Challenging Dogma - Fall 2011

Saturday, December 17, 2011

Why the ‘Drive Sober or Get Pulled Over’ Campaign Fails to Reduce Impaired Driving - Ellen Coughlin

Throughout the late 1980s and early 1990s there was a decline in the occurrence of alcohol impaired driving and its consequences. During this period, alcohol related fatal crashes dropped by 35-40%. But since 1995, there has been little decline in the level of alcohol impaired driving offenses and accidents. Instead the problem has stabilized at a remarkably high level (1), and alcohol impaired driving continues to be a major problem in the United States. In 2009, over 1.4 million arrests were made for driving under the influence, which is less than one percent of the 147 million self-reported occurrences of alcohol related driving (2). During the same year, 10,839 people were killed in alcohol related crashes in the U.S. (3). In fact, thirty people die every day in the U. S. due to vehicle crashes involving an alcohol impaired driver (2).

Beginning in 2004, the National Highway Traffic Safety Administration (NHTSA) began a campaign to decrease alcohol impaired driving and the resulting accidents by having police checkpoints on the roads and highways. This action was accompanied by a media campaign to make people aware of the increased police presence (4). The ‘Drive Sober or Get Pulled Over’ campaign is the NHTSA’s newest slogan and accompanying advertisements bear this message (4, 5). The campaign was initially run from late summer through Labor Day, but will begin again on December 15th to decrease impaired driving during the holidays. The campaign will use television, radio, online and billboard advertisements (4). The target audience is male drivers aged 21-34 years old, the demographic who most frequently drive impaired. To reach this audience, advertisements will be featured during sporting events and other television programs with a largely male audience (5).

The campaign’s logo features a cartoon drawing of an authoritarian police officer with a stern look on his face above the words ‘Drive Sober or Get Pulled Over.’ The general shape of the logo looks like a police badge. The television commercials feature invisible police officers eerily watching people who, the audience is to supposed to assume by their hysterical laughter, joking and personal closeness, have been drinking. After the group gets in the car, they arrive at a sobriety checkpoint (or are pulled over by a police officer in another commercial). The authoritative voice in the background states “they will see you before you see them,” meaning the invisible police are watching and will catch you driving impaired. The commercial closes with the same authoritative voice saying “drive sober or get pulled over,” followed by the authoritative logo (4).

Any publicly funded campaign has a responsibility to be both efficient and effective. For a public health intervention to be effective, it must be grounded in sound theories and concepts. The NHTSA’s ‘Drive Sober or Get Pulled Over’ national media campaign relies primarily on the principals of the Health Belief Model, without understanding that many people possess an optimistic bias that certain events will not happen to them. The campaign also stimulates psychological reactance by its authoritative and domineering message and tone. Analyzing the flaws of this campaign allow us to create a campaign better suited to change the behavior.

Health Belief Model

This campaign’s first flaw is that it relies primarily on the Health Belief Model. The Health Belief Model (HBM) was developed in the 1950’s by the U.S. Public Health Service as a way to explain why people were not taking advantage of free Tuberculosis screenings. Today, it is one of the most widely used theories in public health to explain why individuals do or do not take certain health related actions (6). The model examines an individual’s perception of susceptibility and severity of the problem, benefits and barriers to taking action, and factors influencing the decision to act (6, 7). These factors are rationally weighed through a cost benefit analysis and a decision is made to engage or not engage in a certain behavior (7).

This campaign depends on the HBM for behavior change because it gives us information regarding susceptibility and severity of the problem. The commercial is explicit that everyone who drives impaired will be seen by police officers and be caught. The slogan ‘Drive Sober or Get Pulled Over’ means that if you drive, you will, without a doubt, get pulled over. This is an attempt to increase susceptibility. The hope is that once the audience realizes that they are susceptible, they will not make the decision to drink and drive. Furthermore, the commercial shows the person who drives impaired put in hand cuffs and taken away in a police car, and presumably taken to jail. The campaign wants getting arrested and serving jail time to be severe enough to deter people from drinking and driving.

Using this information the campaign hopes we will weigh our options. The proposed benefit to driving sober and safely is to remain out of trouble with law enforcement. One barrier to driving sober is not being able to drive home after a night out, but the ads want you to believe that this is outweighed by the extreme negative consequences. Weighing all these concepts, the advertisements anticipate that drivers will believe that driving impaired is a poor decision and therefore will choose to not drive under the influence of alcohol. However, the problem of impaired driving has not been stopped since these advertisements and others like them have aired (2, 3), suggesting that drivers are not evaluating actions as the campaign expects. Therefore, the HBM lacks authority due to over-simplification and incorrect assumptions.

Research has shown that people cannot weigh their options and possible outcomes in a rational manner, thereby nullifying the underlying assumption of the HBM. The model assumes “that individuals decide how to respond to recommendations made by a health service by reflecting on the costs and benefits of such action” (8), but many adults discount risks and perceive themselves as invulnerable to harm (8, 9). Therefore their decision after weighing the costs and benefits is faulty. Instead, people often make decisions based on emotion, which often has a greater influence in making health related decisions (9). Adding emotion to this equation makes rational decision making even tougher.

In addition to an inability to properly process risks and outcomes, the model also assumes that a change in knowledge alone will lead to changes in behavior- in this case people will stop driving impaired. The model is based on the assumption that people follow “an established linear path from awareness to attitude to action,” (9) but in reality this is not how individuals behave. Yoder agrees stating “analysis of survey data rarely found a close correspondence between changes in knowledge and changes in behavior” (8). If knowledge and information is not sufficient for behavior change, then this campaign is less effective because although it gives us knowledge about consequences it may not actually lead to behavior change. The missing correlation between knowledge and action renders the campaign insufficient.

The model also does not take into account non-health reasons for actions. Janz suggests that the HBM further falls short in that “many health-related behaviors are undertaken for what are ostensibly nonhealth reasons.” He goes on to give examples of dieting to appear more attractive or quitting smoking for social approval (6). In the case of alcohol impaired vehicle operation, drivers may face logistical problems in finding themselves impaired, but still requiring a means to return home, as well as a course to return a vehicle to the home. Other influences could involve social pressures, as drivers may be pressured to ‘not worry about it.’ Or, possibly others may rely on the driver for a ride home and the perceived obligation outweighs the risk of apprehension.

Relying on the Health Belief Model alone suggest that the NHTSA’s campaign will under perform and fail to decrease impaired driving. Although the HBM has historically been a popular method for attempting to create an actionable change within society, there are likely more effective methods to reach desired goals.

Optimistic Bias

As mentioned briefly above, the ‘Drive Sober or Get Pulled Over’ campaign does not account for people’s distorted view of their risk of negative outcomes. This perception is part of a larger bias called the Optimistic Bias, which is defined as the belief that negative outcomes are more likely to happen to peers, than to oneself (10, 11). An optimistic bias was first demonstrated by Weinstein when he reported that college students viewed the probability of positive outcomes happening to themselves as higher than their peers and the probability of negative outcomes happening to them lower than their peers. He concluded that people believe that others will be to be subject to adversity, but not them (10). It has been shown that this bias is widespread and occurs for both men and women across age groups and education levels (11). The concept has been demonstrated in predicting future life events (owning a home, stating salary), being a victim of crime, suicide, (10), developing smoking-related illnesses, developing skin cancer from sunbathing and being involved in a serious automobile accident (12).

Optimistic bias is particularly problematic to practitioners in the field of public health who try to make people aware of their risks in an effort to make them change their behaviors. Weinstein argues “optimistic biases in personal risk perceptions are important because they may seriously hinder efforts to promote risk reducing behaviors” (13). Perception of susceptibility to harm is essential to get people to change their behavior. McKenna asks and states, “Why protect yourself from an event which will not occur? The impact of mass media campaigns aimed at increasing self-protective behavior may be adversely affected by this illusion since the vast majority of individuals may consider that the communication is directed at other people who are more vulnerable than themselves” (15). Therefore when addressing a risk, the audience must be made to feel that this risk can happen to them.

Impaired driving campaigns must also deal with this issue, as the optimistic bias has been shown to be active in decisions to drive impaired. In general, drivers perceive themselves as less likely to be involved in an accident than an average driver in the same circumstances (16). Failure to recognize that driving while intoxicated puts the driver and others at risk may keep the person from making changes.

This campaign relies on drivers to understand the risk of being pulled over and arrested, and also to properly evaluate the likelihood of that happening to the driver’s self. The optimistic bias discounts the likelihood of negative events occurring and therefore, the effectiveness of a measure can be compromised. When optimistic bias leads a driver to believe that a negative event, such as being arrested for driving while intoxicated is unlikely to occur, there is little incentive to engage in healthy behavior. Therefore, giving the audience information regarding getting pulled over if you drink, is not going to change behavior, because people believe that they are not at risk for detection by law enforcement. Therefore, it is more difficult to convince them to take precautions and the campaign will not change their behavior.

Psychological Reactance

The final problem with ‘Drive Sober or Get Pulled Over’ is that the campaign’s message and images may inadvertently encourage impaired driving. This effect is known as psychological reactance. Brehm defines psychological reactance as “a motivational state directed toward the reestablishment of the free behaviors that have been eliminated or threatened with elimination” (17). To counter the perceived threat and restore the freedom being taken away individuals may do the prohibited act (17, 18). Consequentially, an instinctive reaction might be the opposite of what was initially intended.

As public health campaigns seek to improve the health of the general population, sensitive marketing measures must be taken to ensure that conditions do not deteriorate as a result of the campaign. It has been shown that certain public health interventions and campaigns produce actions or beliefs in direct conflict with the goal of the program (18, 19). These outcomes emphasize the struggle in pursuing an intervention on a population while attempting to avoid provoking retorts within the target audience (18). Therefore, a public health campaign should be heavily scrutinized to ensure that none of the campaign aspects produce psychological reactance.

The ‘Drive Sober or Get Pulled Over’ campaign may not be exempt from the effects of psychological reactance. The danger with this campaign is that if drivers sense that freedom is being lost, instinctively, they might choose to defy the plea to maintain a sense of freedom and autonomy. As the campaign is fighting the dangers of impaired driving and striving to end the instances that it does occur, the reactive response is quite contrary to the purpose of the campaign, and is an unintended consequence that may potentially be avoided. Ringold affirms “in particular there is a need to carry out well-designed scientific evaluations of the effectiveness of current or new prevention efforts which target young people’s alcohol misuse” (19).

Certain messages and messengers provoke more psychological reactance than others. Authoritarian messengers or more authoritarian messages provoke more psychological reactance in the individual (19). This campaign logo features a stern police officer looking at the audience over the shape of a police badge. The commercials also have invisible police officers watching people and then actual police officers arresting drunk drivers. Police officers are commonly seen as disciplinarian figures in society and these images lead people to believe their freedom will be threatened. Even the voice saying “they will see you before you see them” feels dominating. Ringold affirms that an authoritative delivery or a “high pressure communicator” increase the perceived threat and therefore creates further desire to defend a threatened freedom (19). This campaign needs to be adjusted to avoid psychological reactance and promote safe driving.

The target audience of the NHTSA’s campaign is young male drinkers (5) and there is some evidence that this group, in particular, may experience greater psychological reactance from this campaign. For example, men tend to drink for different reasons than women and these reasons often lead to increased psychological reactance. Ringold found that “men tend to drink for the effect of drinking (i.e., to get high or drunk), to weaken bonds with others, and to violate rules and roles” (19). As one of the cited motives for drinking may be to violate rules, suggesting that ‘drinking and driving’ is a risky behavior may provide a contorted incentive to rebel against the campaign, or at a minimum leave a driver unresponsive these threats. Furthermore, heavy alcohol consumers were significantly less receptive to campaigns and information regarding driving under the influence of alcohol, than users those who consumed less alcohol. The heavier users gave less credibility to, had more negative approach, and showed more psychological reactance toward warnings about the dangers of impaired driving (19). Interestingly, this same target audience is also bombarded by messages from alcohol marketers that equate heavy drinking with masculinity, and thereby increasing all the aforementioned effects (18).

Keep the Party Alive’

The fundamental problems with this campaign strategy need to be addresses in order to decrease alcohol impaired driving in the United States. My proposed intervention, called ‘Keep the Party Alive,’ will correct many of these issues. ‘Keep the Party Alive’ will be a television commercial that targets the same population as the ‘Drive Sober or Get Pulled Over Campaign,’ which is males 21-34. The commercial will air during sporting events and shows with a majority male audience (similar to the original intervention) (5).

The commercial will feature a man named Dan (or another generic and generally likeable male name), who is about 30 years old, of strong stature with an athletic build to appeal to masculine men. The man will be discussing the car accident that killed his fiancée, Laura (or another generally likeable female name). He was behind the wheel and had been drinking. He will tell the story of how they were just having a regular night out with their friends. He was drunk, but there had been past instances in which he was more intoxicated and drove home ‘safely,’ so he figured he would be fine tonight. But ultimately they got in a car accident and his fiancée, Laura, died on the way to the hospital. At one point in the commercial his eyes will get watery and he will get emotional, making it hard to continue with his story.

Throughout the commercial, it will show black and white pictures of him and Laura having fun with friends. These pictures will appeal to the culture of partying and drinking. It will also show close-ups of the man’s face while he is talking. This part of the commercial, along with the campaign slogan, is intended to appeal to the partying culture, which is not addressed in ‘Drive Sober or Get Pulled Over.’ The new slogan ‘Keep the Party Alive’ also appeals to this culture, as it is not saying to stop going out and socializing. Instead it is focusing on partying in a safe manner. The hope is that these features will resonate with people who frequently go out to consume alcohol.

In the background will be a slow version of the song “Forever Young” by Bob Dylan. This song generally invokes thoughts of having fun as a young adult. Here it will be used ironically, as the woman’s youth was taken away. Then at the end will be the words ‘Keep the Party Alive,’ and then the man’s voice saying: “We should have called a cab or chosen a designated driver."

Using Emotion Instead of Information

The new intervention will not rely on information and hope that people rationally weigh the health information, as the Health Belief Model would lead the audience to do. Instead the new intervention will relay on emotional arousal. The power of information is enhanced if it is presented in emotionally evocative ways (20, 21). Our hope is that people will have an emotional response and this will lead to behavior change. We hope that Dan’s story, his emotions at losing a loved one, the black and white pictures and the slow song will combine to evoke this emotional response. Empathy is another emotion that may lead to behavior change (20). Furthermore, audiences remember emotional messages better than ordinary messages containing more statistics (22).

Instead of relying on the Health Belief Model, commercial marketing theories and approaches will be more beneficial. Marketing theory examines people’s strongly held personal values (23). They utilize this information to get consumers to use their products (24) and promote voluntary behavior change (23). Our campaign ‘Keep the Party Alive’ will appeal to the important value of companionship. Dan lost his companion, Laura, because he drove impaired. We do not want others to lose their companions.

Addressing Risk Perception

Dan’s narrative will address the optimistic bias, but not directly. Instead he will discuss how he never thought this would happen to him and how he thought he was a good driver. Many drivers look at prior experiences to convince themselves of their own safety (16), but only one instant can change an entire lifetime and Dan will express that he felt this way as well. Dan's emotional story stresses that regardless of any prior experience avoiding tragedy, drinking and driving can ruin lives. By appealing to emotional responses, initial reactions may be transformed from an attitude of 'couldn't happen to me' to an attitude of 'what if it were me responsible for a similar situation?' Rather than a commercial telling the audience how to behave, the commercial indirectly uses loved ones to ask the driver to drive sober.

Another way to improve risk perception is to present a risk that is more meaningful than other risks. Alberry found that stories about accident involvement including serious injury and death are a greater deterrent than apprehension by law enforcement (16). Refocusing impaired driving campaigns on the possibility of an accident, rather than the legal consequences of driving impaired should make the message more persuasive (16). Changing the focus of the anti-impaired driving campaign could change people’s perceived risk and ultimately decrease the cases of impaired driving. Dan’s message will not focus on the legal consequences of his impaired driving, but focus on the accident and its negative consequences.

Deflecting Psychological Reactance

Keep the Party Alive’ will be carefully crafted to reduce the psychological reactance to the message. Decreasing the message’s dominance (or perceived threat), being explicit in with the message content and including a reason for the warning (25) have all proven to be successful in decreasing psychological reactance in messages. To decrease the perceived threat or dominance of the message, which may cause anger in some (18), Dan will not be authoritative and state that the audience must stop drinking and driving. Rather, Dan will share his story and the consequences of his story. He will be explicit that his message is about the dangers of drinking and driving, without being overbearing. Finally, he will explain that he lost his future life companion and that is a good reason to stop driving under the influence of alcohol. Reason is particularly important because it decreases intrusive feelings, which we are trying to avoid in this situation (18).

We have also chosen our messenger to be someone similar to our target audience. Similarity improves credibility, which ultimately leads to compliance (25). Audiences who see similarities in the message communicator feel that the communicator is not judging their actions but instead providing good advice. People perceive messages from communicators that are similar to them as less threatening in general. In fact, Silvia found that if the message communicator was similar to the person receiving the message, a threatening message did not produce reactance of the same magnitude, compared to the same exact message from a different communicator (25). Therefore, in our study we chose Dan to be our spokesperson, because our audience can relate to him. Not only is he physically similar to the target audience, but the pictures of him and Laura partying together will also show that his activities were also similar to the target audience.

Keep the Party Alive’ approaches alcohol impaired driving from a different perspective than the ‘Drive Sober or Get Pulled Over Campaign.’ It is a more positive approach with an emotionally provocative message. It has been carefully crafted to resonate with the target audience and ultimately change their behavior. Therefore, the new campaign will have a greater impact on alcohol impaired driving and will decrease accidents and fatalities across the nation.


  1. Williams A. Alcohol-impaired driving and its consequences in the United States: The past 25 years. Journal of Safety Research 2006; 37: 123-138.

  1. Centers for Disease Control and Prevention. Impaired Driving: Get the Facts. Atlanta, GA: National Center for Injury Prevention and Control.

  1. National Highway Traffic Safety. Traffic Safety Facts. Washington, DC: U.S. Department of Transportation.

  1. National Highway Traffic Administration. Drive Sober or Get Pulled Over. Washington, DC: U.S. Department of Transportation.

  1. National Highway Traffic Safety Administration. “Drive Sober or Get Pulled Over” Holiday Campaign 2011. Washington, DC: U.S. Department of Transportation, 2011.

  1. Janz N, Becker M. The Health Belief Model: A Decade Later. Health Education Quarterly 1984; 11(1): 1-47.

  1. Edberg M. Individual Health Behavior Theories (chapter 4). In: Edberg M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers, 2007, pp. 35-49.

  1. Yoder S. Negotiating Relevance: Belief, Knowledge, and Practice in International Health Projects. Medical Anthropology Quarterly 1997; 11(2): 131-146.

  1. Airhihenbuwa C, Obregon R. A Critical Assessment of Theories/Models Used in Health Communication for HIV/AIDS. Journal of Health Communication 2010; 5 (S1): 5-15.

  1. Weinstein N. Unrealistic optimism about future life events. Journal of Personality and Social Psychology 1980; 39: 806-820.

  1. Klein C, Helweg-Larsen M. Perceived Control and the Optimistic Bias: A Meta-Analytic Review. Psychology and Health 2002; 17 (4): 437-446.

  1. Clarke V, Lovegrove H, Williams A, Machperson M. Unrealistic Optimism and the Health Belief Model. Journal of Behavioral Medicine 2000; 23(4): 367-376.

  1. Weinstein N. Optimistic Biases About Personal Risks. Science 1989; 246(4935): 1232-1233.

  1. Branstrom R, Kristjansson S, Ullen H. Risk Perception, Optimistic Bias, and Readiness to Change Sun Related Behaviour. European Journal of Public Health 2005; 16(5): 492-497.

  1. McKenna F. It won’t happen to me: Unrealistic optimism or illusion of control? British Journal of Pscyhology 1993; 84: 39-50.

  1. Alberry I, Guppy A. Drivers’ biased perceptions of the adverse consequences of drink-driving. Drug and Alcohol Review 1996; 15: 39-45.

  1. Brehm J. A Theory of Psychological Reactance. New York: Academic Press 1966.

  1. Dillard J, Shen L. On the Nature of Reactance and its Role in Persuasive Health Communication. Communication Monographs 2005; 72(2): 144-168.

  1. Ringold D. Boomerang Effects in Response to Public Health Interventions: Some Unintended Consequences in the Alcoholic Beverage Market. Journal of Consumer Policy 2002; 25: 27-63.

  1. Biener L, Taylor T. The continuing importance of emotion in tobacco control media messages: a response to Hastings and MacFadyen. Tobacco Control 2002; 11: 75-77.

  1. Hastings G, MacFadyen L. The limitations of fear messages. Tobacco Control 2002; 11: 73-75.

  1. Lang A, Dhillon K, Dong, Q. The effects of Emotional Arousal and Valence on Television Viewers’ Cognitive Capacity and Memory. Journal of Broadcasting & Electronic Media 1995; 39: 313-327.

  1. Grier S, Bryant C. Social Marketing in Public Health. Annual Review Public Health 2005; 26: 319-339.

  1. Vinson D, Scott J, Lamont L. The Role of Personal Values in Marketing and Consumer Behavior. Journal of Marketing; 41(2): 44-50.

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

Labels: , ,


Post a Comment

Subscribe to Post Comments [Atom]

<< Home