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.

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D.A.R.E.’s Failed Attempt to “Just Say No”-Sarah Doersam

Young adults in today’s generation are exposed to drugs, gangs and violence in a variety of ways; from what they see on television ads to what they are taught in their school systems. The way they choose to respond to the information they are given also varies in multiple ways, depending on factors from their environment to their personal behaviors. In today’s society, where teens have access to any type of information they desire, it is imperative that public health officials are successful in relaying and delivering their desired message to young adults (undoubtedly a complicated task). A major ineffective public health intervention that was implemented in the 1980s and 1990s to keep young adults off of drugs and away from gangs and violence is the D.A.R.E. program (Drug Abuse Resistance Education) (see Figure 1).

Figure 1.

The D.A.R.E. program, founded in 1983 in Los Angeles, is a “drug resistance education” program taught to young adults from kindergarten to the 12^th grade, and was implemented in 75% of American school districts and in more than 43 countries around the world (1). The program was led by community police officers, who taught a series of lessons inside school classrooms about how to resist peer pressure and “live productive drug and violence-free lives” (1). According to the D.A.R.E. website, “millions of school children around the world will benefit from D.A.R.E.; the highly acclaimed program that gives kids the skills they need to avoid involvement in drugs, gangs, and violence” (1). Students who enter the D.A.R.E. program sign a pledge to never use drugs or join a gang after the ten-week curriculum. To date, this program has failed to meet federal guidelines that the program be both research-based and effective, disqualifying them from eligibility for receiving federal grant money. According to the Center for Disease Control and Prevention, throughout the 1990s (at the height of the D.A.R.E. campaign) marijuana, cocaine, methamphetamines, and steroid use all increased in students in 9^th to 12^th grades (2). Unfortunately, the D.A.R.E. campaign failed to accomplish what it set out to do, and in fact during the height of its implementation, illicit drug use rates among young adolescents rose.

This public health program, intended to raise awareness, and in return decrease rates of drug use and gang participation failed on multiple levels. Despite annual spending of 1 to 1.3 billion dollars in 2001, the U.S. Surgeon General placed D.A.R.E. under the category of “Ineffective Programs”, and the Department of Education has prohibited schools from spending its “Safe and Drug-Free Schools” money on D.A.R.E. because of its ineffectiveness (3). In addition, multiple studies have been conducted refuting D.A.R.E.’s efficacy. According to a Time article, D.A.R.E.’s “goals include teaching kids creative ways to “just say no" to drugs, while simultaneously bolstering their self-esteem (which D.A.R.E. founders insist is related to lower rates of drug use). [According to Time] it's apparently not a bad way of educating five-year-olds about the dangers of drinking cleaning fluid. But it's a bust at keeping teenagers from smoking pot” (4). The article also found that D.A.R.E. status in the sixth grade was negatively related to self-esteem at age 20, indicating that individuals who were exposed to D.A.R.E. in the sixth grade had lower levels of self-esteem 10 years later (4).

Another study at the University of Illinois suggested that some high school seniors who’d been in D.A.R.E. classes were more likely to use drugs than their non-D.A.R.E. peers. More than 1,000 10 year-olds enrolled in D.A.R.E. classes were given a survey about drug use and self-esteem, and then, a decade later, the same group filled out the same questionnaire. Results from the study showed that 20-year-olds who’d had D.A.R.E. classes were no less likely to have smoked marijuana or cigarettes, drank alcohol, used "illicit" drugs like cocaine or heroin, or caved in to peer pressure than kids who’d never been exposed to D.A.R.E. (4). Researchers from this study also speculated that “by making drugs seem more prevalent, or "normal" than they actually are, the D.A.R.E. program might have actually pushed kids who are anxious to fit in towards drugs” (4).

Lynam et al. also conducted a study in 1999 that studied the long term effects of the D.A.R.E. program. The authors initially sampled a group of 230,000 sixth graders during the 1987-1988 school year in a Midwest metropolitan area. Data was collected before and after entry into the D.A.R.E. program, and follow-up questionnaires were collected from participants over a five year period when students were in the sixth to tenth grades. The 1, 002 participants (average age was 20.1 years) that were followed up with were sent a questionnaire asking about their use of alcohol, tobacco, marijuana and other illegal drugs. Results show the D.A.R.E. program had no effect on alcohol, cigarette, marijuana, or illicit drug use. Additionally, D.A.R.E. status had no effect on peer-pressure resistance levels, and D.A.R.E. status in the sixth grade was negatively related to self-esteem (5). Clearly, the program’s solution to “just say no” was an ineffective anti-drug message that wasted millions of dollars.

Theory of Reasoned Action

The multiple studies that confirm D.A.R.E.’s unsuccessful public health campaign to “just say no” prove that the intervention failed to consider, and appropriately apply several social sciences theories. First, the intervention failed to successfully apply the Theory of Reasoned Action. The Theory of Reasoned Action “suggests that a person's behavior is determined by his/her intention to perform the behavior and that this intention is, in turn, a function of his/her attitude toward the behavior and his/her subjective norm” (6). The Theory of Reasoned Action also holds that only specific attitudes toward the behavior in question can be expected to predict that behavior, and suggests that behavioral change ultimately is the results of changes in beliefs, and that people will perform a certain behavior if they think they should perform it. The D.A.R.E. program assumed that if they could change young adults’ beliefs about drugs, violence and gangs by telling them to “just say no”, they would be able to change their behavior and keep more adolescents off of drugs and out of gangs. This model is supposed to work on an individual level; it assumes individuals will rationally weigh their perceived outcome expectancies against their perceived subjective norms of changing a behavior (7). The campaign fails in that it does not consider the fact that people, especially adolescents, can act and behave irrationally. Although participants in a campaign, in this case a large population of adolescents, can be given accurate information and facts (drugs are bad, ect.), they sometimes do still participate in the wrong behavior. D.A.R.E. only offers its participants one solution concerning drugs, violence and gangs; to “just say no”, and they assume kids who participate will consider this to be a rational solution to drug abuse and resistance. D.A.R.E. does not consider that it is highly unlikely that adolescents will act “rationally” in every situation they come across where drugs, gangs and violence are involved.

The Psychological Reactance Theory

The Psychological Reactance Theory is defined as “an adverse affective reaction in response to regulations or impositions that impinge on freedom and autonomy and is especially common when individuals feel obliged to adopt a particular opinion or engage in a specific behavior” (9). According to the theory, reactance “often encourages individuals to espouse an opinion that opposes the belief or attitude they were encouraged, or even coerced, to adopt” (9). The D.A.R.E. campaign never considered this possibility over their two decade run. “Reactance” occurs whenever a free behavior is restricted, and this is exactly what happened with this campaign. D.A.R.E restricted participants’ behavior with “just say no”, so many acted out and did exactly the opposite behavior D.A.R.E. intended. The program took away young adults’ freedom to make their own decisions about actions to take in peer groups and social settings, making adolescents try to re-establish their freedom by rebelling against the program altogether.

D.A.R.E. was not the only public health campaign that failed to consider the Psychological Reactance Theory; “Above the Influence”, a more recent anti-drug campaign, also unintentionally caused adolescents to rebel against the intended message. The Above the Influence campaign was created with the intention to target teens with anti-drug messages, primarily concerning the use of marijuana (10) (See Figure 2 below). Despite a great deal of funding provided by the government, Above the Influence, similar to D.A.R.E. failed to successfully influence teenagers not to abuse marijuana, or other types of recreational drugs. The advertisements created for this campaign told viewers that they must live “above the influence” or they would become just another statistic of a teen lost to drugs. By depicting teenagers who smoke marijuana as lazy and irresponsible, the campaign dissociated their target audience and caused them to rebel (as seen in many parody UTube videos). The campaign did not give teens a sense of control, and that loss of control and freedom was the primary instigator for rebellion, and a failed public health intervention. Because the campaign focused on how teens should not behave and what they should not do, many teens felt that their personal freedoms were threatened. Above the Influence failed to create a sense of identity for its target audience and, similar to D.A.R.E., only focused on restricting young adults’ behaviors. In a report released in 2006, the United States Government Accountability Office “did not find that the youth anti-drug media campaign was effective in reducing youth drug use” (11). The study found that that “among current, non-drug-using youth, exposure to the campaign had unfavorable effects on their anti-drug norms and perceptions of other youths’ use of marijuana- that is greater exposure to the campaign was associated with weaker anti-drug norms and increases in the perception that others use marijuana” (11).

Figure 2.

As demonstrated with the increase in recreational drug use trends during the 1990s, D.A.R.E. failed to successfully reign in its target audience; adolescents, again, reinforcing their failure to apply the Psychological Reactance Theory. The D.A.R.E. campaign tells its participants not to do drugs by unsuccessfully using police officers to deliver their message. Because the target audience is adolescents, the program should not have used a population (police officers) that is so different from them. According to a PBS released study, “the young adolescent brain works differently than an adult brain, and responds differently, especially in emotional situations, acts more impulsively and considers consequences less compared to adults” (12). Although the police officers may have taught accurate information about drugs, violence and gangs, they were unsuccessful in delivering their message because they do not easily relate to the adolescent population; their brains work differently. This sent the wrong message to teens that drugs are a law enforcement issue, not a public health issue.

Additionally, a police officer may “intimidate adolescents who have experimented with drugs from asking lifesaving questions out of fear that they would get into trouble” (13). Fear-based advertising “is a specific type of social marketing that employs scare tactics or other anxiety-producing mechanisms to highlight the dangers of engaging (or not engaging) in a certain practice”, in this case, teen drug use (14). This type of strategy was also implemented by the New York City Department of Health and Mental Hygiene with its anti-smoking campaign, “Smoking Kills” in 2009. The Department believed that by using graphic images smokers would become more aware of the health risks associated with the behavior and be influenced to quit (See Figure 3. below). Instead, when smokers saw the graphic images on the cigarette packages, they became stressed out and smoked even more, completely negating the purpose of the campaign. Similar to the failed “Smoking Kills” campaign, D.A.R.E. unsuccessfully used fear to try and implement their message to a target audience that was completely dissimilar to those who were relaying the message; causing the target population to rebel against the intended message.

Figure 3.

Optimistic Bias Theory

The D.A.R.E. campaign also fails to consider the Optimistic Bias Theory and its effect on adolescents. Optimistic bias is commonly defined as the mistaken belief that one's chances of experiencing a negative event are lower (or a positive event higher) than that of one's peers (15). This means that giving statistics and facts alone are not enough in public health campaigns; they need to tell a story and be able to capture the viewers’ emotion to be powerful and impactful. According to this theory, people do not believe their own risk of adverse behaviors is elevated. Weinstein (1980) demonstrated that “a majority of college students believed their chances of events such as divorce and having a drinking problem to be lower than that of other students, and their chances of events such as owning their own home and living past 80 years of age to be higher than that of other students” (15). The implementers of the D.A.R.E. campaign did not consider the fact that many adolescents feel like they are immortal and that nothing bad could ever happen to them (i.e. being confronted with drugs and potentially becoming addicted). Weinstein also says “It is possible to be optimistically biased by being overconfident about the objective chances of experiencing a positive event (or avoiding a negative event), irrespective of how one's chances compare with those of one's peers” (15). Again, D.A.R.E.’s failed campaign negated to consider vital Social Science theories.

Proposal for an Alternative Intervention

An alternative intervention to the D.A.R.E. campaign could show significant improvements in the campaign’s lack of beneficial results. By incorporating the appropriate Social Sciences theories and learning from what was unsuccessful in the old D.A.R.E. campaign, the new program can better organize and apply its approach. The new anti-drug campaign will be called “Dare to Dream and Succeed” and will incorporate, and appropriately use Advertising Theory, Psychological Reactance Theory and the Social Cognitive Theory.

Advertising Theory

Rather than using facts and figures to relay a public health campaign, an adolescent anti-drug campaign would be more effective if it was based on Advertising Theory. Advertising is a form of communication used to persuade its audience to take action in respect to products, ideas or services, and if appropriately used can be successful in public health campaigns. The “Dare to Dream and Succeed” campaign will advertize teen (the target audience) involvement in things other than drugs, like sports or clubs (anything that requires ambition and goal setting) and will use a messenger more similar to them, yet able to catch and hold a teenager’s attention; Justin Bieber. To make this advertisement successful, it will incorporate a promise, support, and core values. Justin Bieber will deliver a message that tells adolescents to follow their dreams by being involved in ‘healthy and safe’ activities so one day they too can be successful, and possibly even famous. The promise made in this advertisement will be that if you get involved in activities that support your long term goals (whether it be joining a team to be a professional athlete or joining the debate club to be a successful lawyer) you, like Justin Bieber, can be successful, happy, and potentially rich and famous (which is what will appeal to the target audience most). This promise is supported by Justin Bieber telling the target audience if they get involved in following their dreams and don’t allow drugs to get in their way, they can be like him. Also, this advertisement incorporates core values of hard work, dedication, attractiveness, money and success, which are ideals this audience values. A good public health campaign the “Dare to Dream and Succeed” can turn to is the Truth Campaign (see Figure 4 below).

Figure 4.

The Truth Campaign “is the largest national youth-focused anti-tobacco education campaign ever and is designed to engage teens by exposing Big Tobacco's marketing and manufacturing practices, as well as highlighting the toll of tobacco in relevant and innovative ways” (16). The Truth Campaign has been very successful in delivering their message; “seventy-five percent of all 12 to 17 year-olds in the nation - 21 million - can accurately describe one or more of the Truth ads, nearly 90 percent of youths aged 12 to 17 - 25 million - said the ad they saw was convincing, and eighty-five percent - 24 million - said the ad gave them good reasons not to smoke” (16). Thanks in large part to the Truth Campaign, declines in smoking rates among high school students has decreased by more than one million. This public health campaign has been so successful because of its effective use of Advertising Theory, and its ability to “capture the promotion of rebellion against the tobacco industry as a call to action to commit to a tobacco-free lifestyle” (17). The Dare to Dream and Succeed campaign, similar to the Truth Campaign, will not be a rebellion against abusing drugs, but call for a rebellion against unhealthy influences that get in the way of reaching your dreams.

Psychological Reactance Theory

This new campaign’s advertisement will target young adolescents though the Psychological Reactance Theory; understanding that a person will react to a perceived threat to their freedom when they are told what to do as well as what not to do. By turning the tables and delivering the message that drugs will take away your freedom to reach your dreams, teens will be more likely to rebel against experimenting with and abusing them. This new campaign will focus on positive messages; that by staying involved, you can reach your dreams. The Dare to Dream and Succeed campaign gives young adults a sense of ownership that they can reach their dreams, take control of their lives and make their own decisions, without the influence of drugs. This campaign can be successful if they follow in the Truth Campaign’s footsteps by delivering the message that the unhealthy behavior is what is taking their freedom away, and that is what teens should rebel against.

Social Cognitive Theory

The Dare to Dream and Succeed campaign will also be successful if it applies the Social Cognitive Theory. The Social Cognitive Theory defines human behavior “as a triadic, dynamic and reciprocal interaction of personal factors, behavior, and the environment” (18). This campaign will consider young adults’ environment, behavior, and personal factors and recognize that each person is different, behaves differently, and is in a different environment. Simply “just say no” cannot be universally applied to each individual and thought to be successful, so the new anti-drug campaign will equip its target audience with tools that can be used in a variety of environments and peer-pressure situations; the ability to recognize drugs are what will take away their freedoms. Because the new campaign offers young adults the opportunity to aspire to be something and to be involved with activities that lead them to their dreams, they have multiple reasons to not get involved with drugs.

According to the Social Cognitive Theory, a behavior change is “made possible by a personal sense of control”. When individuals have ownership in their actions (self-efficacy), they are more likely to adapt to positive health behavior changes (19). When young adults have ownership in something, they are more likely to make the decision to not do drugs. Having something they are involved with gives them an ownership over something that drugs would interfere with. Also, incorporating “modeling behavior” is essential when utilizing the Social Cognitive Theory. When a ‘model person’, someone that is similar to the individual, successfully masters a difficult situation, “social comparison processes can enhance self-efficacy beliefs”, and ultimately successful behavior changes; when young adults see their peers (and Justin Bieber!) making health choices not to do drugs, they will be more likely to do the same.

If Dare to Dream and Succeed can be turned into a movement, similar to “the 84” campaign, a successful public health initiative is much more probable. The 84 is “a youth led movement fighting for a tobacco-free generation in Massachusetts”, and has successfully marketed their organization into a movement (20) (See Figure 5 below). The “84” represents the 84% of Massachusetts teens who choose not to smoke, giving teens a positive association to be a part of. This movement is successful in that it, similar to the Truth Campaign, organizes teens to fight against the tobacco industry for trying to infringe upon their freedoms. The 84 successfully leads young adults in a rebellion against smoking, and a movement to “do positive things” (20). Dare to Dream and Succeed needs to implement the 84’s strategy of calling teens to join a movement to do “positive things”, and NOT to do drugs.

Figure 5.

Dare to Dream and Succeed’s campaign success is dependent on the incorporation of each of the previous models appropriately and in a cohesive manner. It is important that we look to the old D.A.R.E campaign to examine where and why it was unsuccessful, and learn from their mistakes. Impacting a teen’s behavior and decisions is not an easy task, but it is possible and has been done before with multiple successful public health programs like the 84 and Truth campaigns. If we can look to what is successful, learn from past mistakes and consider the implications of Social Science Theories, Dare to Dream and Succeed has the potential to join the ranks with the 84 and Truth campaigns as public health successes.

References

1. Drug Abuse Resistance Education. D.A.R.E official website. Accessed on December 2, 2011 at: http://www.dare.com/home/Resources/Default5647.asp?N=Resources&M=16&S=0.

2. The Center for Disease Control and Prevention. Trends in the Prevalence of Marijuana, Cocaine, and Other Illicit Drug Use, National YRBS: 1991-2009. Accessed on December 2, 2011 at: http://www.cdc.gov/healthyyouth/yrbs/pdf/us_drug_trend_yrbs.pdf.

3. Drug Policy Alliance, D.A.R.E. New York, NY: Drug Policy. Accessed on December 1, 2011 at: http://www.drugpolicy.org/library/factsheets/D.A.R.E/index.cfm.

4. Reaves, J. (2001). Time, U.S. Just say no to DARE. Accessed on December 1, 2011 at: http://www.time.com/time/nation/article/0,8599,99564,00.html#ixzz1fFIMYosm.

5. Lynam DR et al. Project D.A.R.E.: No Effect at 10 Year Follow up. Journal of Consulting and Clinical Psychology 1999; 67: 590-593.

6. University of Twente. Health Communication. Theory of Planned Behavior/Reasoned Action. Accessed on December 1, 2011 at: http://www.utwente.nl/cw/theorieenoverzicht/Theory%20clusters/Health%20Communication/theory_planned_behavior.doc/.

7. Siegel, Lecture, Theory of Reasoned Action. Boston University School of Public Health. October 6,2011.

8. University of Twente. Health Communication. Health Belief Model. Accessed on December 2, 2011 at: http://www.utwente.nl/cw/theorieenoverzicht/Theory%20clusters/Health%20Communication/Health_Belief_Model.doc/.

9. Psychlopedia, Everything Psychology. Psychological Reactance Theory. Accessed on December 1, 2011 at: http://www.psych-it.com.au/Psychlopedia/article.asp?id=65.

10. Above the Influence, website. Accessed on December 2, 2011 at: http://www.abovetheinfluence.com/.

11. United States Government Accountability Office (2006). ONDCP media campaign: contractor’s national evaluation did not find that the youth anti-drug media campaign was effective in reducing youth drug use.

12. Frontline. Inside the Teenage Brain. Accessed on December 1, 2011 at: http://www.pbs.org/wgbh/pages/frontline/shows/teenbrain/interviews/todd.html.

13. Common Sense, for Drug Policy. The Effective Drug Control Strategy 1999. Accessed on December 2, 2011 at: http://www.csdp.org/edcs/page10.htm.

14. Bradley, I. (2011). Clinical Correlations. Ethical Considerations on the Use of Fear in Public Health Campaigns. Accessed on December 2, 2011 at: http://www.clinicalcorrelations.org/?p=4998.

15. National Cancer Institute. Optimistic Bias. Accessed on December 1, 2011 at: http://cancercontrol.cancer.gov/brp/constructs/optimistic_bias/index.html.

16. Truth Campaign. Protect the Truth. Accessed on December 2, 2011 at: http://www.protectthetruth.org/truthcampaign.htm.

17. Evans, W.D. Hastings, G. (2008). Chapter 1: public health branding: recognition, promise, and delivery of healthy lifestyles. Public Health Branding: Applying Marketing for Social Change, Oxford: Oxford University Press. 3-24.

18. Stone, D. (1993) Social Cognitive Theory. Learning. Accessed on December 1, 2011 at http://www.mendeley.com/research/social-cognitive-theory/#.

19. Luszczynska, A., Schwarze, R. Predicting Health Behavior. Social Cognitive Theory. Accessed on December 2, 2011 at http://www.ihepsa.com/files/predicting%20Health%20beh%20avior.pdf#page=144.

20. The 84, website. Accessed on December 2, 2011 at: http://the84.org/.

Failure of Brief Alcohol Screening for College Students (BASICS) in the college environment- Tavierney Rogan

Introduction

Binge drinking and alcohol abuse among the college population is a significant public health concern. A majority of college students are between the ages of 19 and 29, the age range at highest risk for current and lifetime excessive drinking and diagnosable alcohol and substance-use disorders (1). Reports from the Harvard School of Public Health College Alcohol Study indicate that 44.4% of students binge drink (2). Approximately 1,700 fatal injuries occur annually as a result of binge drinking and 500,000 unintentional injuries are alcohol related (3). Excessive drinking increases the risk of fatal and non-fatal injuries, violence, sexual abuse, unsafe sexual behavior, academic failure, trouble with the law, and possible development of alcoholism (3). Public health interventions are necessary to reduce the harms associated with excessive drinking.

This public health issue has been the focus of intervention and prevention programs over the past few decades. Past programs are primarily education based and have been minimally successful in decreasing the incidence of excessive drinking on college campuses (1). Recently public health professionals transitioned into using approaches that are less directive and more interactive in an attempt to reach through to students. Motivational Interviewing (MI) was introduced by William Miller in 1983 for promoting change in cases of substance abuse (4). MI is described as “a directive, client-centered counseling style for eliciting behavioral change by helping clients to explore and resolve ambivalence” (5). MI developed from Prochaska and DiClemente’s Transtheoretical Model of Behavioral Change (6). MI is applied through brief patient encounters. Personal feedback intervention (PFI) is a type of brief motivational interviewing (BMI) that includes informational feedback on the individual’s behavior, the risks of the behavior, and how to change the behavior (3). PFI is used on college campuses in an effort to prevent and reduce binge-drinking. One of the first and most widely used programs is Brief Alcohol Screening for College Students (BASICS). The BASICS model is a compilation of Miller and Rollnick’s MI with cognitive-behavioral skills training in an effort to reduce harm associated with excessive or binge drinking (3). BASICS is conducted over 2 sessions. The first session assesses the drinking habits of the individual through an interview. Educational information about the effects of BAC levels and negative health effects is also provided. During the second session the facilitator gives students feedback about their own drinking patterns as well as strategies to reduce drinking. Feedback is given in the form of a facts sheet that compares their drinking habits to those of other students on their campus, as well a list of personal risk factors (3).

The goal of the BASICS model is to use motivational enhancement (e.g. feedback on the extent of one’s personal risk, alcohol use and expectancies in relation to peers) to increase clients’ readiness to change and to help them through the process of change (3-5). It is also expected that the MI will change the students’ perceptions about risk, peer use as well as alcohol expectancies and in response the student will reduce drinking and harm (3). Lesley Perkins and Alan Bromowitz’s Theory of Social Norms plays an important role in the efficacy of BASICS. Research strongly shows the college students most often overestimate the amount and frequency their student peers drink and make decisions to drink based on that (7). The Theory of Social Norms states that behavior is hugely influenced by the norms set by an individuals’ social circle and that an individual will behave in order to fit within the social norm. BASICS operates on the idea that once students find out that their peers do not drink as much as them or less then they assumed, then the student will reduce their own drinking. While BASICS and other programs based on PFI (a type of BMI) are more effective than education-only based prevention and intervention programs, research still has yet to see a significant decrease in binge-drinking among the college population and binge drinking over the long term for individuals (3). As a result of the individualistic approach the BASICS program does nothing to change the community or environment as a whole, leaving the individual vulnerable. The BASICS model also fails to account for the fact that behavior is unplanned, out of the individual’s control, and dynamic. Finally the BASICS plan is likely to invoke psychological reactance due to its statistical nature and dissimilar messenger.

BASICS individual focus ignores the college community and environment as a whole

BASICS relies heavily on the Social Norms Theory. The program assumes that students’ will change their behavior once they are aware of that their peers on average drink less than what they previously assumed. Social norms are vital in understanding social order and human behavior. Group norms dictate attitudes, expectations, and behaviors. The individual will act according to their reference group, i.e. their groups of friends, family, religious community, and school community. Research shows in the peer group is the most influential reference group for college students (3).

The BASICS program does employ Social Norms Theory, however, it does so in an intangible way (i.e. a facts sheet). It does not change what the individual sees their friends and peers doing in their own college environment. Research indicates that the following are the most common reasons students drink: to relax, feel better about themselves, or to “fit in” with their peers (2). Students do not create this misperception entirely by themselves; it is based on what they see on their college campuses (2). Students report several drinking centered locations on their campuses: bars, dance clubs, fraternities and sororities, and even certain residential buildings (7). They are essentially surrounded by drinking atmospheres.

Research demonstrates that a self-fulfilling prophecy among students occurs as a result of the misperception of drinking norms. In response drinking norms are pulled higher (7). Moderate drinking students also report being discouraged to publicly express opposition to heavy drinking and from intervening in the drinking behaviors of peers because of their misperception and the presence of strong drinking environments on campus (7). Those conservative drinkers report feeling alienated from their universities and peer communities and thus the misperception is perpetuated. Therefore a discrepancy is created between what they are told by the BASICS personnel and what they see in their own environment.

Humans are socialized from the moment they enter the world and continue to develop as a result of socialization throughout their entire lifespan. People learn how to behave according to what they see others do and what their social group determines as acceptable behavior, this is termed modeling. The Social Expectations Theory explains this dynamic as the drive behind human behavior and therefore the drive behind behavior change (8). Social Expectations Theory operates on the idea of social norms however its focus lies on social organization and how that construct determines behavior (8). It is a group level model and therefore has strong implication for the problem of drinking on college campuses because it focuses on interactions of the community as a whole, which is a vital part of the college experience.

Research shows that in the presence of the intervention students understand the statistics provided (1,2,3). Intellectually they can accept that their peers do not drink as much as they thought. However, they do not see their community being addressed as a whole. Therefore their environment in which they have taken part in drinking and in which they developed their misperception does not change. BASICS is meant to reduce ambivalence between their values and behaviors (9). According to the Social Norms theory they develop these values based on what their peers determine to be important (7). Therefore it is important that the values of their peers change in a way that is visual. The Social Expectation Theory says the rules of the group, determined by social organization, should be targeted in order to induce behavior change rather than the thoughts of the individual in relation to the group (8). This is especially important in the college environment because young adults put much more value the opinions and lifestyle of their peers, than adults who are past their college years (7). The BASICS program’s lack of individualistic focus thus leaves a gap between the individuals’ behavior and motivation to change and the motivation for the community to change as a whole. The individual cannot change if the values and expectations of the community he or she sees in reality and not on paper does the not change.

BASICS is likely to invoke Psychological Reactance due to its statistical and clinical nature.

An important premise for the efficacy of the BASICS program is that it is done in an empathetic, non-confrontational, and non-judgmental manner. However, the intervention is delivered by trained personnel (i.e. a public health worker, registered nurse, clinical social worker). The program itself is clinically based with a focus on feedback based on health risks and statistics. This poses problems for its efficacy among college-aged students. BASICS is likely to induce Psychological Reactance in its participants due to the structure and deliverance of the program.

Psychological Reactance Theory (PRT) is the behavioral phenomena where an aversive affective reaction occurs when regulations or impositions threaten the freedom and autonomy of the individual (10). PRT postulates that when an individuals’ freedom is threatened they are likely to behave in an opposite manner. When a public health intervention urges a particular behavior in a way that the individual feels as though their freedom is being taken away they will do the opposite behavior (i.e. the behavior that the intervention is attempting to stop or reduce). This is termed reactance (11).

Psychological reactance can be avoided if a public health intervention or prevention program contains certain characteristics. An important characteristic is similarity. When the target individual or group feels a similarity to the person or group giving the public health message reactance is reduced (11). The “trained personnel” used by the BASICS program does not provide that similarity for college students. Even though the environment is considered non-confrontational, reactance is likely to occur because of the lack of interpersonal similarity.

The BASICS program is essentially indicating that what the student doing is wrong and that he or she is not matching up to his or her peers. This can create an emotional and psychological disturbance in which the individual feels his or her freedom to choose his or her own behaviors is threatened. This is particularly severe for a college student who has just gained their independence from their parents (7). Psychological reactance is often created as the result of an authoritarian figure (11). While the BASICS program is non-confrontational it could easily be misconstrued, creating the desire to continue the drinking even though being warned against it.

BASICS does not account for the irrationality of behavior

BASICS assumes that as a direct result of norms correction and the health risks of drinking that the individual will be motivated to change, develop a strategy for change and successfully implement change. Research shows that human behavior is often irrational, out of the individual’s control, and dynamic (12). Humans often act according to their emotional centers and the influence of the environment rather than according to their intellectual understanding of the risks involved in certain behaviors. This common human trait is illustrated in a wide variety of research on anything from failure to lose weight to the inability to save money. Research shows that in some cases it is a matter of a lack of self-control (12-13) but it is also the result of a behavioral phenomenon called unrealistic optimism. Unrealistic Optimism is the idea that people tend to think they are not vulnerable to negative consequences of risky behavior (14). Research shows that people tend to underestimate their own risk of a negative event (14). This is especially important in college students who binge drink. The risk of negative consequences (injury, sexual assault, and violence, penalties from school, arrest, academic failure and death) due to binge-drinking is very high, and most students are aware of this however, they still routinely take part in these high-risk activities. They do so because they truly believe that “it won’t happen to me”

The BASICS program contains two vitally important flaws. Risk is not necessarily a strong enough motivator for behavioral change. In the BASICS program, not only does it assume the students will change once they or informed of their risks and misperceptions but it does not provide substantial on-going support to help overcome the irrational nature of humans. Once the feedback sessions are over, the students are left to face the temptation and stress of their college environment. The influence of the information provided by the feedback fades and the irrational nature of humans takes over (15). A problem occurs because the time between intent and action is not considered. Although many studies have found reduction in binge-drinking behavior a majority of studies are based on short term follow-up (a majority under 2 years) (3). In one study, the number of drinks was reduced in a group receiving the BASICS program compared to an assessment only, however the volume of alcohol consumed per occasion, frequency of drinking or alcohol-related problems were not significantly different from controls (3). In another study, the BASICS group were found to have reductions in drinking at 3 and 6 months but were not significantly different from the control group by month 9 (3). This demonstrates that programs such as BASICS lacks an element that will help guide the student in his or her new behavior once the initial assessment is completed.

Proposed Alternative Intervention

In order to overcome the three main flaws of the PFI program BASICS, it is necessary to take a group approach that involves peer facilitators and provides on-going support for the new health behaviors. A campaign for a lifestyle that does not include binge-drinking would help accomplish the reduction of binge drinking amongst the college population.

A program like BASICS based on PFI should still be available for those students who break Universities rules involving underage drinking, public intoxication, or providing alcohol to minors or for students who are concerned about their own drinking. As a way of avoiding psychological reactance, the PFI should be facilitated by trained peers. By using peers that students feel more familiar with they are less likely to feel threatened or as if they are being told what to do. Rather they feel a similarity and bond with someone their own age, gender, or someone from their own school (11). The absence of a threat makes the choice to reduce drinking more empowering and more autonomous rather than something being mandated by an authoritarian figure (10). When a student feels as though they are making their own decision a sense of ownership develops and the decision to partake in a certain behavior makes it more valuable (12-16).

In order for a public health intervention to more effectively reduce binge-drinking among college students it needs to infiltrate the college environment and community in a long term way. Research shows that advertising and marketing campaigns are an effective way of reducing negative health behaviors (16-18). Creating a campaign through mass media would create widespread exposure to the cause (16). Campaigns are more successful when they use a mix of media channels in order to reach as many members of the student body such as print, web, and television (18). The content would include a set of advertisements with the statistics and facts about the actual drinking habits of the college campus. As a result, the wider community is exposed to normative corrections. There is also potential for it to spread quickly as a controversial topic. Conversation about the normative drinking behaviors of the student body would take place between students rather than facilitator and student (18). By targeting the community as a whole Social Expectations Theory is more accurately applied (8).

In order to overcome people’s aversion to statistics and number while also creating some familiarity, the advertising and marketing campaign would also include a set of advertisement with real life stories of members of the college community. They would include stories from people who have experienced the decisions involved around binge drinking. The stories could range from people who have suffered from the negative consequences to people who actively chose every day to not partake in binge drinking. By showing a college aged person sharing a story about consequences, psychological reactance is less likely to occur because it is not an admonition; it’s a cautionary story from someone just like them. Furthermore, they demonstrate how drinking took away their freedom and the regained it by choosing a different lifestyle.

On the other hand, the student that does not to binge drink is a real life representation of the majority. They are an example of how to hold on to their freedom by not drinking but also a tangible representation of the norm. It also humanizes the statistics and information about drinking making it more relatable. Creating familiarity and similarity goes back to the idea of inducing compliance by reducing reactance (11).

Furthermore, the use of causal arguments through relatable stories creates a sense of peer leadership. It breaks the stigma of a person who does not fit in because they do not drink by putting them in such a prestigious and celebrity-like position. The advertisements would need to portray images that attract college students and appeal to their values (i.e. healthy, attractive youths, who have their lives together) (8-19).

The marketing aspect of the campaign can take further advantage of the tenets of Social Expectations Theory by challenging those who hold high rank in the social organization to get involved. If groups on campus that are viewed as leaders amongst the community get involved then people will pay attention and act accordingly because those at the top of rankings, peer leaders, have the most influence on the norms set for the group and therefore the behavior of the members of the group (8). By using the existing social rankings, campus group leaders, and also creating new leaders by portraying the norm (those that don’t binge drink) in an attractive and desirable light than the structure of the community as a whole can be changed.

An important aspect of Advertising and Marketing Theory is that it takes advantage of the power of branding. Youths and young adults today are heavily saturated and influenced by media. The TRUTH campaign in Florida is a prime example of how a public health campaign can be viewed as a brand that the target population wants to buy. In turn, the youth buys into that brand which creates the desired behavior change. A brand represents a product that brings its consumer happiness and success in life (16). People learn to trust a brand and they believe that brand can help them achieve their innermost goals and desires. Through accumulated awareness, the campaign becomes recognizable and respected among the college community (16). If the lifestyle brand that the campaign sells is something that the students believe will bring them happiness and help them achieve their goals, then they will buy into it.

The campaign would be more effective with the addition of celebrity endorsement. As mentioned previously, this could include on campus leaders (club presidents, team captains and varsity athletes), but also celebrities from the world of TV, music, and movies. As DeFleur explained, “the mass media through selective presentation and emphasis of certain themes, create impression among their audiences that common cultural norms concerning the emphasized topics are structured or defined in some specific way….the media [would] then [serves]… to influence conduct” (17). Images that are seen in the media have a profound effect on the individual’s determination of appropriate and acceptable behavior. Furthermore, media consumption studies show that young adults consider what they see in the media to one of the strongest influences (after the influence of peers) for the decisions they make about their own image, which includes their own behaviors (19).

The final stage of the proposed intervention would include the development of a support system for the lifestyle that is being advertised. As discussed before, intention does not necessarily lead to action. There needs to be an avenue for college students to develop the skills it takes to lead the kind of lifestyle they choose to lead. Therefore students not only need help in developing the skills it takes to be more responsible around drinking (18) but also social situations in which this is encouraged. Therefore it would be ideal for lifestyle groups to be created around campus for students who would like the opportunity to find support in dealing with the stresses and temptations of the college environment. Self-efficacy increases when thee students feel like there is an opportunity to develop the skills they need to create lasting behavioral change (18). Furthermore, creating organizations and support groups allows for norm to become a tangible reality. Once again this must be based on a brand and a movement, a product students can feel connected to but also a product that is widely accepted in their community (8).

This new lifestyle could be based around student events and activities not focused on drinking or clubs that chose to partake in activities not based around drinking. It would also be important advertise more openly and aggressively the professional resources that are available on campus for people who think they might need help. This opportunity for support offers empowerment and ownership while also making a visual shift in the perceptions of students on their environment.

Conclusion

The incidence of binge drinking among college students is a serious public health concern. Studies show the over 44% of college students abuse alcohol. Binge drinking increases an individual’s risk for injury, violence, academic failure, mental health issues, sexual assault, trouble with the law, and death. Recently public health interventions have developed passed educational-based programs to interventions based on brief motivational interviewing. More specifically a majority of the intervention programs use personal feedback interventions. Programs such the Brief Alcohol Screening for College Students are developed on the two assumptions: that the student overestimates the amount their peers drink and that once a student is informed about their risks and the actual amount that their peer drinks that they will change their expectations and values constructed around binge drinking. Research shows that this interventions effects are short term and inconsistent across studies.

There are three major flaws that can explain its lack of success and consistency. First, its’ focus on changing the individual’s behaviors and values ignores the college community and environment as a whole. This is problematic because people of college age are particularly concerned with the values and behaviors of their peers and their environment. They are also highly susceptible to temptations due to the stressful dynamic and pervasive drinking environment of college campuses. Additionally, BASICS is likely to invoke psychological reactance in its participants due to its statistic nature and the unfamiliarity of its messenger. BASICS is administered by trained professionals. Research shows that if the person who delivers a particular message is too dissimilar to the person receiving it, they experience a threat to their freedom, called reactance. This reactance has the ability to drive the individual to react in the opposite way the message is trying to encourage. Finally, BASICS does not account for the irrational and emotional drive behind human behavior. This intervention is targeted at members of a higher education community who can understand the risks involved without a struggle and yet they still take part in that behavior. There is no guarantee that a reminder of the risks involved or the correction of a normative misperception will create action in the long term even if intention is implied.

An alternative intervention would thus need to target the community as a whole in order to correct norm misperceptions. The structural organization of the college community is an important influential factor in the incidence of binge drinking (students do it to “fit in” and be like their peers). In order to target the community as a whole the intervention would need to create a campaign centered on a way of life that does not involve binge drinking that is also endorsed by community and media leaders. Furthermore, in addition to presenting the correct norm to the community as a whole it would be important to provide a human aspect to the campaign so that the statistics and the lifestyle become more tangible. It would be important for a PFI program to continue but it would be more advantageous to be facilitated by peers in order to avoid psychological reactance. As a whole the campaign should be enacted through the voice of peers in order to keep the power in the hands of students. Finally in order for this type of campaign to have long term effects a system of support for the skills needed to reduce binge drinking and an outlet for the new lifestyle would need to be created through campus events and organizations.

References

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