Challenging Dogma - Fall 2011

Friday, December 23, 2011

Why the D.A.R.E. program is Ineffective: A Critique Based on Social and Behavioral Science Principles and Theories-Arpita Husain

Introduction
The Drug Abuse Resistance Education (D.A.R.E.) program is a police office-led drug and substance abuse prevention program, targeted towards children from kindergarten to eighth grade. The goal behind the D.A.R.E. program is that it teaches good decision making skills to help children avoid high-risk behavior to ensure they lead healthy lives (1). D.A.R.E. is currently the most popular school-based substance abuse prevention program in the United States. As of February 2010, D.A.R.E. was used in more than 75% of school districts (2). Although this program is very popular, it faces many criticisms. Many studies have been conducted showing that D.A.R.E. has not been effective in lowering adolescent drug use (3). Despite its popularity, the D.A.R.E. program fails to be effective due to misuse of several social and behavioral science principles and theories. It invokes reactance, utilizes an ineffective psychological model and fails to use Marketing Theory properly. Misuse of these theories explains some of the major flaws with D.A.R.E., and proposed interventions should take these flaws in mind to create a more effective program.

About D.A.R.E.
The D.A.R.E. program was created in 1983 as a joint project of the Los Angeles Police Department and the Los Angeles Unified School District. The program was designed to help adolescents resist the peer pressure of experimenting with drugs. The curriculum is taught by police officers and the programs aim to reduce experimentation of drugs by providing adolescents with information that encourages them to make healthy decisions (4). Trained police officers present 17 one-hour lessons and lessons focus on self-esteem, decision making, and alternatives to drug use (5). Even though the D.A.R.E. program is very popular, evidence has shown that the D.A.R.E. program is ineffective in preventing drug use among adolescents. Several studies have shown that D.A.R.E. did not show statistically significant effects for self-reported drug use (3). One study made note that the D.A.R.E. program had limited effects on drug use and the curriculum effects had a general tendency to decay over time (6). Cleary, the D.A.R.E. program has several limitations and faults, making it an ineffective program.

How D.A.R.E. invokes reactance
A main limitation with the D.A.R.E. program is that it invokes reactance. The Psychological Reactance Theory states that any persuasive message may cause a motivation to reject the advocacy. This motivation is called reactance and this theory offers an explanation for resistance to persuasion. Reactance occurs when a freedom is threatened or eliminated. There are four components to the Psychological Reactance Theory: freedom, threat to freedom, reactance and restoration of freedom. People have freedom to the extent that they have knowledge of that freedom, and people believe that they have the freedom to enact the behavior. In essence, people want to maintain control of their freedom, and if it is threatened, people want to gain control of their freedom (7).
Social influence can threaten people’s freedom, to form attitudes, and to act the way they want to act (8). Threatening people’s freedom invokes reactance. In the context with the D.A.R.E. program, the message is that one should not do drugs. By telling adolescents what to do, this threatens their freedom of making their own decision and in turn invokes reactance so that that the children will not follow the message of the D.A.R.E. program. This theory states that when a person’s perceived freedom is threatened or eliminated, then that person will be motivated to reestablish that freedom. Freedoms may be restored indirectly by increasing the likelihood of performing the negative behavior. This restoration of freedom causes the person to actually do the negative behavior (8). So with D.A.R.E., the adolescent would try to reestablish their freedom by doing the forbidden act, which is experimenting with drugs, the complete opposite message that D.A.R.E. is trying to send.
Reactance is also invoked because the adolescents cannot relate to the people that display the message, who are the police officers. Adolescents have absolutely nothing in common with police officers and therefore cannot relate to them. Attraction to the communicators helps with compliance to a public health message because it enhances the credibility of the communicator and further increases a person’s compliance (8). Adolescents cannot relate to police officers; they are completely different groups of people so adolescents are likely to not absorb the messages that the police officers give. Adolescents also cannot relate to police because they are viewed as authority figures and adolescents are known to rebel against parental and authority figures. Since police officers are thought of as authority figures, this view automatically gives adolescents a perception of their freedom being threatened. In recent studies, the general consensus has been that adolescents do not support the police and in fact had negative attitudes towards them (9). There is a pre-established adolescent norm that the police are a threat to freedom, and to reestablish that freedom, adolescents will succumb to the pressures to reestablish that freedom. Regarding anti-drug messages provided by D.A.R.E., the greater the exposure of these messages, the greater the reaction to re-establish that freedom (10).

D.A.R.E. is developed from an ineffective psychological model
Another limitation with the D.A.R.E. program is that it applies the psychological principle of the Health Belief Model (HBM) to explain, predict and influence behavior. The HBM is an individual based model that hypothesizes that health-related action depends on several factors: the existence of sufficient motivation or health concern to make health decisions, the belief that one is susceptible to a serious health problem, and the belief that a health recommendation would be beneficial in reducing the perceived threat. A major weakness of the HBM is that this model assumes that variables affect health behavior directly and remain unchanged by behavioral intention. Additionally, important social norms and influences are not included. This model also assumes that change is static, and it is an individual based theory, which makes it difficult to affect groups of people (11).
The problem with the HBM is that although this model is designed to predict behavior, much of the variance in behavior is left unexplained; The HBM does not take into consideration of social norms, behavioral intentions and attitudes which are largely shaped by peers (12). The HBM assumes that people are rational thinkers, and it also assumes that people value good health and that they expect that a particular health behavior will promote good health (13). The D.A.R.E. program is assuming that adolescents value good health and therefore they expect to keep that proper health by not smoking. However, there are several other factors that influence behavioral control that the HBM does not take into account, such as peers and social influence. In regards to using drugs, peer influence is significant with influencing behavior but the D.A.R.E. program does not encourage social interactions amongst their peers which are significantly important. Several studies show that peers are major determinants of adolescent drug use considering that many study results show that adolescents who said that their friends use drugs were at increased risk of using drugs themselves (14). Also, another limitation with the HBM is that it is static and linear in view of the health attitude and behavior change process. This makes the assumption that a person’s health decision will remain unchanged through time since they are previously aware of the health consequences (13). The health belief model would assume that the elementary student that makes a health decision after learning the negative consequences of drugs would be able to make the same decision regarding health behavior at an adolescent age. The health belief model does not take into consideration the person’s peers attitudes towards drug that could shape behavior during the period of growing up.
Another issue with utilizing this model is that adolescents have a low perceived susceptibility which can be contributed to the fact of the low exposure to drugs at this age. Perceived susceptibility refers to the beliefs about the likelihood of getting disease. For example a teenager must believe there is a possibility of getting lung cancer before they stop smoking. D.A.R.E. is targeted towards elementary and middle school students and these young adolescents, on average, are not exposed to drugs or partaking in drugs at this age. Often, the last thing on their mind is thinking about the possibility of getting lung cancer. Because their perceived susceptibility is low, or even non-existent, they cannot apply the information they learn from D.A.R.E. (13). Since their health decisions are not static, they cannot apply what they learn in D.A.R.E. later in life when they are exposed to drugs.

Failure to utilize Marketing Theory
The third limitation of D.A.R.E. is that the curriculum is not engaging to adolescents. Police officers providing 17 one hour lectures will not keep adolescents entertained, and the curriculum does not touch among core values. Marketing theory is defined as a program planning process that applies commercial marketing concepts and techniques to promote voluntary behavior change (15). Marketing theory is mostly applied to consumers, appealing to consumers’ core values to sell goods, but it is also used in public health to promote positive behavior change. Applying Marketing Theory to public health, the health behavior is what is being sold to the people, who are the consumers (16). D.A.R.E. is not engaging to adolescents because the program does not appeal to their core values such as independence and freedom. Also, the stiff structure of the program does not allow them to voice out what values are important to them. The fact that the curriculum is built on long lectures is not conducive to young adolescents since it is not engaging and involving the students.
The premise of Marketing Theory is that program planning decisions need to adhere to a person’s wants and needs, which D.A.R.E. does not adhere to. One must gain a deeper understanding of what the adolescents needs, aspirations and core values are (15). It is important that the social marketing addresses a person’s needs and interests in promoting a health behavior program. The main motto that D.A.R.E. preaches is “Just Say No (6).” This strong statement is not catering to the core values of adolescents which are values such as freedom and control. This statement is just telling adolescents what to do, and not giving them freedom to make decisions about their health behavior. This is turn also invokes reactance among adolescents, since it is removing their freedom by telling adolescents what to do. Most public health campaigns and programs are built on fear, and these interventions hope that by instilling fear, this will invoke a behavior change. D.A.R.E. is based on the value of fear by introducing the dangers of drugs with the hope that adolescents will not engage in drug use. Health practitioners and researchers continue to contend that the use of fear actually backfires (17).

An Improved Intervention
The information that D.A.R.E. provides is meaningful and important, but the program itself is not efficient enough to invoke a behavior change. One of the main problems with D.A.R.E. is that the curriculum is based on an individual level psychological model while the program expects to make changes to groups of people. New changes to D.A.R.E. should steer away from ineffective models and utilize group levels of behavior change. The information that D.A.R.E. provides does not have to change, but the way content matter is conveyed needs to be changed. D.A.R.E. needs to update facets of its program to assess the flaws of teaching a curriculum based on an ineffective psychological model, invoking reactance, and not utilizing Marketing Theory. By understanding social and behavioral behavior principles and theories, D.A.R.E. can keep the content material the same, but revamp certain aspects of its program to make it more effective.

Deflecting Reactance
As mentioned, having police officers as the communicators invokes reactance because they are authority figures. Communicators should be those that the adolescents can relate to and look up to. For younger students, teachers should be appropriate since these are the people the younger students can trust and the teachers will always be around if the students have questions. Teachers should receive training from D.A.R.E. officers so that they are taught properly to instruct the lessons. For the older students, another proposed intervention to improve D.A.R.E. would to change the communicators to people the adolescents can relate to. For the older groups of children, high school students or college students should convey the messages to the adolescents. This group is more similar to the audience and is not a power of authority so they would not invoke reactance. Public Health students interested in drug awareness should be recruited to undergo D.A.R.E. training and teach the adolescents. Although these people are bit older than the students being taught, they serve as role models for the adolescents. High school students and college students that want to be educators would also receive formal training through D.A.R.E. police officers. Older teenagers and college students that are communicators should bring in, if possible, their younger siblings for a few lectures so that the younger siblings can share their experiences about learning about drugs. This is an effective intervention measure because studies show that youth respond more favorably when the teachers or communicators are members of their own group (8).
The Truth antismoking campaign, launched in February 2000, has exposed youth to provocative commercials about the effects of tobacco and tobacco industry marketing tactics (18). The successful Truth campaigns deflect resistance because it is a movement driven by the youth; adolescents, not adults, display the messages about drugs. Also, heavy research had been conducted on youth marketing, and the general consensus was that the youth did not want to be told what to do. They wanted to learn the facts about drugs, and make their own educated decision. The “Truth” campaign listened to these views, and realized that the campaigns needed a message other than “don’t.” The successful ad campaigns never preach the message of “don’t” in any way. The ad campaigns display the message about drugs, and the viewers are left to make their own decision (19). Studies have shown the Truth campaign to be associated with changes in tobacco-related beliefs and attitudes and decreases in youth smoking (18). D.A.R.E. clearly has a motto which is “Just Say No.” This message is too strong and again it is threatening the freedom of adolescents by telling them what to do (8). D.A.R.E. should completely eliminate this motto and not have a motto at all so that adolescents can form their own beliefs.

Strengthen social interactions
D.A.R.E. needs to stray from the HBM and utilize models for group behavior change. By utilizing group behavior models, social interactions are emphasized which really effect behavior. Rigid lectures do not promote social interactions so standard lectures should be changed to more interactive lectures to encourage social interactions. With more interactive lectures, the revised curriculum will not be purely based on the ineffective health belief model. Types of interaction models should cater to the age group.
The Al’s Pals: Kids Making Healthy Choices is a resiliency-based substance abuse program targeted to children aged 3 to 8. The curriculum consists of 46 lessons lasting 10-15 minutes each. This program is very interactive and includes role playing exercises, puppetry, and song books to enhance social interactions among peers (20). Studies have shown increased coping behaviors and social behavior skills and decreased aggression (20). D.A.R.E. should take aspects of Al’s Pals to strengthen social interactions among children. As children get older, D.A.R.E. should use different interactive models to cater to the age group.
The Keepin’ it REAL program is a drug prevention program targeted to older elementary students to early high school students. This program has been effective to reducing anti-drug attitudes and beliefs, and its motto is to how to say no to drugs without losing friendships. This program encourages social interactions by having interactive lectures consisting of videos and group activities entitled booster activities. This program has been highly successful, and helped students maintain pre-existing negative attitudes towards drug abuse (21). D.A.R.E. has recently teamed up with Keepin’ it Real to incorporate aspects of the program to D.A.R.E. However, there is no recent data that explains what components of Keepin’ it Real that D.A.R.E. has adopted (1). D.A.R.E. should incorporate social interactions among students by incorporating small group projects in the lectures. The group projects can entail activities such as poster projects explaining the effects of drug use, worksheets with questions and trivia games. Group members should change with each group project so that the adolescents continue interacting with new groups of people. The addition of these assignments will strengthen social interactions, and hopefully as a group D.A.R.E. can influence positive behavior.

Utilize Social Marketing Theory
The new intervention to improve D.A.R.E. should also utilize Social Marketing theory because researchers have realized that the most successful substance abuse programs are prevention programs that reflect aspects of the adolescents’ culture. Keepin’ it REAL is very successful because it emphasizes core values and caters its curriculum based on common core values of different ethnic groups. Several studies show that there are certain values that are more commonly emphasized by certain ethnic groups. Euro-American values that are more commonly portrayed are individualism, goal-planning, and independence. Among Mexican-Americans, they entail family, politeness and respect. Among African-Americans, they entail respect, communalism, drive, endurance and creativity (21). Other important adolescent values are love, independence, and freedom. D.A.R.E. needs to sell these values and the best way to do it would be a media intervention to grab adolescents’ attention. Videos should be shown to them of not how bad drugs are to health, but how drugs threaten one’s freedom and core values. Videos of the truth campaigns would be shown since they are very successful. The Truth campaign does an excellent job of appealing to the core value of control and empowerment. These ads have sought to empower teens by encouraging them to be part of a nationwide anti-smoking group. Results have shown that the Truth campaigns are successful in in changing smoking behavior (19).
Before starting the D.A.R.E. lectures, the communicators should make a list of popular core values and distribute to all the students. The paper should ask the student to circle which core values are important to them, and to list any other that is not included. The communicators should figure out which core values are more important and cater lessons to the core values. For example, if most children value success, lectures should cater to how drug abuse impedes success and how students have control of their success by not doing drugs.
Lectures should also be engaging and not be dry and long. Long lectures will not keep the adolescents engaged, and there is a high possibility of them being bored. For the younger students, younger children, puppets should be used to give some information which proves to be successful in the Al’s Pals campaigns. Songbooks and cartoons should also be used in class to keep the younger students engaged. For the older students it is best to show videos and highly encourage group activities since these adolescents are getting close to the age where drug use will become popular. Instead of a few long lectures, there should be many small lectures. Adolescents lose their attention span after a while and it is best to keep the lectures around thirty minutes. To reiterate, lectures need to cater to the values that students find most important, and teachers should show the students what happens to these values if they use drugs.

Conclusion
The educational content in D.A.R.E. is great information to teach to adolescents, but D.A.R.E. needs certain aspects to change so that adolescents take in the information and make smarter choices about drug use. The proposed interventions are not to eliminate the D.A.R.E. program from schools, but ultimate improve certain aspects of D.A.R.E. so that it is a more effective program. The proposed interventions would include social interactions, deflect reactance by using communicators that the students can relate too, and broadcast materials in and interactive way to target core values. The proposed interventions should change social norms on drug use so that students have the ingrained thought that using drugs are bad. By not using the health belief model, deflecting reactance and using marketing theory, students will be able to make smarter choices about drug use.

References
1.
D.A.R.E. America. The Official D.A.R.E. Website. Los Angeles, CA: D.A.R.E. America. http://www.dare.com/home/default.asp.
2. Smith, E. Student’s Transform Drug Runner’s SUV into winning D.A.R.E. vehicle. Tech Directions 2010; 69(7): 18-19.
3. Birkeland, S., Murphy-Graham, E., & Weiss, C. Good reasons for ignoring good evaluation: The case of the drug abuse resistance education (d.a.r.e.) program. Evaluation and Program Planning 2005; 28(3): 247-256.
4. Pan, W., and Bai, H. A Multivariate Approach to Meta-Analytic Review of the Effectiveness of the D.A.R.E. Program. International Journal of Environmental Research and Public Health 2010; 6(1): 267-277
5. 12. Bachrach D. Drug Abuse Resistance Education. TELEMASP Bulletin 1996; 2(3): 201-208.
6. Clayton, R., Catarello, A., & Johnstone, B.
The Effectiveness of Drug Abuse Resistance Education (Project D.A.R.E.): 5-Year Follow-Up Results. Preventive Medicine 1996; 25(3): 397-318.
7. Dillard, J., & Shen, L. On the nature of reactance and its role in persuasive health communication. Communication Monographs 2005; 72(2): 144-168.
8. Silvia, P. J. Deflecting reactance: The role of similarity in increasing compliance and reducing resistance. Basic and Applied Social Psychology 2005; 27: 277-284.
9. Hurst, Y., & Frank, B. How kids view cops: The nature of juvenile attitudes toward the police. Journal of Criminal Justice 2000; 28: 189-202.
10.
Hornik R, Jacobsohn L, Orwin R, Piesse A, & Kalton G. Effects of the national youth anti-drug media campaign on youths. American Journal of Public Health 2008; 98:2229-2236
11.
Rosenstock, I., Strecher, V., & Becker, M. Social learning theory and the health belief model. Health Educ Beha0v 1988; 15(2): 175-183
12. Ogden J. Some problems with social cognition models: a pragmatic and conceptual analysis. Health Psychology 2003; 22:424-428
13.
Glanz, K., Rimer, B., & Kasisomayajula, V. Health behavior and health education: theory, research, and practice. (4 ed.). San Francisco: Jossey-Bass, 2008.
14. Bauman, K., & Ennett, S. Peer influence on adolescent drug use. American Psychologist 1994; 49(9): 820-822.
15.
Grier S. and C. A. Bryant. Social Marketing in Public Health. Annual Review of Public Health 2005; 26:319-339
16.
Lefebvre, C. R. PhD, and J. A. Flora, PhD. Social Marketing and Public Health Intervention. Health Education and Behavior 2010; 11: 859-866
17. Witte, K., & Allen, . A meta-analysis of fear appeals: implications for effective public health campaigns. Health Educ Behav 2000; 27(5): 591-615 .
18. Farrelly, M., Davis, K., Duke, J., & Messeri, P. Sustaining ‘truth’: changes in youth tobacco attitudes and smoking intentions after 3 years of a national antismoking campaign. Health Education Research 2007; 24(1): 42-48.
19. Hicks, J. The strategy behind florida's “truth” campaign. Tobacco Control 2001; 10(1): 3-5.
20. Joseph, G., & Strain, P. Comprehensive evidence-based social–emotional curricula for young children: An analysis of efficacious adoption potential. Topics in Early Childhood Special Education 2003; 23(2): 65-76.
21. Hecht, M., Marsiglia, F., Elek, E., Wagstaff, D., Kulis, S., Dustman, P., & Miller-Day, M. Culturally grounded substance use prevention: An evaluation of the keepin’ it r.e.a.l. curriculum. Prevention Science 2003; 4(4): 233-248.



Labels: , ,

0 Comments:

Post a Comment

Subscribe to Post Comments [Atom]

<< Home