platform through which one can engage an audience in many ways that cannot be done through other media (13). The DUCK website fails to capitalize on this. Its website has a very limited scope and is wholly unexciting. There is tab for facts, but no tab that provides information on how to quit if one already smokes (and where to find help) or how to talk to a friend who currently smokes. This information is critical, and it is rather surprising that it is not on a youth tobacco prevention website. It seems that developers of the intervention forgot that using media alone is seldom an effective way to change behavior—simply seeing a cartoon character turn down a cigarette is not going to be enough to discourage teens from smoking (14). A case could be made for the fact that the website is a prevention website, not a cessation website, so the resources are unnecessary; however, this is hardly a valid excuse. The website is a youth resource, and it is important to provide an array of resources.

In addition to not providing resources, the website is simply boring. As stated previously, it is not current. There are no moving graphics on the site and no clever ways of linking to others parts of the site; there are static pictures and very basic tabs. Today’s tech savvy youth will quickly tire of this lifeless site.

The fact that these problems with the campaign are so blatant suggests that those responsible for maintaining it have become complacent. After the success of the campaign in its infancy, it seems developers patted themselves on the back and walked away, leaving DUCK and his friends to become old and irrelevant.

An Alternative Approach

In order to increase the efforts of Texas’ department of state health services, one could simply revamp the DUCK campaign. DUCK could be updated—given a new look and new interests—and his friends too. The website could be redesigned to make the graphics engaging and the games more audience-appropriate. The scope of the website could be expanded, as could the reach of the media. It is questionable, though, whether this would be effective to any significant degree. The DUCK intervention has become hackneyed; it would be a better plan to scrap the DUCK campaign entirely and, instead, to develop a new program that resolves the issues addressed in the preceding discussion.

The new campaign consists primarily of television spots, beginning with a series of three, with the possibility of adding more if they prove effective. Because the advertisements are being created to target Texas teens, they will reflect this group: one features a Caucasian woman, one a black man, and one a Hispanic woman. The premise of each of the public service announcements is similar. Each one features a split screen and begins with the image of a person approximately 50 years old. The person on the right, however, appears noticeably less healthy. As the ad runs, the people on screen age backward, and the viewer gets a glimpse into the lives they have led. Just what these lives look like will depend on which character’s story is being told. Contextualizing the message increases the likelihood that it will be heard by the audience (15). Either of the women, for example, might have a scene depicting the birth of a child. For the woman on the left side of the screen, this is an incredibly happy day, and she is shown holding her baby; the woman on the right side, though, is shown touching the case of her infant’s incubator because he was a low birth weight baby. The ad continues backward in this fashion, and the viewer begins to see that the two people on screen look less different than they did in the beginning. As the spot winds to a close, it becomes apparent that the two people on screen are in fact the same person, whose life took a different trajectory based on his or her decision to smoke—the decision that is the last shot of the ad. This campaign will rely on digital technology to age the teen hired for the role. This person will be digitally aged to the appropriate extent for each scene, and the way in which the character is aged will differ realistically for the smoker versus the nonsmoker. The teens in the ads are 14 or 15 and reflect the average Texas teen—they wear normal, trendy clothes appropriate for their demographic; they are attractive without being so attractive as to be alien (the girl next door, for example). This is done to increase the similarity between the target and the messenger, which is found to increase receptiveness to a campaign (5). Additionally, the differences in the quality of life depicted in the advertisements/PSAs are to be realistic differences that might occur. The use of the digital technology will catch the viewers’ attentions, making them more attuned to the message. This falls in line with the elaboration likelihood model—if a person is connected to a message it increases receptivity (15).

While the television aspect of the campaign serves as the primary point of contact, there are other components of the intervention as well. This intervention will take full advantage of the technology available to the developers. A companion website exists as a complement to the ads on screen. The website is highly interactive and includes features relevant to teens. One example of this is the message board. This is a forum where teens can post about what is going on in their lives, whether it is related to smoking or not. There will be threads specifically devoted to how to quit smoking and how to talk to friends who currently smoke. Because the advice is coming from peers, it will be much more honest than has traditionally been the case. That said, there are board moderators, who ensure that the threads are not needlessly obscene or irrelevant. Another interactive aspect of the website is the section where the user can upload a picture of him or herself and use the same (or similar) technology as the television ads to see how he or she might look in 40 years, and how the appearance differs based on whether or not he or she smokes. A last interactive part of the website is one in which teens can record and upload their own videos about their experiences with smoking (personal, familial, or friends) and quitting. Before the videos are posted to the site, they will be reviewed by moderators to ensure that they are pertinent and not explicit (these two things will be stated as necessary conditions for the video to be posted online). These personal testimonials will serve to further personalize the effects of smoking for teens. One focus group consisting of teens found that these sorts of personal experience better represent “truth” than do less personal messages (16).

In addition to being interactive, the website also provides professional resources for teens. These resources include information about where a teen can find help to quit smoking, the number of a quit-line, et cetera. Other resources might include those on mental health (links to other websites and hotlines) because mental health status might be correlated with smoking status. There will also be data and statistics on the site, because some teens are interested in the numbers.

As the campaign progresses, a contest will be implemented. The contest will be to create the best anti-smoking ad on the website, as mentioned above. The users of the website will then vote on the videos, with the prize being that the best video will air on television

One important thing for the campaign is that it must continue to develop. It must not stagnate—it needs to stay relevant and fresh in order to maintain the attention of its target market. One way to ensure that this happens is by conducting analyses at the end of each year to address any changes in the culture that occurred. Another way to stay relevant is by frequently updating the website, with a complete redesign annually

The aired commercials are to be uploaded to YouTube by a member of the campaign team. Additionally, it is possible to upload the self-recorded videos on the site to YouTube. When recording the videos, users will be presented with a box to check, indicating whether they consent to their videos being uploaded to YouTube or not. All of the videos will be uploaded with the same set of tags, which include Texas, youth, smoking, and anti-smoking, among other things. This is done to ensure that watching one video will link to the others as “recommended videos”.

In order to further increase the effectiveness of this intervention, spokespeople for the program will go into the middle schools and high schools to educate teens about not smoking (17). The use of a spokesperson affiliated with the program will be a better tactic than simply giving a health teacher a script because the spokesperson can be specially trained in how to appeal to students’ desire to for acceptance. Plus, a person working for the campaign is more invested in the success of the program than is a health teacher only covering smoking because it is in the curriculum.

This program is more likely than the DUCK campaign to be effective because it is fresh, relevant, and more accessible. It meets teens where they are by providing pertinent resources, and it makes it easy for them to engage with the intervention through interactive aspects of the website. it utilizes modern technologies to tell its story and to spread it. Through all of these things, it reaches both those teens who know that smoking is uncool and those who are not yet convinced.

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