Failures in Public Health Interventions to Minimize Marijuana Use among Adolescents in the United States-Nausheen Punjani

“Above the Influence” or “Under the Influence”

Introduction

In the United States, marijuana is the most commonly used illicit drug and in 1999 the average age for new users was approximately 16 years old for males and 17 years old for females (1). Surprisingly, marijuana use has increased at a much higher rate compared to cigarette smoking (2). Specifically, marijuana rates are relatively high among adolescents, who view the gateway drug as a form of experimentation that serves the teenage experience. For grades 8^th, 10^th, and 12^th, marijuana usage increased from 2009 to 2010 (2). Long term ingestion of marijuana is known to cause several health effects on multiple organ systems, particularly “mental, pulmonary, immune, and reproductive functioning” (3). In addition, evidence suggests that intoxication of marijuana has lead to many accidents and injuries (3). Therefore, there are numerous public health interventions geared toward minimizing marijuana use among adolescents. However, marijuana consumption rates among adolescents are constantly escalating. One of the most prominent public health campaigns is The National Youth Anti-Drug Media Campaign.

The National Youth Anti-Drug Media Campaign develops media campaigns such as, “Above the Influence” to prevent substance abuse among the youth, particularly adolescents. Above the Influence campaigns focus on advertisements that directly target adolescent drug abuse especially marijuana usage. As a public health advocates, they were successful in exposing their advertisements to the entire nation because most people are aware of Above the Influence media campaign. However, their public health campaign has failed to accomplish their main objective to reduce marijuana usage among. This is evinced by data that shows constantly increasing rates of marijuana use. In essence, although many adolescents are aware of the advertisements there is very little change to reducing marijuana usage. Perhaps, The National Youth Anti-Drug Media Campaign failed to address that most youths are aware of the health consequences but they have other reasons that influence them. In this paper, we will criticize the campaign, Above the Influence and illustrate the possible reasons for the unsuccessful campaign to minimize marijuana usage among youth. Specifically, we will focus on three psychological models that might explain why the campaign was not successful in reducing marijuana usage rates among adolescents: psychological reactance theory, theory of reasoned action, and optimistic theory.

“Withholding My Freedom”

The U.S. Congress has spent approximately 1 billion dollars for the National Youth Anti-Drug Media Campaign from 1998-2004 (4). Most of the investment is aimed toward short advertisements that target adolescents and demonstrate the negative consequences of illicit drugs especially marijuana. However, the campaign has not attracted many youths to avoid marijuana usage. One of the most important reasons that this campaign has been unsuccessful is because it focuses specifically on the negative consequences of marijuana use. Often, many youths rebel against the messages because they find the advertisement as a threat to their freedom of choice to experience and engage in certain behaviors (4). Many youths reacted against the Above the Influence advertisements by mocking the videos and illustrating the same video in a pro-drug approach. For example, one of the aired advertisements described a dog talking to a youth and telling her that he does not like her smoking. Soon after, a parody was created about the talking dog, ridiculing the anti-drug commercial. Essentially, this behavior originates from the theory of psychological reactance where individuals believe that control is taken away from them and they want to reclaim that freedom. In our example, youths who were exposed to these advertisements reacted against the original campaign to reestablish their freedom, which produced an effect that was opposite of what was intended (5). Based on psychological reactance theory, youths were in fact more attracted to marijuana after exposure of the anti-drug commercials (5). For example, one college student states, “…it’s like my little way of saying, ‘take that. I’m going to do it anyways.’ I’m being the bully, the rebel that I never was in high school or grade school” (6). Specifically, this suggests that the campaigns will have greater negative impact on high-risk adolescents such as those who have friends that use marijuana or are offered marijuana in comparison to low-risk adolescents (7). In addition, the ad campaigns attract those who are curious to learn about marijuana and to be accepted by their peers (7). Therefore, many youths find the anti-drug advertisements as a restriction to their freedom causing them to eliminate the restriction by experiencing marijuana. Ironically, the increasing presence of anti-drug commercials in the mainstream media has led to a stronger reactance for youths in support of marijuana use (4). Therefore, it is necessary to initiate a program that will not cause psychological reactance but ultimately be effective in deterring youths against toxic drug habits.

Social Norms: Our Youth Culture

Above the Influence advertisements generally focus on providing reasoned arguments against the use of cannabis. In addition, the campaign focuses on what the social norms are regarding drug use and also targets how to change the social norms for marijuana usage among adolescents. The campaign ultimately developed a framework that incorporates social norms using the theory of reasoned action by providing reasons to not smoke marijuana and what others think about marijuana on an individual level attitude (8). The anti-drug campaigns geared their ads to show what others think about their potential marijuana use. However, instead of attempting to show a family or friend’s opinion the advertisements often portrayed a pet’s opinion. Not many youths are concerned about their pet’s opinion thereby the campaign ineffectively used the theory of reasoned action. Therefore, many studies illustrate that this approach is “too indirect” to change social norms (9). Furthermore, these types of ads can negatively affect adolescents because many youths will assume that marijuana usage is popular among peers (10). Indeed, this reinforces the concept that many youths will want to experiment marijuana for social acceptance from their peers (9). Ultimately, this method could result in a boomerang effect where the target audience develops negative social comments in response to the campaign (11). For example, many adolescents developed youth groups via the internet and satirized the Above the Influence ads thereby developing a social norm rebelling against the ads. Generally, adolescents have a desire for peer approval and the critical dilemma is to develop an anti-drug campaign that is designed to attract peers to refuse experimentation with marijuana. However, Above the Influence campaigns develop advertisements that show youths using marijuana and the negative consequences of marijuana usage. Unfortunately, the more the campaign shows advertisements similar to these methods, the more adolescents will feel the urge to experiment marijuana to become socially accepted by their peers.

The theory of reasoned action is also an effective approach for the campaign because it is a static model which means that it does not account for dynamic changes that occur in an individual. The theory is criticized because it illustrates that individuals follow a linear decision making process when in fact most individuals have a dynamic decision making process (12). This is an important limitation in the model and perhaps one of the most significant limitations resulting in the campaign’s ineffectiveness because often drug-related beliefs and attitudes are dynamic (13). For example, many youths may have a reason to quit using marijuana but are unable to quit because of addiction or they might quit for a period of time and then start again. When many youths attempt to quit or reduce marijuana, they develop withdrawal symptoms such as anxiousness and restlessness. In essence, negative moods associated with marijuana withdrawal elicits more cravings for marijuana and thereby promote marijuana use amoung many youths(14). Indeed, those attempting to quit marijuana have reported significant experiences of craving marijuana and find it difficult to quit (14). In addition, numerous marijuana users who experience marijuana related health consequences and want to quit but are ambivalent about making changes to quit marijuana usage (15). Overall, these decision making processes do not follow a linear decision making process because many users develop an addiction to marijuana thereby reducing their ability quit. Of the youths who are able to quit marijuana, some might start using it again and go through the cycle constantly. Essentially, these behaviors are a dynamic decision making process and the campaigns are more focused on a linear model where youths will quit marijuana use and move to the next stage instead of regressing back to the initial stage. Therefore, this theory may not be the most beneficial model for minimizing marijuana usage among adolescents. In addition, anti-drug campaigns such as, Above the Influence, need to focus more on a dynamic decision making process instead of a linear model.

“It Won’t Happen To Me”

Adolescents are often optimistic and not concerned about their health because they do not perceive their health risks as severe in comparison to the population. Therefore, many youths believe that experimentation of marijuana is a rational and a positive choice because they believe that they will face no serious health consequences. One study explains that many youths believe that the health consequences will not affect them personally even though they are fully aware of the associated health risks (6). Hence, many youths are tempted to try marijuana because they consider themselves as an exception to the rule. This attitude is known as optimistic theory, where people do not believe that their personal risk is elevated as Dr. Siegel describes. In addition, optimistic theory varies with age and in general adolescents tend to be more optimistic in comparison to adults (16). Therefore, many youths feels impenetrable to the health risks associated with marijuana usage. For example, one college student states, “nothing bad will happen to me now so why bother?” (6). Many preventions programs such as The National Youth Anti-Drug Media Campaign try to only improve knowledge about the health risks associated with marijuana. However, these programs are not effective and often led to poor results in reduction of drug usage (16). Therefore, if Above the Influence advertisements constantly provide statistics of health risks, many youths will ignore the message assuming that they will not be part of the statistics. Even though most youths are aware of the negative health consequences they may be afraid of becoming just another number. Providing such statistics could lead to denial where youths will believe that the risks will not harm them in comparison to the entire population (17). For example, many youths have developed a belief of invulnerability when they view these campaigns and say, “it might happen to others but not to me” (18). In addition, one study observed that youths rated their risks to negative health consequences associated with marijuana use much less in comparison to others (19). Therefore, developing such advertisements can become counterproductive and force youths to experiment with marijuana.

A New Anti-Drug Campaign

Above the Influence Campaign has developed targeted efforts to prevent illicit drug abuse specifically marijuana among youths by illustrating the dangers and health risks. Although, this advertising campaign’s ultimate goal is to reduce and prevent the use of such drugs, it has not been a success by any means. Hence, we propose a new anti-drug campaign that maintains a similar goal to the previous campaign but incorporates innovative methods to achieve the goal. To develop a new public health intervention for the anti-drug campaign, we will focus on three modifications: positive messages, developing popularity among youths, and focusing only on one story/aspect instead of several statistics. Indeed, much more is required to develop a public health campaign but these three modifications could gradually evolve into a better and more resourceful program overtime in comparison to the previous campaigns. In addition, developing a public health campaign applying these methods may target more youths and reduce marijuana usage rates among youths in comparison to Above the Influence Campaign. Ultimately, we do not want to draw adolescents to the campaigns with fearful messages and instead we want to draw them with these three models.

Positive Messages

We can use positive messages in our public health campaign instead of graphic images or stories that arouse fear among youths. For example, one study portrays a happy young girl in the ad and under her picture it states, “She’s living proof that Treatment Works” (18). Instead of persuading youths with negative imagery, this advertisement provides hope by targeting those individual who desire to quit marijuana. In addition, this advertisement depicts an adolescent who quits marijuana and is happy with her life. This image illustrates a positive message by portraying the concept that it is possible to quit illicit drugs and still be able to maintain a normal and happy life. Therefore, our goal is to elicit positive messages such as warmth and happiness and eliminate facts that describe the negative health consequences of marijuana usage. By this method, we are trying to sell happiness to youths if they quit marijuana and trying to “unsell” a previous behavior (19). An example of a successful anti-drug campaign for youths is the Minnesota DARE Plus Project, which focuses on connecting youths through positive messages and preventing illicit drugs use such as marijuana. For example, their campaign provides positive peer role models that discourage drug use and instead encourages other extracurricular activities (20). Therefore, we can develop a program that emphasizes his or her success story of not using marijuana. For example, we can portray a story of a young happy girl named Sally, who is extremely popular among her friends circle. At the end of the advertisement we can say, “and she rejected drugs.” Using this method, we are trying to sell happiness by promoting messages of not using illicit drugs thereby eliminating negative or fearful messages associated with drug abuse. In addition, this method will motivate youths to take control over their lives by “rejecting” marijuana through peer pressure. Therefore, it is essential to encourage better decision making skills among adolescents and deliver positive messages by associating optimistic messages with non-use of marijuana. Indeed, this method will not only help to prevent drug abuse but also develop a negative image of drugs.

Building Popularity among Peers

Marijuana usage is prominent among adolescents and is increasingly developing popularity among youths. Many adolescents believe that marijuana use is a radical and a deviant behavior that can gain them peer acceptance. In addition, many anti-drug campaigns gear their advertisements toward negative statistics such as the percentage of marijuana users among youths or the percentages of risks associated with marijuana usage. Indeed, these percentages attract youths to experiment with marijuana so they can join their peers or those percentages. Thus, many marijuana users form a bond or a social group and often smoke with others thereby alienating other non-users (21). Many non-users become users to obtain popularity among their peers and join these groups to develop solidarity. The construction of the adolescent image is often contingent on group behavior and dynamics. Therefore, it is crucial to change the social norms among adolescents regarding marijuana usage. Not only do we have to eradicate the current social norm of marijuana among youths but also replace it with popularity to reject marijuana. For example, we can develop an advertisement that illustrates popular youths in a group together walking in the mall, taking random pictures, and having fun. Then at the end of the ad, we can say “they don’t need marijuana to have fun.” Another example of an effective ad could be of a group of popular adolescents in a band together and on stage showing off their catchy music followed by many fans. At the end of this advertisement, we can say, “they rejected marijuana.” Based on this advertisement, we are trying to “sell” popularity among youths and demonstrate that it is not necessary to gain popularity through drug use. In addition, the advertisement illustrates that instead of wasting time smoking marijuana, youths should participate in other activities such as band groups, sports, etc. Another method to reduce marijuana would be to create student groups where youths develop innovative techniques to reduce marijuana. For example, The Dare Plus Project developed student group activities where youths participated after school with other peers to address issues associated with drug use and the development of solutions to reduce drug use among their peers (20). This approach would allow youths to become involved in preventative campaigns against drug abuse. If youths are involved in such programs they can impact other youths to join the program and thereby developing popularity against marijuana usage. In addition, we can advertise positive statistics such as percentage of non-users or percentage of youths who quit marijuana thereby increasing youth groups against marijuana usage. This method can allow youths to form coalitions against marijuana and essentially decrease the popularity of marijuana users. Such methods can eliminate the alienation of non-users and perhaps reduce marijuana usage among regular users. Indeed, simple changes such as involving youths in the programs or advertisements that sell popularity without marijuana can drastically alter an ineffective campaign by establishing popularity among youths against marijuana usage and increase awareness.

Capturing the Story of One Person

Anti-drug campaigns often provide youths with numerous statistics to build awareness regarding the health consequences of illicit drugs such as marijuana. However, many youths ignore these messages and it sometimes leads to opposite effects because such messages do not offer youths what they want and instead threaten their freedom. Many advertisements target individuals by offering happiness or freedom through their products. For example, many people are willing to buy luxury brand products such as, Louis Vuitton, because the brand uses advertisements that associate their brand with a personal journey to freedom (22). Therefore, to attract youths against marijuana usage we have to offer them with such core values as health and happiness. In addition, we have to develop an advertisement that revolves around the story of one person and their journey to happiness instead of several statistics. For example, we can construct the story of one boy named, Jonathan, who is a typical adolescent and his life consumed with problems when he used to use marijuana. We can show brief glimpses of his past and how much he struggled until he decided to quit. Then, the story depicts his transition into a better and more joyful life after he quits smoking marijuana and breaks from his old habits. At the end of the story we can say, “join the journey, the discovery, to a new life.” In addition to this story, we can add a peaceful song in the background to increase emotional response and the attitude towards the advertisement. Overall, the advertisement illustrates the average youth gaining freedom by leaving marijuana. Essentially, using this method we are selling a journey to a new life that promises happiness and freedom. Therefore, we can attract youths not on the basis of spreading awareness through statistics but by promising successful stories of individuals who quit marijuana.

Conclusion

All in all, anti-drug campaigns such as Above the Influence have a critical task to prevent the use of illicit drugs such as marijuana among adolescents. Despite constant advertisements, such interventions have struggled to maintain adequate acceptance from adolescents. Often, youths ignore or mock the advertisements developed by Above the Influence because they believe these campaigns are targeting their freedom with fearful messages. The implications of marijuana use are profound. Although the health effects of marijuana use can be deleterious, it is known more importantly as a powerful gateway to other drugs such as cocaine. Therefore, there is a compelling need to alter these campaigns and develop effective interventions that encourage youths to refuse marijuana and stop the development of other toxic drug habits. In this paper we illustrate alternative methods to combat marijuana usage among youths through the use of positive messages aimed to promise better health and happiness. Perhaps the employment of these methods can shift the current paradigm and approach to marijuana cessation through adolescent-centric intervention that appeals to the identity-forming process that teenagers undergo during this critical period.

REFERENCES

Book:

1. J. Kennet et al., Evaluating and improving methods used in the National Survey on Drug Use and Health (Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2005).

Website:

2. National Institute on Drug Abuse – High School and Youth Trends (2011). Retrieved 11/27/2011, 2011, from http://www.nida.nih.gov/infofacts/hsyouthtrends.html

Journal Article:

3. M.R. Polen et al., “Health care use by frequent marijuana smokers who do not smoke tobacco.,” Western Journal of Medicine 158, no. 6 (1993): 596.
4. Hornik, Robert et al., “Effects of the National Youth Anti—Drug Media Campaign on Youths” American Journal of Public Health 98, no. 12 (2008): 2229-2236
5. L Henriksen, “Industry sponsored anti-smoking ads and adolescent reactance: test of a boomerang effect,” Tobacco Control 15, no. 1 (February 1, 2006): 13-18.
6. Wolburg, Joyce, “College Students’ Responses to Antismoking Messages: Denial, Defiance, and Other Boomerang Effects” The Journal of Consumer Affairs 40, no. 2 (2006): 294.
7. Yahui Kang, Joseph N. Cappella, and Martin Fishbein, “The Effect of Marijuana Scenes in Anti-Marijuana Public Service Announcements on Adolescents’ Evaluation of Ad Effectiveness,” Health Communication 24, no. 6 (August 31, 2009): 483-493.
8. Cohen, Elisia et al., “Anti-Smoking Media Campaign Messages: Theory and Practice,” Health Communications 22, no. 2 (2007): 91-102.
9. P. Palmgreen et al., “Effects of the Office of National Drug Control Policy’s Marijuana Initiative Campaign on high-sensation-seeking adolescents,” American Journal of Public Health 97, no. 9 (2007): 1644.
10. Yahui Kang, Joseph N. Cappella, and Martin Fishbein, “The Effect of Marijuana Scenes in Anti-Marijuana Public Service Announcements on Adolescents’ Evaluation of Ad Effectiveness,” Health Communication 24, no. 6 (August 31, 2009): 483-493.
11. David, Clarissa et al., “The Social Diffusion of Influence Among Adolescents: Group Interaction in a Chat Room Environment About Antidrug Advertisements,” Communication Theory 16 (2006): 118-140.

Book:

12. Mark Edberg, “Chapter 4: Individual Health Behavior Theories,” Essentials of Health Behavior: Social and Bheavioral Theory in Public Health, Sudbury, MA: Jones and Bartlett Publishers, 2007. pp. 146.

Journal Article:

13. Zhiqun Tang and Robert G. Orwin, “Marijuana Initiation Among American Youth and Its Risks as Dynamic Processes: Prospective Findings from a National Longitudinal Study,” Substance Use & Misuse 44, no. 2 (January 2009): 195-211.
14. S.J. Heishman, E.G. Singleton, and A. Liguori, “Marijuana craving questionnaire: development and initial validation of a self-report instrument,” Addiction 96, no. 7 (2001): 1023–1034.
15. Stephens, R. S., Roffman, R. A., Fearer, S. A., Williams, C., Picciano, J. F. and Burke, R. S. (2004), The Marijuana Check-up: reaching users who are ambivalent about change. Addiction, 99: 1323–1332.
16. E. R. Danseco, P. M. Kingery, and M. B. Coggeshall, “Perceived Risk of Harm from Marijuana Use among Youth in the USA,” School Psychology International 20, no. 1 (February 1, 1999): 39-56.
17. R. Hornik and I. Yanovitzky, “Using Theory to Design Evaluations of Communication Campaigns: The Case of the National Youth Anti-Drug Media Campaign,” Communication Theory 13, no. 2 (2003): 204–224.
18. Gerard Hastings, Martine Stead, and John Webb, “Fear appeals in social marketing: Strategic and ethical reasons for concern,” Psychology and Marketing 21, no. 11 (November 2004): 961-986.
19. P. TODESCO and B.H. STEPHEN, “Risk perception: Unrealistic optimism or realistic expectancy,” Psychological reports 84, no. 3 (1999): 731–738.
20. C.L. Perry et al., “The Minnesota DARE PLUS Project: Creating community partnerships to prevent drug use and violence,” Journal of School Health 70, no. 3 (2000): 84–88.
21. J.W. Clarke and E.L. Levine, “Marijuana use, social discontent and political alienation: A study of high school youth,” The American Political Science Review 65, no. 1 (1971): 120–130.
22. Wilcox, Keithe et al., “Why Do Consumers Buy Counterfeit Luxury Brands?” Journal of Marketing Research XLV (2008): 1-46.