Why We Are Not Getting Through to Teens: A Critique of the ‘Every 15 Minutes’ Program — Sarah Baird

Whether it is realistic to expect teens to wait until they turn 21 to drink alcohol is debatable, but one thing is certain—some teens do drink. Teenage drinking is a risky behavior that 71% of high school seniors have participated in at least once and 41.2% report drinking within the last month (1). The prevalence of underage drinking combined with the fact that motor vehicle fatality is the leading cause of death amongst teens, has spurred many anti-drunk driving programs, some more successful than others (2). When I was in high school, my school chose the ‘Every 15 Minutes’ program to sell the “don’t drink and drive” message. ‘Every 15 Minutes’ is a worldwide, school based, anti-drunk driving intervention. The origins of the program date back to 1995 when the Chico Police Department developed this two-day intervention (3). The program’s name was coined from an early 1990’s statistic that someone in the United States dies every 15 minutes from an alcohol-related collision (3).

When a high school chooses to host this program, it involves the participation of community members such as law enforcement, paramedics, hospital staff, coroners, and funeral homes, in addition to actual high school students and staff members (4). Several students are chosen to participate in the intervention and on day one a “grim reaper” pulls one of the selected students out of class every fifteen minutes, their obituary is read, and they return to class as the “living dead” unable to communicate with their fellow classmates (4). A drunk driving collision is then simulated on school grounds with students watching. The simulation is intended to be as realistic as possible. Emergency response teams attempt to rescue injured students, some students are pronounced dead on scene and others are rushed away by ambulance, police officers administer sobriety tests to the drivers and they are booked on drunk driving charges (4). In order to simulate the separation from friends and family that occurs with death or jail time, the students who participate in the collision retreat to a hotel for the night (4). Day two involves an assembly with a video presentation of the previous day’s events and reflections from participants. The students who played a part in day one read letters addressed to their parents as if they actually died and parents read similar letters addressed to their children (4). A parent who actually lost a child in an alcohol-related collision will speak to the student body along with hospital staff and police officers (4). The program is intended to be dramatic and evoke strong emotions, provoking students to think about the consequences of their actions. A video showing this intervention in further detail can be seen on the ABC news program Good Morning America: Every 15 Minutes (5). Despite the widespread use of this intervention at high schools across the country, ‘Every 15 Minutes’ is flawed and unsuccessful in effecting change in teens’ behavior.

The Danger of Expectations
The expectation established by this intervention is one of the major downfalls of this program. The entire program is represented under the idea that a tragic death occurs every 15 minutes as a result of an alcohol-related crash. In reality, 10,839 deaths occurred in 2009 as a result of alcohol-impaired driving collisions, which translates to one death every 48 minutes (6). Alcohol-related driving fatalities have declined in recent years, but even when this program first began in 1995 there was one alcohol-related crash on average of every 30 minutes (7). From the start, the foundation of this intervention was based upon an incorrect statistic. While the ‘Every 15 Minutes’ website does acknowledge the number of individuals killed in alcohol-related crashes has decreased, an updated statistic is not referenced (4).

The inflated statistic is of concern for multiple reasons—one being that the ‘Every 15 Minutes’ message is increasing the perception of the prevalence of the problem. The message causes students to overestimate the norm of drinking and alcohol-related fatalities. Researches have linked the failure of the anti-drug campaign DARE to this same flaw, criticizing the program for making drugs seem too “normal” and misrepresenting the prevalence of drug use (8). Social norms are often a strong predictor of behavior and this correlation is explored by social norms theory, which is based on the principle that people incorrectly perceive the behaviors and attitudes of others to differ from their own (9). Perkins and Berkowitz first suggested what is now social norms theory in 1986 and have done extensive research of social norms relating to student alcohol use (9). Studies of this theory have shown individuals often overestimate the prevalence of risk behaviors and change their own behavior to conform to the perceived norm (10). Additionally, those who partake in risky behaviors use the misperceived norm to rationalize or justify their unhealthy behavior (10).

Applying social norms theory to ‘Every 15 Minutes’ suggests students will drink and drive and possibly justify their behavior because they misperceive their peers to be tolerant of and partaking in the behavior themselves. Social norms theory also implies students could feel uncomfortable speaking out against drinking and driving because they misperceive their peers to be drinking and driving at a greater rate than reality would dictate. Research has consistently found that students considerably overestimate the prevalence of heavy drinking and drunk driving (11). Perkins suggests interventions aimed at dispelling misperceptions can reduce problem drinking through empowering responsible students and restraining those who partake in the risk behavior (11). The ‘Every 15 Minutes’ program does the exact opposite, creating a negative cycle where risk behaviors are perpetuated and healthy behaviors are suppressed (10). Thus, the expectation of this intervention perpetuates an existing misperception, making the misperception reality.

Provoking Reactance
The overarching message of ‘Every 15 Minutes’ could be summarized as “don’t drink and drive or else.” Ideally teens would never choose to drink and drive, but the choice exists. This intervention removes that choice without offering much of an alternative. The program’s message is not only simplistic, but the domineering tone also threatens teens’ freedom.

The fear appeal structure of ‘Every 15 Minutes’ poses a threat to teens’ freedom. The standard fear appeal structure involves threat-to-health and threat-to-freedom components (12). The threat-to-health component is substantiated through the physical and emotional consequences, fake injuries and death, and statistics on alcohol-related fatalities. The threat-to-freedom component is validated through the staged prosecution and punishment, and idea that the only option is to abstain from drinking and driving. Health promotion messages that utilize strong threats to health and freedom have been associated with increased reactance (12). Under Brehm’s theory of psychological reactance, when free behaviors are threatened or eliminated, people experience a motivational state to reestablish those freedoms (12). Specifically, Brehm defines reestablishing freedoms as participating in the behavior that one has been told they cannot or should not participate in (13). Individuals will act to restore freedoms through any available means and their level of reactance is proportional to their value of the lost freedom (12). It is also of note that individuals may or may not be aware they are experiencing reactance (12).

Under the principles of the psychological reactance theory, telling teens ‘no’ could motivate them to say ‘yes’ and ‘Every 15 Minutes’ does just that. The program uses scare tactics to emphasize drinking and driving is a big problem with drastic consequences, which teens are at risk of, and in the face of this immense threat the underwhelming answer is—just do not drink and drive. Students walk away from this intervention knowing what they are not supposed to do, but not much else. The only solution offered up by the intervention is to act responsibly—a paternalistic message often hammered into teens. Looking back on our teen years we all know this is easier said than done. The “Just Say No” approach did not work for DARE and the equivalent message does not work here (8). Reactance is minimized when someone familiar and relatable delivers the message, which this intervention partly does, but the message is just too simple here to be effective (14). This theory also explains that those most likely to engage in the free behavior that is being threatened exhibit the highest degree of reactance (13). Thus, students that are most likely to drink and drive are also most likely to feel this intervention is trying to tell them what to do, motivating them to reestablish their control of the situation. By using threats, fear, and a paternalistic tone to persuade teens to adopt a responsible behavior this intervention just positions itself to provoke rebellion in those that are most at risk.
Failure to Overcome Teens’ Invincibility

‘Every 15 Minutes’ acknowledges that teens understand the dangers of drinking and driving, yet most believe it will never happen to them (3). In light of this knowledge, the program was designed to show teens they are not invincible (3). In terms of social science theories, teens believing they are invincible would be called optimistic bias, illusion of control, or restraint bias. Combating teens’ optimistic bias and illusion of control seems like an effective approach to address this public health problem; however, ‘Every 15 Minutes’ fails to do so.

Optimistic bias is the phenomenon that people tend to underestimate the risk of something bad happening to them and overestimate the risk of something good happening to them (15). People tend to underestimate the probability that bad things will happen to them even when they understand or overestimate the risk that bad things will happen to other people (15). For instance, 72% of drivers do not believe it is very likely that they will get caught drinking and driving and students have been shown to think their risk of developing a drinking problem is much lower than that of other students (15-16). Under the principles of optimistic bias, even if teens fully understood or overestimated the risks associated with drinking and driving, they would underestimate their own personal risk. According to Professor Siegel, optimistic bias tends to be highest in teenagers and when trying to overcome optimistic bias, telling stories about individuals is much more impactful than delivering public health messages via statistics. ‘Every 15 Minutes’ attempts to deliver the anti-drunk driving message through a story involving peers; however, this story is only a dramatization. The intervention takes the theatrics too far with fake blood, a grim reaper, and students playing dead, so it seems like a cheesy television show rather than a realistic situation. The fact that the events of the intervention are staged limits the believability and detracts from the effectiveness in overcoming the optimistic bias of the teen audience.

Illusion of control is the idea that people have an unrealistic sense of the extent to which they can control an event or the events that happen to them (17). Illusion of control and restraint bias are essentially one in the same, with restraint bias being the idea that people overestimate their ability to control their behavior, particularly as it relates to temptation (18). Applying these principles to the problem of teenage drinking and driving would imply teens overestimate their ability to control whether or not they would drink and drive in general or be involved in a drunk driving accident. In simple terms, these overestimations account for a sense of invincibility. In studies exploring temptation control under a hot versus cold state, individuals tend to overestimate their impulse control when in a cold state and be more realistic of their abilities when in a hot state (18). Since ‘Every 15 Minutes’ is delivered in the cold state (i.e. teens are sober), teenagers will tend to overestimate their ability to say no to driving after drinking or getting in a car with someone who has been drinking. Interventions delivered in the cold state are less effective and without effectively addressing how to handle the hot state, the impact of the program is limited by its delivery.

Conclusion
‘Every 15 Minutes’ is potentially an effective intervention for anti-drunk driving. The message is delivered in a story format, largely by peers, and relies more on appealing to emotions than persuasion via statistics and facts. The intervention’s website claims participants are satisfied with the program, but does this satisfaction translate into behavior changes? Unfortunately it does not. Research has shown this intervention changes teens’ attitudes for the short term, but not their behavior (19).
The failure of this program can be partially attributed to the aggressive dramatization of the intervention. The reality is the program aims at creating a sense of hysteria in order to scare teens into changing their behavior. Teens are often hormonal and emotional, so throwing some fake blood on their friends and rushing them away in ambulance will provoke a strong emotional reaction in some teens. However, at the end of the day, teens know this two-day intervention was staged and their friends and family are safe and sound. Students can rationalize the events of the intervention are just a tall tale and go back to relying on their optimistic bias and illusion of control. Without empowering students or giving them any sense of control ‘Every 15 Minutes’ is unsuccessful in effecting behavior change amongst teens. Once the shock of experiencing the intervention wears off, it seems as though the message does as well.

Proposed Intervention
In order to reach teens, we must understand them. Through comprehending where ‘Every 15 Minutes’ fails and the application of social science theories, a more effective school-based anti-drunk driving intervention can be developed. Based on the pitfalls of ‘Every 15 Minutes,’ a more successful intervention would dispel misperceptions, minimize reactance, and combat optimistic bias and illusion of control shared by teens.

Instead of focusing on a staged, dramatization of a drunk-driving collision, the new and improved intervention could focus on sharing a true story. An individual who has lived through an alcohol-related driving experience, preferably a recent alumnus of the target high school or a neighboring school, would share their story with the high school students. The individual could be someone who was charged with a DUI or in an alcohol-related collision. They would speak to the student body about the reality of being charged with a DUI and the effect it had on their life and their friends and family. Rather than telling students what not to do, the emphasis would be on what they learned from the experience, what they lost, and how it has changed them as a person. The speech would highlight the gravity of the situation with intent to inform rather than to scare the students. The tone would be serious, but not accusatory.

The speech would be coupled with educational and interactive components. The educational component would focus on dispelling myths about teen drinking habits, empowering teens with skills on how to deal with their decisions regarding alcohol use, and providing information on local designated driver services or who to call if they ever need a ride. There would be an anonymous question and answer session where students could safely voice any questions or concerns. The intervention would get parents and the community involved much like ‘Every 15 Minutes’ does, providing an opportunity to open up dialogue with parents about drinking. The success of the anti-drunk driving campaign would be maximized through community efforts to enforce laws and a no tolerance policy on selling alcohol to minors.
Using Expectations in Another Way

The new intervention would use expectations in another way than they are used in the ‘Every 15 Minutes’ program. Rather than representing the program under a negative, exaggerated statistic, the program would flip the statistics around. Focus would be placed on dispelling misperceptions related to teen alcohol use and drinking and driving, using social norms theory to impact teen behavior. The speaker would emphasize that they are the exception not the norm and encourage students not to share in their mistake. The program would highlight the positive side of teen trends, such as the fact that the majority of teens do not drink—a recent study found that almost 60% of teens surveyed did not have a drink within the last month (1). An even greater majority, almost 83%, of people age 12-20 are not binge drinkers (20). In 2009, 90% of teens had never driven a car or vehicle after they had been drinking and 72% of teens had never ridden in a car with a driver that had been drinking (21). Drawing attention to the good decisions teens make establishes positive rather than negative expectations.

As discussed early, expectations and perceived social norms are a powerful indicator of behavior. In particular, there have been many studies on how norms influence drinking amongst adolescents and how norms can be used to reduce alcohol consumption (9-11). Correcting misperceptions has been shown to reduce problematic behavior and encourage healthy behavior (10). Most students already believe their peers drink more than they actually do and perceive their peers to be more permissive in their drinking attitudes than they actually are (11). The expectations delivered by ‘Every 15 Minutes’ only add to the misperceptions already held by students. Setting the story straight on teens’ actual attitudes and behaviors as they relate to drinking and driving will help to correct these misperceptions. Empowered with the facts, teens can feel more comfortable abstaining from drinking, reducing their drinking, or voicing their opinion against drinking and driving.
Changing Words to Minimize Reactance

The new intervention will employ the principles of psychological reactance to increase acceptance of the message and effect change in teen behavior. ‘Every 15 Minutes’ focuses on pointing out teens’ bad decisions and telling them what not to do, the new intervention will remove the accusatory tone and focus on alternative options. Instead of a ‘just abstain from the behavior’ message, the new program will have a ‘be in control message’—reminding teens they are the one’s with the power. The speaker will incorporate messages such as “We know some of you will choose to drink. If you are going to drink, arrange a safe ride home. Figure your ride out before you start drinking. Have a cab’s number in your cell phone.” These messages are more neutral in tone and leave the option up to the student, making them feel in control and thus minimizing reactance. In preparation of the intervention, the school can send home flyers to parents encouraging parents to let their children know they can always call them for a ride, no questions asked. Of course not all parents will feel comfortable with this, but for those that are, it is important their teens know they have this option.

Research has shown the persuasiveness of anti-drinking campaigns is largely dependent on the level of reactance they create (22). Reactance is minimized when more gentle, subtle language is used and when someone familiar delivers a message (12,14). ‘Every 15 Minutes’ attempts to reduce psychological reactance by involving students in the intervention program. The new intervention will go a step further, using someone familiar and toning down the paternalistic message. Students will be able to relate to the speaker because they are close in age and from the same area, creating a sense of familiarity. Removing the graphic visualizations from the intervention and using positive statistics helps to reduce the threat-to-health aspect seen in ‘Every 15 Minutes.’ By giving teens freedom to choose from options, making them feel in control, and minimizing the perceived threats, the message is more likely to be accepted by a broader audience (12-14).

The Power of a True Story
‘Every 15 Minutes’ acknowledges that there is a sense of optimistic bias and illusion of control in teens, but solely relies on theatrics and fear to overcome these obstacles. In the proposed intervention, the speaker will share their story without any of the hysterics of ‘Every 15 Minutes,’ making the message more genuine and believable. Students can dismiss ‘Every 15 Minutes’ because it is fake, the raw honesty of an individual who has actually lived through a DUI arrest or alcohol-related collision is something students cannot deny. Students will walk away feeling moved by the personal story, but not scared by fake blood and mangled cars. People can understand probabilities and even overestimate them but still not grasp their own risk—telling stories about individuals will be a lot more impactful than probabilities (15).

The most realistic approach to combating illusion of control and restraint bias is empowering teens so the illusion is removed and they are in fact in control. Interventions delivered during the hot state tend to be more impactful because people are more realistic about the level of control they have over a given situation (18). This could be difficult to accomplish because this public health issue involves underage drinking and it would obviously be inappropriate to have teens drink before the intervention. However, the goggles that simulate vision when intoxicated could be used to illustrate to teens what their coordination and perception is like when they have been drinking. By empowering teens with information, whether it is the reality on teen drinking trends or what their options are when they find themselves in a situation involving alcohol, knowledge is power. The new intervention would remove the theatrics of ‘Every 15 Minutes’ and inform teens about the less dire consequences of a DUI such as the embarrassment of telling friends you do not have a drivers license, the nuisance of not being able to drive yourself anywhere, and the negative impact it has on your ability to get a job. These consequences that affect one’s independence and social life are more relatable and relevant to teens than killing a friend or going to jail, which just seem too farfetched for most teens to fully comprehend. Illusion of control and optimistic bias are difficult to overcome, but the new intervention aims to combat these tendencies by leaving teens with a more realistic grasp on the situation.

Conclusion
Whether a life is lost every 15 minutes or every 48 minutes, the point is a life is lost. The tragedy is a death from an alcohol-related collision is completely avoidable. As public health practitioners we are responsible for intervening and educating the public on this risky behavior. However, designing and implementing an effective public health intervention is no small feat. People are complex and irrational, but social science theories can help demystify the motivations, attitudes, and behaviors of individuals. Hopefully by using these theories to design and implement an anti-drunk driving intervention teens will be persuaded to maintain healthy behaviors and change unhealthy behaviors.

































REFERENCES

1. National Institute on Drug Abuse InfoFacts. High School and Youth Trends. Bethesda, MD: National Institute on Drug Abuse National Institutes of Health, 2011.
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Failures in Public Health Interventions to Minimize Marijuana Use among Adolescents in the United States-Nausheen Punjani

“Above the Influence” or “Under the Influence”

Introduction

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

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

“Withholding My Freedom”

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

Social Norms: Our Youth Culture

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

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

“It Won’t Happen To Me”

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

A New Anti-Drug Campaign

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

Positive Messages

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

Building Popularity among Peers

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

Capturing the Story of One Person

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

Conclusion

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

REFERENCES

Book:

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

Website:

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

Journal Article:

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

Book:

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

Journal Article:

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

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/.

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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.

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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.

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