Don’t Burn It, Unless It’s Not Yours-Jennica Allen

Introduction

In a few neighborhoods in the city of Boston, there are billboards featuring

unusual equations. These equations include three packages of tip cigars times 52 is

equal to a laptop, and a blunt cigar times 365 equals an iPad. These billboards are part

of the Don’t Burn It campaign and are in very strategic locations around the city. These

locations are generally in areas with large minority populations. These include South

Dorchester, Mattapan, and Roxbury.

Boston Public Health Commission created this campaign to alert area youth to

the dangers of tobacco, and the deception of the tobacco industry. The main message of

the billboards is that with the money youth spend on flavored tobacco products, such as

blunt cigars and tip cigars, they could instead buy something more appealing and longer

lasting, such as sneakers or a video game console. The message is It’s your money.

Don’t burn it.

There are many things this campaign does very well. Until the advent of the

Truth Campaign era, traditional anti-tobacco work focused on the behavior of the

individual and ignored the behavior of Big Tobacco. The Don’t Burn It campaign’s

website informs visitors “Big Tobacco is targeting YOU” (1). Psychological

Reactance Theory explains that “when people this that a freedom is threatened they

experience reactance, a motivational state aimed at restoring the threatened freedom”

(2,3). This is particularly applicable among youth, so by convincing them that the

tobacco industry is jeopardizing their freedoms, the Don’t Burn It campaign aims to

encourage rebellion in the form of choosing not to smoke.

The Don’t Burn It campaign also works in conjunction with the 84 campaign of

Massachusetts, a campaign that seeks to increase the visibility of the 84 percent of

Massachusetts youth who are tobacco free. It is important to emphasize that tobacco

use is not as widespread as youth may think.

Finally, the Don’t Burn It campaign utilizes many avenues to spread its message.

These include the aforementioned billboards as well as commercials and print materials.

Don’t Burn It conveys a very important message to youth, particularly racial and

ethnic minorities, in the city of Boston. While there are many aspects to this campaign

that make it a unique approach to an old problem, there are a few things the designers

should consider. With these considerations come a few entry points at which the

creators can begin to make Don’t Burn It the most effective intervention possible.

Critique 1-Consider the Source

The general premise of the Don’t Burn It campaign is that “it’s lame to waste your

money on rollies and other flavored tobacco products” (1). To convey this idea, the

campaign uses materials, billboards, commercials, and other print materials to indicate

that the money spent on daily or weekly tobacco purchases, could instead be used to buy

a laptop, an iPad, fashionable sneakers, or a video game console.

It is likely that these equations are mathematically sound. Multiplying the cost of

a package of blunt cigars by 365 will probably generate an amount of money large

enough to purchase an iPad.

However, one important concept that weakens this message is that of social

sources. That is to say that many tobacco users, particularly youth, do not get their

tobacco by purchasing it in stores, i.e. commercial sources. Social sources are

particularly popular among youth under the age of 18 (4) This is because many states

enforce stringent restrictions on underage purchasing of tobacco products in an attempt

to reduce access. Research suggests that access focused interventions are unsuccessful

because there is “relative rarity of exclusive reliance on commercial sources for

obtaining either cigarettes or alcohol, ranging from less than one to nine percent of

users depending on substance and grade in school” (4).

Research also shows that younger smokers consider tobacco easy to obtain

regardless of federal restrictions. School age children rate tobacco among the easiest

substances to obtain via multiple social sources (4,5).

Only once use becomes more regular do tobacco sources shift from social to

commercial, and at this point, a message about how money can be better spent may be

too late (4,6).

Even youth who obtain tobacco from social sources do not get it for free. They

often pay friends who otherwise acquire the tobacco products. Youth obtain the tobacco

at reduced prices, rendering the Don’t Burn It campaign’s equations a bit skewed.

DiFranza and Coleman conducted a study in ten Massachusetts communities

with merchant compliance rates of at least 90 percent. The study found that even in the

face of such overwhelming restrictions, youth managed to obtain tobacco. New smokers

got tobacco products from friends and even parents (7).

Some youth shoplift tobacco from merchants with young or otherwise

unsuspecting clerks. To combat this, some anti youth smoking advocates suggest

raising the minimum age for purchasing as well as selling tobacco to 21 (7,8). Research

on the effect of supply and demand on youth smoking shows that access interventions

are generally ineffective, so laws regarding minimum age may not be successful.

If youth obtain their tobacco from non-commercial sources for little to no money,

it is unlikely that the Don’t Burn It campaign message will strike a chord with them.

Critique 2-Number Crunching

Beyond the surface message of the Don’t Burn It campaign, the creators present

website visitors with alarming statistics about the harmful effects of tobacco use. These

statistics include that one third of youth smokers will eventually die from tobacco

related disease and smoking causes nearly 8,000 deaths each year in Massachusetts (1).

Public Health campaigns often bombard the target audience with statistics. They

do this in order to shock the target into changing the risky behavior. This is ineffective

particularly regarding tobacco because smokers are usually fully aware of the health

risks related with smoking and even overestimate the negative health consequences.

Humans are subject to “unrealistic optimism”, as they tend to underestimate the

probability that bad things will happen to them (9). The theory that explains this is

Optimistic Bias. This bias operates on a systematic level and under its influence,

people fail to assign the same risk to themselves as they assign to others for the same

behavior.

The Law of Small Numbers explains that humans have a distorted view of

probability and are not good at judging probability and risk. This is certainly applicable

in the realm of public health, particularly with respect to tobacco interventions.

The statistics regarding the harmful effects of tobacco are staggering, with

exposure linked to lung cancer, heart disease and other dangerous outcomes. However,

confronting smokers with these numbers usually invites a reply about a distant relative

who smoked a pack a day for 70 years and lived to be more than 80 years old. This is

because people grasp on to one example that operates counter to what public health

messages tell them and use this case to discard the statistics.

The highest levels of Optimistic Bias occur in adolescents, making it particularly

relevant to the Don’t Burn It campaign. People do not necessarily correctly interpret

statistics, and even if they do, the numbers are not enough. People assume they are

different from the masses.

This is applicable to the Don’t Burn It message because the youth are likely to

assume that they are part of the two-thirds of youth smokers who do not die from

tobacco related disease. In a state of more than six and a half million (10), youth

smokers will assume that they are safe from the tobacco reaper that claims 8,000

Massachusetts lives annually.

Optimistic Bias indicates that people are biologically irrational due to innate

biases. People, especially youth, fail to make emotional individual connections to

statistics. Therefore, the Don’t Burn It campaign and Public Health in general should

reconsider approaches to interventions that aim to change behavior.

Critique 3-First Things First

It is clear from the public materials of the Don’t Burn It campaign that the

creators made some assumptions about the priorities of youth smokers. The billboards

show that the designers assume that those currently smoking flavored tobacco products

value certain material goods. These include the aforementioned sneakers, laptops,

video game consoles, and iPad tablets. It is very plausible that the target audience finds

these things valuable. For this reason, the Don’t Burn It campaign places its materials

in areas where these worlds-that of young users of flavored tobacco and those who value

goods such as video game consoles and sneakers-collide, i.e. urban neighborhoods with

high populations of ethnic minorities.

However, these communities are often plagued with issues inherent in inner city

living. Safety, education, and job opportunities are often concerns of residents in urban

settings. Thus, these often take precedent over the desire for worldly possessions.

This method of prioritizing is further elucidated by Maslow’s Hierarchy of Needs.

Abraham Maslow created a paradigm regarding people’s behavioral motivation. This

paradigm includes a pyramid of needs with the most basic of needs serving as the base.

There are eight levels to the pyramid. The bottom , most basic level is Physiological

Needs which include food, water, and similar sustainability structures. The next level is

Safety Needs and includes security. The next level is Belongingness and Love Needs

which refer to the need to be affiliated with and accepted by others. The fourth level is

Esteem Needs, the need to achieve and be recognized as competent. The next level is

the Need to Know and Understand which operates on a cognitive level regarding the

need to know and explore. The next level is Aesthetic Needs referring to the need for

order and beauty. The seventh level is Self-Actualization which refers to the need to

achieve fulfillment through reaching one’s potential. The final level, and point of the

pyramid is Transcendence which encompasses the needs of humans to achieve

fulfillment beyond oneself and help others to reach their potential as well (11).

The Public Health field acknowledges that health tends to fall among the needs

higher along the pyramid. This makes health difficult to sell in communities that lack

stability in basic needs, and in tobacco related interventions, the main selling point is

almost always health. In the case of the Don’t Burn It campaign, the creators are selling

the idea of material goods. These goods are supposed to appeal to youth smokers on a

visceral level, that is, they should find themselves immediately drawn to the

attractiveness of a new laptop or pair of sneakers. Something like a new pair of sneakers

can likely only fulfill aesthetic needs, the sixth level of Maslow’s Hierarchy of Needs.

If members of the target communities find what Maslow refers to as deficiencies

in their basic needs, such as stable housing and security, a public health message selling

aesthetic needs will simply fail to resonate. Maslow explains that people cannot begin to

fulfill higher order needs until the most basic needs are met.

Conclusion

There are three aspects of the Don’t Burn It campaign that contribute to its

failure to reach its full potential as a Public Health intervention. There are however,

many facets that render the campaign both unique and effective. These include the

highlighting of Bog Tobacco’s deceptive ways and the affiliation with the 84 campaign of

Massachusetts. Another important aspect of Don’t Burn It is that of ownership.

Ownership can lead to greater success in behavior change. Don’t Burn It encourages

ownership through a “Tobacco-Free Pledge” that youth can sign. Youth are more likely

to commit to remaining tobacco-free if they believe they are accountable for their

behavior.

Don’t Burn It has the makings of a truly effective, valuable intervention

campaign. If the creators address the three sources of critique mentioned above, the

movement can be the first step in changing the way the Public Health field interacts

with its target audiences.

Interventions

Intervention 1-

In order to address the gap in the consideration of tobacco sources, the Don’t

Burn It campaign can take an approach that will broaden its scope. Once the creators of

the intervention resolve to take into account the prevalence of social sources of tobacco,

they will find that they have a new, larger audience for their message.

Commercial sources are independent in nature and presuppose that the smoker

is operating in a vacuum, unaffected by outside forces. Research shows that social

sources are far more widespread than the Don’t Burn It campaign indicates. By

considering and addressing these sources, the campaign should become even more far-

reaching and effective.

The first step is to aim the message at more than one person at a time. Right

now, the message is “It’s your money. Don’t burn it”. If the message instead becomes

something more like “Don’t spread the wealth” or “Not sharing is caring”, the campaign

can address entire social groups at one time.

Billboards that explain the fast spreading nature of harm from tobacco exposure

from one individual to another may begin to make strides in getting at the underlying

issues of access to tobacco for youth.

Making it socially unacceptable to share tobacco products will alter social norms.

Social norms can be the most influential forces in any public health issue specifically

tied to harmful behavior. Changing these norms is the most effective way to modify

risky behaviors.

Social sources of tobacco for youth often go underexplored and unacknowledged.

Bringing this concept to light is the first step toward getting it on the public agenda. The

framing of an issue determines whether and how the public chooses to address it. High

visibility among the general public of the prevalence of social sources of tobacco can

serve to affect public opinion. If providing youth with tobacco products is no longer

acceptable, simply by virtue of being recognized, behaviors will begin to change.

Affecting groups of individuals is much more feasible than affecting a single

individual. This is also a more effective means of creating changes in behavior.

Considering the impact of framing, group behavior, and social norms, the Don’t

Burn It campaign should add an element to their message that accounts for social

sources of tobacco. This may include billboards that expose the vectors of transmission

tied to tobacco and tobacco related disease, and how the spread is only expedited when

tobacco is shared within social networks.

Intervention 2-

Perhaps the most difficult change to make to an existing public health

intervention involves moving away from statistics. Practitioners often work in

conjunction with epidemiologists and biostatisticians and arm themselves with sound

statistics and other mathematic figures in order to go to battle against harmful health

behaviors.

The assumption is that if people only knew just how bad their behavior is for

them, and what kind of harm it is causing, they would no longer participate in such risk

taking. This is a dangerous assumption as it leads to action that seeks to attack a

knowledge gap that may not exist.

This problem is particularly applicable to the Don’t Burn It campaign because

research indicates that with respect to tobacco, those participating in harmful behavior

are fully aware of the associated risks. No quantity of disquieting statistics will alone

change risky behaviors.

People also often misunderstand or utterly disregard statistics that attempt to

confront them with their own mortality. Instead, they hold on to a single experience

that is for them influential, swaying, and able to convince them that they are not as

vulnerable as statistics may suggest.

The best way to combat this human tendency is to provide an equally compelling

individual story. Yul Brynner is a good example of the effects of this method of

conveying a public health message. Yul Brynner was an actor best known for his

Academy Award winning role in the 1956 film The King and I. Brynner smoked

frequently and died of lung cancer in 1985. Prior to his death, he expressed desire to

create an anti-smoking commercial. The American Cancer Society released a

posthumous public service announcement in which Brynner pleads with the viewers to

never smoke. This public service announcement was a very effective tool for the anti-

tobacco movement because people connected to it on a personal, emotional level.

The Don’t Burn It campaign can learn from this and create a compelling message

that is relevant to its target audience. This will likely involve a subject to whom the

audience can relate.

Since the message of the campaign is that there must be a tradeoff between

tobacco and other things, the story should feature a young person who had to face the

same decision and suffered the consequences of choosing tobacco. The loss this young

person experienced may be financial or more abstract, like loss of trust of a family

member or friend. These are things that young people in most settings value, so a

believable, individual story of jeopardizing these precious entities, is likely to resonate.

Intervention 3-

Maslow’s Hierarchy of needs is a potentially very helpful framework for public

health interventions. Understanding how people prioritize various needs and how these

priorities dictate behavior can provide valid entry points for public health practitioners

to begin to affect change.

It is important to note that health generally qualifies as a higher order need and

therefore takes a back seat to other, more basic needs. Therefore, it is critical that in

intervening, public health practitioners sell something other than health to the target

audience. The intervention should sell something more in line with basic needs.

Perhaps the most important and effective thing that a public health campaign can

emphasize is freedom. As Psychological Reactance Theory explains, people resist

threats to their freedom and seek out ways to regain whatever freedom is lost. The

Don’t Burn It campaign in a way does attempt to alert its audience to threats to their

freedom by uncovering some deceptive practices of Big Tobacco. The campaign seeks to

get the audience to regain this freedom and rebel by never beginning to smoke.

There are other ways in which the Don’t Burn It campaign can convey its message

using the foundation of base level needs.

The campaign focuses largely in urban neighborhoods in Boston with large

numbers of racial and ethnic minorities. The social determinants of health show that

neighborhoods like these are disproportionately affected by lower socioeconomic status,

higher unemployment rates, and weaker infrastructure leading to less safety and

stability.

Many of the things that are deficient in the inner city are basic foundational

needs according to Maslow. This provides an important opportunity for the Don’t Burn

It campaign.

If the campaign can manage to sell security as the opponent of tobacco products

for youth, it will be significantly more effective. If the campaign’s creators instead

equate rejecting daily and weekly purchases and use of tobacco products with job

opportunities and increased income, they might find that the campaign’s efficacy

improves as the message reverberates with larger numbers of youth throughout the city

of Boston.

Conclusion-

Don’t Burn It is in many ways a public health campaign that takes a unique

approach to changing behavior. The intervention employs seldom used methods to

convey an important message to youth regarding tobacco use. The campaign uses

various avenues to express ways in which tobacco can cause harm.

There are ways however to improve the Don’t Burn It campaign. Delivering a

message that goes directly for social norms will undoubtedly be effective in exposing the

prevalence of social sources of tobacco for youth.

Sharing a compelling story that resonates individually and emotionally with the

youth in the target audience will likely prove more successful in modifying behavior.

Selling basic needs as the yield for rejecting tobacco will create an intervention to

which a large segment of the target audience can relate.

These three simple additions to the Don’t Burn It campaign may return

exponential improvements, affecting youth for generations to come.

References-

1. Boston Public Health Commission. Don’t Burn It. Boston, MA:2011. http://www.dontburnit.org/

2. Silvia, Paul J. Deflecting Reactance: The Role of Similarity in Increasing Compliance and Reducing Resistance. Basic and Applied Social Psychology 2005; 27(3): 277-284.

3. Brehm, J.W., and Cole, A. Effect of a favor which reduces freedom. Journal of Personality and Social Psychology 1966, 3:420-426.

4. Harrison, Patricia A. et al. The Relative Importance of Social Versus Commercial Sources In Youth Access to Tobacco, Alcohol, and Other Drugs. American Journal of Preventive Medicine 2000; 31:39-48.

5. Forster, JL, et al. Perceived and measured availability of tobacco to youth in fourteen Minnesota communities: The TPOP study. American Journal of Preventive Medicine 1997; 13:167-74.

6. Wagenaar, AC, et al. Where and how adolescents obtain alcoholic beverages. Public Health Rep 1993; 57:459-63.

7. DiFranza, Joseph R., and Coleman, Mardia. Sources of tobacco for youths in communities with strong enforcement of youth access laws. Tobacco Control 2001; 10:323-328.

8. DiFranza, JR, et al. Is the standard compliance check protocol a valid measure of the availability of tobacco to underage smokers? American Journal of Public Health 2001.

9. Weinstein, Neil D. Unrealistic Optimism About Future Life Events. Journal of Personality and Social Psychology 1980; 39(5):806-820.

10. U.S. Census Bureau. Massachusetts QuickFacts. 13 Oct 2011. http://quickfacts.census.gov/qfd/states/25000.html

11. Huitt, W. Maslow’s Hierarchy of Needs. Educational Psychology Interactive 2007.