Thursday, December 20, 2012

The Imminent Failure of the USDA’s “Team Nutrition” Campaign and Specific Suggestions for Improvement-Shannon Miller

            Team Nutrition is public health campaign sponsored by the United States Department of Agriculture (USDA) that aims to change eating and physical activity behaviors in children in order to promote healthy habits throughout life. The program uses the school setting to foster change through food service training, nutrition education, and community support, and its intervention strategies on recommendations from the USDA’s Dietary Guidelines for Americans, a complex database of facts and statistics determined by current academic studies on the relationship between caloric intake, physical activity, and weight status. However, Team Nutrition is structured using traditional models of public health campaign design, which rely on false assumptions of human behavior. First, Team Nutrition attempts to influence children to eat healthily and exercise regularly through educational curriculums, assuming behavior is a rational decision. It also directs school employees, parents, and community leaders to relay campaign messages, which fails to relate to the main target audience of students and introduces the risk for psychological reactance. Finally, Team Nutrition includes health as its main core value of the campaign, which is a weak and potentially ineffective tactic in order to create group-level change. Because of these significant flaws in design, the campaign is likely to be ineffective in influencing students to adopt healthy behaviors.
An intervention that could serve to eliminate several flaws in Team Nutrition’s current design is the integration of a student-led program called “Champions” into the existing campaign. In this program, a small group of enthusiastic student volunteers – either from within the school or an outside visiting cohort – would start an inclusive movement to recruit fellow “champions” to participate in a lifestyle dedicated to healthy behaviors. The program would place limited emphasis on educating students on the facts of healthy eating and exercise, and rather influence students to become a part of a branded movement, initiated by fellow peers. Implementing these strategies would reach further into the culture of students to stem change from within student groups themselves, rather than dictating change from explicit messages given by authority figures in schools. By introducing basic concepts of Communications Theory, applying modern theories in marketing, and framing the campaign around the core value of freedom, the Champions campaign will more efficiently influence students to live healthier lives. Although its efforts to affect behaviors in children are well intended, if Team Nutrition does not adopt a effective design, it will likely fail at producing radical, long-term behavior change among younger generations.

Critique Argument 1
            Team Nutrition’s main approach to affecting eating and exercising behaviors in children is through educational efforts in schools. The campaign’s policy statement explains its most prominent intention: to provide educational resources and implement programs to teach children healthy habits that will influence future behavior. (USDA) The campaign advises schools to teach nutrition education to children in a classroom setting in order to “build skills and motivation for children to make healthy food and physical activity choices.” It also aims to “allow students to use the knowledge they have gained in the classroom to practice healthy behaviors in the dining room” (USDA) The website associated with Team Nutrition also houses several brochures, modules, educational activities, and other teaching resources for the use of schools and communities. This type of intervention strategy implements aspects of the Health Belief Model, which assumes behavior is a rational decision and will be directly acted on once perceive costs and benefits of a behavior are assessed. The Health Belief Model also suggests that intention directly leads to action, which is a false assumption in predicting human behavior. Assessments of past failed interventions prove the Health Belief Model inefficient in creating group-level change. For example, the original design of DARE used the Health Belief Model to implement change by educating students on the harmful effects of drug use. While intentions were clear within this campaign, a report by the GAO suggests that, “DARE had no statistically significant long-term effect on preventing youth illicit drug use.” (DARE Long-Term Evaluations, 2003) A subsequent study indicated that school districts in Texas experienced “a shocking 29% increase in drug usage and a 34% increase in tobacco usage among students participating in DARE.” (Hanson, 2002-2007) The DARE program also suggests that behavior associated with the refusal to do drugs will result after intentions to stay drug free are manifested in children. Given the evidence of failure of the DARE campaign to successfully influence behavior change in students, identical assumptions should not be incorporated with campaigns aimed at changing health behaviors in similar populations. Because Team Nutrition directly adheres to a similar campaign design, it will not serve to promote long-term substantial behavioral change in children.

Critique Argument 2
Team Nutrition’s design is also flawed due to fundamental errors in the communication of the program’s specific messages and the likelihood of producing behaviors in opposition of the campaign’s intent. These flaws are attributed to the lack of similarity and likeability of those communicating to students, as well as the potential onset of psychological reactance among students due to the campaign’s use of explicit messages. Team Nutrition relies on parents, teachers, and school administrators to influence change, rather than implementing communication strategies within student groups. However, students are fundamentally different than parents and teachers in terms of wants, needs, and cultural identities. Disparities between the campaign’s main communicators and student audiences will most likely result in a failure to influence persuasion towards adopting health behaviors in children. Furthermore, explicit messages relayed by educators and parents will most likely invoke psychological reactance among students, a concept that suggests individuals will innately act in opposition of explicit instruction due to a perceived loss of freedom. Grandpre and colleagues suggest that in the face of explicit messages, adolescents could be driven to exhibit the same behaviors an intervention may be targeting, and “given that reactance is a function of perceived persuasive intent, messages perceived as explicitly persuasive will result in greater reactance than more implicit messages.” (Grandpre, et al., 2003) As a consequence, reactance will influence individuals to reject explicit directions, suggesting that campaigns designed to overtly persuade behavior are ultimately ineffective. (Rains, 2007) Therefore, while efforts to improve the health of children in schools are well intended, Team Nutrition’s campaign design will fail to produce behavior change and will be at risk for direct opposition among student populations.

Critique Argument 3
            The most significant flaw within Team Nutrition’s campaign design lies in its underlying core value of health. Throughout the entirety of Team Nutrition’s website, resources are specifically devoted to persuading children and families to eat better and exercise more on the basis that it will improve their health. Campaigns designed by competing corporations are in direct conflict with the message portrayed by Team Nutrition because they contain stronger core values that have been proven more influential in affecting behavior change. Powerful companies that target children to consume their products with advertising campaigns associated with core values of freedom or control are remarkably more successful in influencing behavior. However, public health campaigns that only use core values of health have failed in the past, the most noteworthy being the “5-a-Day” campaign, a movement supported by numerous countries around the world. The campaign hoped to “encourage people to eat a combination of at least 5 portions of fruit and vegetables every day” and “came about after scientific research proved that eating fruit and vegetables reduced the risk of certain cancers (especially bowel), stroke, heart disease, diabetes and obesity.” (National Health Services) The 50-a-Day campaign relies heavily on a core value of health in its attempt to influence adults and children to increase fruit and vegetable consumption. Although the program has received substantial visibility among health advocacy groups, assessment research has suggested that “despite the initiation of a national fruit and vegetables campaign in 1991…fruit and vegetable consumption did not increase provide consumers stronger subconscious incentives to adopt similar behaviors.” (Casagrande, et al., 2007) The failure of this program to promote a significant increase in healthy behaviors indicates that a core value of health is ineffective in influencing group-level behavior change. Team Nutrition is associated with a similar core value, which can be seen through one of its main goals: “providing multifaceted, integrated nutrition education for children and their parents” suggesting that “this education will build skills and motivation for children to make healthy food and physical activity choices as part of a healthy lifestyle.” (USDA) Due to Team Nutrition’s similar infrastructure and core value of health to that of the 5-A-Day campaign, it will likely produce an identical outcome and fail to enhance healthy behaviors among students.

Proposal for a New Intervention: The Champions Movement
            In order for significant change in health behaviors among student populations to occur, a new intervention should be integrated within the USDA’s campaign efforts. A new program called the “Champions” will address these specific inadequacies related to the USDA’s current campaign aimed at changing health behaviors among student populations. The Champions will be a branded movement implemented in public and private elementary, middle, and high schools that will allow students to engage in healthy behaviors initiated by a core Champion peer group. Champions will recruit student members into the movement to engage each other in healthy behaviors. Instead of relying on educational materials within a structured curriculum, the program will provide an identity for students to adhere to as a part of a social group devoted to living a healthy lifestyle. This campaign will depart from Team Nutrition’s original core value of health, and rather adopt a new core value of freedom to instill in members of the movement. These significant changes will promote an even more substantial change in health behaviors among student populations due to the integration of modern theories of behavior change.

Defense of Intervention 1
In order to influence attitude change among children in the Team Nutrition campaign, a new tactic must be used that initiates behavior change without relying on instilling a prior knowledge base to develop behavior intentions among student populations. This would eliminate aspects of the Health Belief Model by adopting strategies from modern theories of human behavior. Recent studies imply that successful behavior change is a function of repeated behaviors within a familiar environment, rather than the intention to adopt behavior through education. Wood and colleagues (2002) suggest that behaviors repeated consistently within a familiar environment will be initiated without conscious intent. Although counterintuitive, this notion infers that strong intentions to carry out a behavior do not correlate with actual behavior change. Furthermore, according to a meta-analysis of experimental evidence performed by Webb & Sheeran (2006), “a medium-to-large sized change in intention engenders only a small-to-medium change in behavior.” To incorporate these modern views of human behavior, the Champions campaign would eliminate the enforcement of a structured curriculum to instill behavior intention, and rather begin with manipulating behaviors themselves. To achieve this, each day an enthusiastic group of student leaders within each participating school will initiate an active game or share healthy snack with others. By allowing students to first engage in healthy behaviors without forcing an educational curriculum, behavior change will no longer depend on intention alone. Eliminating aspects of the Health Belief Model and implementing strategies that pertain to recently developed insight into human behavior, student populations will be more likely to adopt substantial behavior change in alignment with the campaign’s original objectives.

Defense of Intervention 2
            The Champions program will work to overcome flaws in the communication process within the Team Nutrition campaign by adhering to principles of Communication Theory and limiting psychological reactance among students. Aspects of Communications Theory suggest that persuasion is most effective when a message is communicated from a source both likeable and similar to the target audience. According to noted behavioral scientist, Robert Cialdini, “people prefer to say yes to individuals they know and like.” (Cialdini, 2001) Furthermore, including a communicator similar to the target audience promotes source credibility and increase the likelihood of compliance (Silvia, 2005) To incorporate these aspects into Team Nutrition, the Champions campaign would feature students similar in age and cultural background as the main messengers of the healthy behaviors movement. Once students find they can relate to those who are encouraging their involvement in the Champions campaign, they will be further persuaded to adopt similar behaviors. Explicit instructions within interventions are also at risk for psychological reactance among target audiences. Fortunately, research suggests “similarity could be particularly effective at creating compliance in the face of threats to freedom.” (Silvia, 2005) The Champions campaign will promote similarity between communicators and target audiences, remove explicit instructions, and communicate implicit messages through a peer-led organization. As a result, these combined effects will influence students to engage in healthy behaviors at school and instill similar lifetime habits.

Defense of Intervention 3
            The field of public health has traditionally included health as a main core value in its campaigns, but has continually failed to produce substantial behavior change. Specific applications of Marketing Theory will be included within the Champions movement in order to further influence widespread change by implementing a core value of freedom and creating a strong brand for the campaign. Marketing Theory is used as a means of influencing behavior by targeting audience aspirations, framing issues around a strong core value, and branding a product or issue that audiences can identify with. Aspects of Marketing Theory have been demonstrated through a prominent anti-smoking campaign in Massachusetts called “The84” created to end tobacco use in youth populations. ( The84 creates an identity for children and adolescents to adopt, which labels them as smoke-free and independent. This newly found independence associates the campaign with a core value of freedom instead of health. The84 also creates a strong brand that children can identify with and has been successful in recruiting hundreds of students into the program. Because the campaign’s intentions do not rely on a core value of health and creates an identity among target audiences, it is significantly more effective in influencing behavior change than past public health efforts to end smoking through education. The Champions movement will emulate this type of program with regard to eating behaviors among students in school settings, where social inclusion and identity formation is heavily prioritized. The campaign will accomplish this by defining those who identify as a “champion” as free to not only live without health complications due to obesity, but also to be whoever they want to be in life. In other words, being a “champion” will mean that a child is a champion of their future, and in control of their own lives. The Champions campaign will also give followers an identity that links them to the cause by using a single image or icon placed on program materials and merchandise to promote visibility of the movement. Students will wear and collect products with the icon to symbolize their status as a “champion” and identify them as a member of the movement. More importantly, their affiliation with the campaign will influence peers to take part in the movement, creating widespread participation and more significant group-level change.

            Changing health behaviors in school-aged children has proven to be a significant challenge within the field of public health. Several programs have been designed to instill healthy eating and exercise habits among students but have failed to significantly decrease childhood obesity rates in the US. Although the USDA’s campaign to influence healthy behaviors among students has sincere intentions to improve adolescent health and prevent childhood obesity, it relies too heavily on traditional models of public health intervention design. If implemented, the proposal above would eliminate Team Nutrition’s fundamental flaws by introducing modern theories proven to influence group-level change. The Champions program would limit the existing campaign’s dependence on education-based interventions, improve communication strategies, limit opposition due to psychological reactance, create a campaign brand, and associate a stronger core value with the movement. It is imperative that Team Nutrition restructures its design to align with the suggestions above in order to truly affect the eating and exercise behaviors of students nationwide.

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