Friday, December 21, 2012

Stopping Youth Illicit Drug Use: A New Approach — Ben Engelberg

Drug abuse among youth remains a pressing public health issue. The Annual Monitor our Future survey conducted by the University of Michigan found that in 2011 36 percent of high school seniors had used marijuana and 15.2 percent abused prescription drugs (1). Half of high school seniors had tried an illicit drug in their lifetime. Despite efforts to reduce the drug use among young adults and adolescents, the rates have remained relatively steady (1).
The high drug use rate among youth is particularly troubling because most drug users start in their teens. According to the National Institute on Drug Abuse, in 2010 there were 3 million new drug users and 57 percent were under 18 (2). Therefore, effective youth prevention and early intervention would significantly help reduce drug use in the general population (3).
The US Office of Drug Control Policy, in response to youth drug use, launched the “My Anti-Drug” campaign in 1998 as the first phase of its “National Youth Anti-Drug Media Campaign.” The campaign’s chief goal was to prevent drug initial drug use among 9-18 year olds. Congress provided the campaign one billion dollars in funding (4).
The vast majority of these funds were spent on advertising, particularly television ads. The campaign, realizing the power of branding, created the “Anti-Drug” brand name that it utilized in its advertisements. The advertisements focused on displaying both the negative effects of abusing drugs and the positive effects of not using drugs. Ads also offered resistance skills. The first ads to air, presented youths explaining what activities kept them away from drugs use. There “anit-drug.” After they offered their answer the phrase “What’s your anti-drug” or “___: My anti-drug” would appear in writing. The goal of these ads was to encourage youths to think about, and focus on, activities that would keep them away from drug use. In addition, the campaign also encouraged youth to send in what their own “anti-drug” was to the campaign online (4).
Later ads focused more on the detrimental consequences of drug use. For example, an ad showed a group of, presumably high teenagers, running over a child on her bike with their car. These later ads were significantly more fear based (4).
Despite the money and effort put into the “Anti-Drug” campaign, it failed in its goal to reduce youth drug use. The Government Accountability Office analyzed the effects of the campaign and found that the rate of marijuana use, the primary target of the campaign, was unaffected (5). Another study published in the American Journal of Public Health came to similar conclusions, finding that the campaign failed to reduce marijuana use (6). Perhaps even more troubling, both studies found an association between exposure to the campaign and weaker anti-drug norms (5) (6). The campaign’s failure opens up the question of where the intervention went wrong.
Flaw #1: Reliance on Rationality
Understanding the failure of this intervention requires an explanation of the model the campaign was based on, the theory of planned behavior. According to this theory people’s behavior is rational and is based on their attitudes towards a behavior, their subjective social norms, and their self-efficacy. Their attitudes towards a behavior are their beliefs of the perceived benefits and or negative consequences that will occur as a result of that behavior. Subjective social norms refer to peoples’ perceptions of the opinions others hold of the behavior, and self-efficacy is their belief in their ability to perform the behavior. According to the theory, people ultimately determine whether to perform a behavior or not after rationally weighing these three factors (7).
The “Anti-Drug” campaign utilized the theory of planned behavior to encourage youth to rationally choose not to use drugs. The campaign tried to change youth attitudes towards drug use by presenting the negative consequences of using drugs and the benefits of abstaining from drug use. For instance, the campaign aired an ad where a teenager wakes up in his bed after a night a party. After hitting his alarm clock, the teen looks over his shoulder and realizes that he does not know the girl he is sleeping in bed with. The ad ends with the phrase “Regret: My Anti-Drug” appearing on the screen. The ads message is that drug use leads to regretful behavior. Through presenting this possible consequence of drugs use, the ad is an attempt to dissuade youth from using drugs.
The theory of planned behavior, however, is flawed because of its assumption that people behave rationally. While people may act rationally the majority of the time, people frequently are irrational. Contrary to the theory of planned behavior, people’s behavior is often not weighed out in kind of cost-benefit analysis, nor are people’s actions always defined by reason. Some behaviors are guided by impulse and irrationality. For example, people that choose to start smoking cigarettes likely understand that smoking has very negative effects on their health yet they choose to start smoking anyways (8). These new smokers are primarily basing their decision on impulse, not reason and rationality (9).
Employing a theory based on rational thinking is particularly ill suited for youth because adolescents and young adult behavior is less rational than adults. Youth are more likely to smoke cigarettes, have casual sex partners, and commit violent crime, all behavior commonly thought of as irrational. Researchers have found that this is partly a result of changes in the brain that increase attraction to risk. Youth, therefore, have an inherent tendency to act irrationally and a campaign that is based on rationality is unlikely to find success. (10).
Flaw #2: Creating a Backlash
The theory of psychological reactance provides further explanation for the failure of the “Anti-Drug” campaign. According to the theory of social reactance, people often perceive messages that attempt to change their behavior as threats to their freedom. As a result, they tend react by ignoring the message, criticizing the source, or performing the action the message is meant to reduce. The message, therefore, proves completely ineffectual (11).
The “My Anti-Drug” campaign either was unaware of the theory of psychological reactance or chose to ignore it. While perhaps not as explicitly urging youth not to use drugs as the “Just Say No” campaign, the message not to use drugs was clear. The campaign’s ads communicated this message by painting vivid pictures of the negative consequences of abusing drugs. The ad previously mentioned of a group of presumably high teenagers running over a young girl is typical of the types of those aired by the campaign. Based on theory of psychological reactance the message that drug use is unacceptable, likely caused a backlash. Youth probably ignored the message, criticized the government for airing the message, or were more likely to use drugs.
Furthermore, a message demanding that youth change their behavior or attitudes maybe particularly ineffective. The teenage and young adult years are commonly marked by rebellious behavior. This rebellious nature makes youth more likely to react negatively to messages from authority compelling them to change their behavior (12). Consequently, the message to young adults and adolescents not to use drugs in the “My Anti-Drug” campaign was never likely to achieve its goal.
Flaw # 3: Creating the Wrong Social Norms
Social expectation theory provides additional insight into the failure of the “My Anti-Drug” campaign. According to social expectations theory, portrayals of people in mass media affect the viewer’s conception of social norms. Conforming to their conception of social norms, the viewer often models their behavior off of people in the media when presented similar situations to those they have viewed. For example, a college freshman may binge drink because of the images of binge drinking the student has seen in the movies and on television. Social expectations, therefore, have an important affect on behavior (13).
The “My Anti-Drug” campaign unintentionally created expectations for behavior that actual supported drug use. The campaign regularly aired ads that showed youth using drugs. This conveys the message that drug use among youth is all pervasive. That youth drug use is expected. These ads, thereby, may have effectively caused more youth to use drugs or, at the very least, accept use by their peers because they perceive it as a normal part of teenage and young adult life.
New Campaign
Drug use amongst youth continues to be a pressing issue and there is need for a different kind of campaign. I propose the federal government invest the money currently apportioned to its current “Above the Influence Campaign” into a new campaign title “The Movement.” The campaign will aim to educate youth about how drug traffickers are exploiting them to fund the drug war, and how, by not abusing drugs, they can feel empowered and fight the drug traffickers.
The campaign will create “The Movement” brand and focus on making the brand ubiquitous. The launch of the campaign will commence with a television advertisement that will first air during a major television event that will have significant viewership. The advertisement will begin with an image of high school age boy sleeping in his room in the second floor of a row house in an unnamed city. Hearing a noise outside, he will awaken and look outside. There he will see other high school age youth marching down the street. Interested in seeing where all these people are marching, the boy will walk down the stairs of his row house and open the front door. Upon opening the door, he will peer to his right and then to his left and see other youth coming out of their row houses and joining the march. The boy will then run out of his row house and join them. Inspirational pop music will begin to play as the camera will pan out and show an aerial view of the march displaying thousands and thousand of youth solemnly parading down the street. In white lettering the phrase “Defund the drug war” will then appear on the screen surrounded by a completely black background. The phrase “Freedom from drugs” will then appear followed by the phrase “The Movement.” Suddenly, the screen will quickly flash the movement logo, a large white m surrounded by a black background with the “The Movement” written under the m in white letters in smaller font. The campaign’s website address will appear on the screen to end the advertisement.
In addition to this ad, the campaign will employ street teams in cities across the United States. These street teams will put up posters of the movement logo on the side of buildings, conduct flash mobs, and pass out literature about the movement. The literature about the “Movement” will focus on how drug traffickers are manipulating and controlling young people through addiction and the harm that drug traffickers are inflicting on the general population in and outside the United States. The literature will also emphasize how youths can empower themselves and fight the drug traffickers by not using drugs.
Youth will have the opportunity to learn more about the campaign from its website. The website will include similar information to the literature passed out by the street teams. It will also include a link to order campaign posters, t-shirts, and other products. This merchandise will have either have the campaigns logo imprinted on it or street art supporting the campaigns message created by paid artists.
Solution #1: Campaign Based on Employing Youth Emotions
Unlike the “My Anti-Drug” Campaign, the proposed “Movement” campaign is not reliant on a flawed belief in rationality. The campaign avoids presenting the negative personal consequences of drug use and the benefits of living life with out drugs. This is recognition that a campaign based on these features is bound to fail.
Rather than attempting to encourage rational thinking, the “Movement” campaign appeals to emotions. Research has found that emotions often affect behavior more than rational thought. Human brains are actually evolutionarily set up to pay more attention to emotion than reason (14). The “Movement” campaign taps into emotion by illustrating how drug traffickers are manipulating youth to fund the drug war through their drug use. This appeals to the universal urge not to feel deceived or used. In addition, the campaign appeals to empathy for people suffering from the drug war. Combined, the emotions provide youth motivation to abstain from drug use
Solution #2: Utilizing Psychological Reactance
Recognizing the power of emotions on people’s behavior, the “Movement” campaign avoids the emotional reaction described in the theory of psychological reactance. The campaigns purposefully never demands youth not use drugs. For instance, in the campaign’s advertisement the phrase “Freedom from drugs” appears on the screen instead of a message such as “Say no to drugs”. The campaigns message is affirmative. Through this form of messaging, the campaign avoids a negative reaction from compelling youth to eschew a behavior or belief.
The “Movement” campaign actually employs the theory of psychological reaction to its benefit. The campaign encourages youth to react against threats to their freedom and independence from drug traffickers. Through the campaigns literature and website, the campaign explains how drug traffickers are manipulating and controlling youth. Drug cartels encourage youth to become addicted to drugs, and become reliant on drug cartels. These youth thereby lose their freedom and independence to these drug traffickers. Youth are encouraged to react against this threat to their freedom by not using drugs.
The “Movement” campaigns subversive nature also is based on the theory of psychological reactance. The campaign’s use of flash mobs, posters on the sides of buildings, street teams, and merchandise imprinted with street art, create a simulated resistance movement against the drug traffickers. Youths are encouraged to join this movement, and rebel by not using drug.
The American Legacy Foundation’s “Truth” campaign already has proven this form of messaging is effective. The “Truth” campaign urged youth not to use tobacco by illustrating how tobacco companies threaten youth’s independence by compelling them to smoke and ultimately become addicted. According to a study published in The American Journal of Preventive Medicine, 450,000 fewer youth initiated smoking nationwide as a result of the campaign. Other studies have found similar reductions in youth smoking rates (15).
Solution #3: Changing Social Norms
In addition to psychological reactance theory, the “Movement” campaign utilizes the theory of social expectations. The core of the advertisement for the campaign is an image of thousands of youths marching down a street. The advertisement infers that these youths are part of  a movement of young adults and adolescents that have chosen not to use drugs. Through this message, the campaign is illustrating that drug use is not pervasive among youth. The campaign furthers this message through the use of street teams that are intended to become ubiquitous in the major cities. The street art and flash mobs create the perception that there is a movement of young adults and adolescents not using drugs. This effectively begins to alter youth’s social norms, and encourages them to abstain from drug use.
The campaign purposefully never employs any image of drug use. This kind of image would further normalize drug use among youth. Instead, by creating the perception of a movement, the campaign leads youth to believe drug use is abnormal.
Past interventions have illustrated the efficacy of public health interventions that change social norms. Former Northern Illinois University Professor Michael Haines’ work altering drinking norms is an example of the power of this type of intervention. Haines dramatically reduced drinking at Northern Illinois University, through social marketing that presented healthy drinking behavior. The proportion of students at the university that reported binge drinking reduced from 45 percent to 25 percent. The proportion reporting that they abstained from drinking increased by 10 percent. The University of Arizona, Rowan University, and other institutions of higher education have effectively employed similar campaigns to change social norms and reduce drinking (16).
The US Office of Drug Control Policy’s failure to reduce drug use through the “My Anti Drug” campaign illustrates the need for a novel approach. Campaigns encouraging rational thinking are bound to fail. Based on employing youths’ emotions, the proposed “Movement” campaign provides an effective method of reducing drugs adolescent and young adult drug use.
(1) National Institute on Drug Abuse. Monitoring the Future: National Results on Adolescent Drug Use. Ann Arbor, MI: Institute for Social Research, 2011.
(2) National Institute on Drug Abuse. Drug Facts: Nationwide Trends. Bethesda, MD: National Institute on Drug Abuse.
(3) National Institute on Drug Abuse. Topics in Brief: Drug Abuse Prevention. Bethesda, MD: National Institute of Drug Abuse.
(4) Evans, D.W., & Hastings, G. (Eds.).  Public Health Branding: Applying Marketing for Social Change. New York, NY: Oxford University Press, 2008.
(5) United States Government Accountability Office. Contractor’s National Evaluation Did Not Find That the Youth Anti-Drug Media Campaign Was
Effective in Reducing Youth Drug Use. Washington, DC: United States Government Accountability Office, 2006.
(6) Hornick, R., Jacobsohn, L., Orwin, R., Piesse, A., & Kalton, G. Effects of the National Youth Anti-Drug Media Campaign on Youths. American Journal of Public Health 200898(12), 2229-2236.
(7) Azjen, I.  Attitudes Personality and Behavior (2nd ed.) Chicago, IL: Dorsey Press, 2005.
(8) Morales, L. Most Americans Consider Smoking Very Harmful. Washington, DC: Gallup.
(9) Hofmann, W., Friese, M., & Wiers, R. Impulsive Versus Reflective Influences on Health Behavior: a Theoretical Framework and Empirical Review. Health Psychology Review 2008, 2(2), 111-137.
(10) Steinberg, L. A Social Neuroscience Perspective on Adolescent Risk-Taking. National Institute of Health Public Access 2008, 28(1), 78-106.
(11) Pfau, M., & Dillard, J. The Persuasion Handbook: Development in Theory and Practice. Thousands Oak, CA: Sage Publications, 2002.
(12) Hersey, J.C., Niederdeppe, J., Blahut, S., Holden, D., Messeria, P., Haviland, P. The Theory of “truth”: How Counterindustry Media Campaigns Affect Smoking Behavior Among Teens. Health Psychology 2005, 24 (1), 22-31.

(13) Fourie, P. (Ed.). Media Studies Volume 1: Institutions, Theories and Issues. Lansdown, South Africa: Juta Education, 2007.

(14) Walsh, D., & Gentile, D. Slipping Under the Radar: Advertising and the Mind. In: Riley, L. & Obot I. (Eds.) Drinking it in: Alcohol Marketing and Young People. Geneva, Switzerland: World Health Organization.

(15) Legacy for Longer Healthier Lives. Truth Research Summary. Washington, DC: Legacy for Longer Healthier Lives.
(16) Berkowitz, A. An Overview of the Social Norms Approach. In: Lederman, L. & Stewart, L. Changing the Culture of College Drinking: A Socially Situated Health Communications Campaign. Cresskill, NJ: Hampton Press, 2005.

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