There Are No Good Excuses for Alienating Your Target Audience: A Cautionary Tale in Bicycle Helmet Advocacy – Marisa Castrini
Introduction: Helmet Safety
According to the CDC, more than 500,000
people in the US are treated in emergency departments, and more than 700 people
die as a result of bicycle-related injuries (1). Of those injured, an estimated 67,000
cyclists visit the emergency rooms with a head injury (2). In relation to other activities, the annual estimated
number of bicycling head injuries requiring hospitalization exceeds the total
of all the head injury cases related to baseball, football, skateboards, kick
scooters, horseback riding, snowboarding, ice hockey, in-line skating and
lacrosse combined (3). Despite evidence showing that up to 85% of
bicycle-related head injuries could be prevented by a helmet, the National
Survey of Bicyclist and Pedestrian Attitudes and Behavior reports that only 50%
of cyclists wear their helmets occasionally and only 35% wear their helmets at
all times (4). While Massachusetts law
requires any person16 years of age or younger to wear a helmet while riding (5),
no mandate applies to anyone 17 years of age or older.
To help address this issue, in October 2012, the Boston
Public Health Commission launched a new helmet safety campaign, with the slogan
“No Excuses Wear a Helmet,” to promote bike safety in the city of Boston. According
to the Boston Public Health Commission (6) the campaign features three images
that appear on two dozen posters throughout the city in high bike-traffic
areas. Two of the images depict young
men with bloodied faces. The first shows the young man, not wearing a
helmet, wiping blood from his chin and reads, “STILL
THINK IT’S THE HELMET THAT’S UNATTRACTIVE?
THERE ARE NO GOOD EXCUSES” above.
The second portrays a young man (again, not wearing a helmet) lying
down, holding his neck and grimacing into the camera, his face heavily scraped
up. The text above reads “AND YOU THINK A HELMET IS UNCOMFORTABLE? THERE ARE NO GOOD EXCUSES.” The final poster in the series features a
young woman wearing a helmet, looking disheveled with a very minor contusion
across her cheek. The text above reads,
“NOT THINKING ABOUT HELMET HAIR NOW, ARE
YOU? THERE ARE NO GOOD EXCUSES.”
Though a new initiative, the No Excuses campaign
has already caused uproar in the cycling community. The campaign has been charged with relying on
scare tactics and putting the sole responsibility of safety in the hands of the
cyclists, ignoring other environmental factors that contribute to
accidents. In addition, the campaign has
been accused of portraying cycling as dangerous, and cycling advocates fear
this will discourage people from riding.
According to various sociological theories, these concerns have merit on
a much larger scale than previously discussed in the media. In this paper, all three concerns will be
addressed and potential resolutions will be considered.
Critique #1: Scare Tactics Are Ineffective Among Teens
While not overtly stated on their
campaign page, one is to assume the targets of these posters are teens and
young adults, particularly males. The
individuals highlighted in the campaign are estimated to be around 18 years of
age, which would be a sensible target considering the national average has
students in grades 9-12 who have ridden a bike in the past 12 months reporting
that 87.5% rarely or never had worn a bike helmet (7). Compared to 72% citywide helmet usage
reported in Boston (8), this puts these teens at a much higher risk for head
injury than the average cyclist. However,
using scare tactics has proven feeble in many anti-drug and alcohol campaigns
for this demographic.
The National Youth Anti-Drug Media
campaign, which used graphic ads claiming that marijuana use lead to the use of
harder drugs, was evaluated in 2002. The
study concluded that the teens that were already planning not to use marijuana
were unmoved by the ads, but more importantly, those categorized as “most likely
to use” were to actually more likely to disbelieve that regular marijuana use
has negative consequences after watching the ads (9). The attempt to use fear to drive behavior
change not only failed to resonate with the teens, but the message actually led
teens to feel manipulated an even further reject the cautionary tale.
The No Excuses campaign falls short for similar reasons. It heavily relies on the Health Belief Model (10), under the assumption that teens don’t fully
understand the risk of riding without a helmet.
The presumption that teens simply need to be informed that they are susceptible to serious
head injuries in order to change their behavior toward helmet use highly
underestimates the role of Psychological
Reactance Theory (11). The images on the posters attempt to shock
its audience, which teens will recognize as hyperbole given their own personal
experiences. In addition, by taking such
an authoritative tone with its tag line, the audience characterizes the
messenger as an authoritative figure, from which they will want to rebel
against. This discredits any further
message the campaign may try to get across.
While the threat of an
accident is certainly real, teens often downplay the idea that it could
actually happen to them personally. The
Optimism Bias is the theory that person perceives their risk of negative
outcomes as less likely than others (12).
It is not that teens do not recognize the threat of risk, but rather
they are overconfident in their ability to control potentially hazardous
situations. This belief is strengthened
each time they ride their bike without a helmet and remain unscathed. The Theory of Cognitive Dissonance describes the
battle between what the target audience has known as true up until now (riding
without a helmet and not becoming seriously injured), and what the No Excuses campaign is outlining (you are going to crash
and get hurt). If the initiative has
already lost credibility with its audience, the belief set that has already
been established will overtake any new ideas.
Another flaw with depending on the Health Belief
Model is that it puts far too much clout in the theory that teens, armed with
the right information, will make logical decisions regarding their health and
safety. MRI research has shown that the regions of the brain responsible for governing impulses and exercising
judgment are not fully developed during adolescence, and in fact, do not finish
developing until the early to mid-20s (9).
People are not rational beings to begin with, and when you consider the
substantial physical and emotional changes adolescents and young adults face,
the main component of your message can’t rely on reasoned behavior.
Psychographics of the target audience of the No Excuses campaign did not seem to factor into
the delivery of the message. Teens want
to feel that they are in more control of their lives than they really are, and by
taking a parental tone and lecturing that there is ‘no good excuse,” the Health Belief Model proves to be completely ineffectual
in its approach to helmet safety. The
campaign attempts to connect with its target with the core values of
attractiveness and comfort. While these
attitudes hit upon common reasons teens do not wear helmets, using these values
to shame the target in the posters evokes a negative reaction and weakens any
affinity teens may have felt with the individuals in the poster.
Critique #2: Blaming the Victim
The message coming out of the No
Excuses campaign is that if you don’t wear a helmet for foolishly petty reasons
(unattractive, uncomfortable, helmet hair), then you are solely responsible for
your injuries. This completely ignores
the outside factors that contribute to cycling accidents to begin with, and
puts the responsibility squarely on the cyclist. Despite very little data having been
collected nationally on the subject (which is a problem of its own right), some
research indicates that the leading cause of cycling accidents is due to a car
failing to yield (13). However, this
campaign speaks only to the cyclist, which further fans the flames of a cultural
war growing in Boston: drivers versus cyclists.
The No Excuses campaign tried to be
very careful with their images, opting not to portray a crash scene or a
mangled bike, or showing any cars or busses, to avoid fostering any sort of
“bikes vs. drivers” sentiment (14).
However, by omitting this factor, the campaign focus shifts too far to
the individual level factors associated directly with the cyclist. The campaign can be interpreted as blaming
the cyclist for their injuries because they did not wear a helmet. This purposely neglects larger factors that
need to be considered to make Boston a more bike-friendly city. Understandably many public health campaigns
choose to focus on one aspect of the problem, to better target their message,
but in this instance it creates hostility within the cycling community and
further alienates the target audience.
This tactic promotes an atmosphere of
self-serving bias for drivers and policy makers. Cyclists who do not wear helmets are labeled
as irresponsible and the negative consequences of Stigma come into play (15). Attaching this “reckless” label to cyclists
who don’t wear helmets disregards the roles played elsewhere. The driver can blame the cyclist for their
injury because they were not wearing a helmet - not because the driver hit
them. Boston newspapers that referenced
cyclist fatalities in the past year mentioned every time, without fail, whether
or not the rider was wearing a helmet.
While true helmets can save lives, the bigger factor remains that there
are particularly dangerous intersections in the city where cyclists get hit by
cars, buses or trains – and the takeaway in those instances should not be
whether or not the rider was wearing a helmet. What needs to be addressed is how to avoid
these accidents in the first place.
Critique #3: Campaign Depicts Cycling as a Dangerous
Activity
The second most popular outdoor activity in the US (16),
cycling is good for reducing other public health threats such as diabetes,
heart disease and obesity. Research
shows adolescents who bicycle are 48% less likely to be overweight as adults (17). Cycling also has discernible environmental
health factors that can cut down on air pollution that is a considerable
trigger for asthma sufferers. However,
the No Excuses campaign chose to focus on the negative, which in turn
illustrates a direct correlation between cycling and a bloody face. In a disservice to other public health
campaigns which are trying to encourage people, especially adolescents to be
more active, this campaign has the potential to scare away existing and future
cyclists from riding in Boston by using fear tactics to get its message across.
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 (18),
in this instance, wearing a helmet. By
advertising the imminent likelihood of a gory crash, the No Excuses campaign is
promoting a fear of cycling. As
previously mentioned, this tactic will be highly ineffective with its target
audience to begin with, but can cause further harm by showcasing cycling as a
dangerous activity to the general public.
With Boston putting in a commendable effort towards improving
infrastructure and bicycle accessibility, this feels like a step backwards for
the overall mission.
Particularly detrimental to the initial public
health push for cyclists, research shows there is safety in numbers. It has been reported that more bikers on the
road promote a safer environment for everyone. Drivers become accustomed
to sharing the road with bikers and checking before they turn or change lanes,
and bikers can ride more confidently and visibly in groups (14). The No Excuses campaign had initially reached
out to cycling advocacy groups when the initiative was still in the planning
stages, and overwhelming response was “anything but a scare campaign.” It appears as though the campaign started off
with good intentions, but then ignored their own research. Cycling advocacy groups know their market
better than public health professionals.
The campaign had a great resource into the psychographics of their
target, and went with a stale method in the end.
Intervention – Know How to Approach
Your Audience
The overall flaw with the No Excuses
campaign is that it alienates the very groups it is reaching out to. The primary target of the campaign is teens
and the secondary audience is a much broader reach of cyclists in general. Sadly, both groups were mishandled by this
campaign. The general tone of the
message was condescending to teens, which will trigger a rebellious
response. In addition, the execution laid
blame squarely on the shoulders of the cyclists, causing many riders to react
aggressively toward the campaign as they felt the need to defend
themselves. Overall, the effort
elicited an immediate knee-jerk reaction and was neither persuasive nor valued
by its intended audiences.
Addressing Critique #1: Talk to Teens as Their Peer, Not Their Superior
Ideally the focus of the next
potential campaign will shift to positive approaches. Giving young adults a sense of ownership,
making them part of a community is important.
Currently, Bikes Not Bombs does a remarkable job at reaching out Boston
youth and getting them actively involved.
Their website asserts: “We believe that the best youth programs are ones
that involve young people not only as participants but also as consultants and
ones that give young people the opportunity to self-manage and become leaders.”
(19) This is exactly how this age group needs to treated. In order to breed life-long habits of safety
and respect, these kids need to feel like they are contributing to a project
and that they are important.
For a shorter-term, more general
approach, I would recommend developing a media campaign that appeals to teen’s
sense of humor. Most importantly, this
message needs to be available where teens spend their time. According to Nielsen, teens are the heaviest
mobile video viewers and more receptive to mobile advertising than older
generations. They spend less time
watching television or to browse the Internet.
They know where they want to go, and get there through their phone. Social media sites and YouTube are the best
places to catch this demographics’ attention.
The main component behind the campaign would be a
series of short 30-second videos. These
clips would exist on a social media site such as Facebook, as well as on
YouTube. In terms of style, parodies are
a great format for this age group. At
the adolescent stage in life, it is cool to mock anything that takes itself too
seriously, such as a public health message.
But if the message itself is poking fun at an existing campaign, teens
feel like they are in on the joke, and are more likely to identify with the
core value of rebellion.
The clips, either two or three in total, would play
on safe sex messages. In one, the camera
shows a teen boy is getting ready for a date.
You see him put several condoms into his backpack and he heads out the
door. His phone vibrates and when he
looks down there is a text message that reads, “Don’t forget the protection
<3.” You see him head back in the
house and grab his helmet on the counter before hoping on his bike and riding
away. Another clip would open on a shot
of two teens making out. For the sake of
perpetuating gender stereotypes in this example, the boy will pull back and ask
the girl “Are you sure you’re ready?” to which she will reply “Did you bring
protection?” The boy smiles, hands her a
helmet, and camera pans out to show them getting on a tandem bike. The scene fades to black as they ride off
into the sunset.
Addressing Critique #2: Involve Cyclists and Motorists Alike
A collaboration between MassBike,
the Massachusetts Department of Transportation, Executive Office of Public
Safety and Security, Department of Public Health, Department of Conservation
and Recreation (I just love it when organizations work together), the website “Same Roads.
Same Rules” does a good job of speaking to the community as a whole. The mission is to reach out to both cyclists
and motorists and debunk common misconceptions.
While there are the typical “safety tip” sheets that advocate helmet use
and proper signaling, the main goal of the initiative is to foster a truce
between cyclist and motorist.
The website provides information two both parties
and holds each responsible for their actions.
There is an almost playful tone in the “Myths Vs Reality” section, where
the site lays out common complaints from each side, and provides solutions in a
calm manner, while subtly drawing attention to how self-entitled the complaints
on either side can be. It is important to note that the message is not explicitly
promoting health; rather it tasks citizens with the responsibility of keeping
one another safe. It forces a sense of
ownership for someone else’s
safety. The “us versus them” mentality
gets reframed to an all-inclusive label of “people” - everyone is in this
together. While this tactic does not
spread a wide net (Bostonians are known for their cynicism, after all), it is
certainly a step in the right direction.
What the No Excuses campaign could learn from this
is that just one group can’t shoulder the responsibility of public health. The most off-putting aspect of the campaign
is that by leaving motorists out of the equation, cyclists feel ganged up on by
the very commission that is claiming to support them. This fundamental attribution error by the campaign
has been interpreted as outwardly hostile towards cyclists, and therefore any
message that follows is met with disdain and defiance. The conversation needs to be shift from
individual responsibility to policy change.
Part of what is hindering further safety analysis
is the lack of data available to advocacy groups. Sadly, most often thorough action is not
taken until a high-profile tragedy hits the media. In the wake of last week’s terrible accident
on Commonwealth Avenue, a bike safety hearing produced a significant victory
for health and safety advocates promising a long-term bike crash data
improvement. The Menino Administration
is commissioning the first thorough analysis of Boston Police narrative reports
for bike crashes in the city, covering 2009-2011, and will be made available to
transportation planners and others involved in the public health and safety
initiative (20). The key to successfully
presenting these results is to refrain from pointing the finger at neither
cyclist nor motorist.
Addressing Critique #3: Promote
Cycling as a Community Activity
The goal of the following is to once
again create an environment for people to identify with wearing helmets. Earlier we focused on a teen target
demographic, but there is also a need to reach the broader population. Boston
hosts bike events throughout the year and these are great opportunities to promote
helmet use for all cyclists. This is an
atmosphere where it is appropriate to hand out fact sheets; all the better if
they also include vouchers for helmets.
For younger attendees, or those who are simply young at heart, a booth
could be available where crafty helmet decorations are available. Items that will not compromise safety, such
as pipe cleaners, stickers, or fake flowers, can create a playful atmosphere
where if you don’t have a helmet, you are left out of the fun.
Much
more structured programs like Roll it Forward reach out to low-income
communities by distributing bicycles and providing proper bike safety
education. Every recipient of a bicycle
from this program is fitted with a helmet and is required to complete a bike
safety education workshop and must demonstrate safe riding skills. They
also must agree to ride courteously and with a helmet. Similar to how Bikes Not Bombs approaches the
initiative, the focus is on providing a sense of identity as a cyclist. Part of that identity involves wearing a
helmet and expands even further to groom responsible cyclists.
This next proposal focuses more on taking advantage
of convenience rather than identifying with helmet culture. Currently inexpensive helmets are available
for purchase near Hubway stations, the bike-share program, but the idea of
buying a helmet when only renting a bike for a short ride does not connect with
members. A possible solution is to have
each bike come equipped with a helmet per rental. There currently do not exist rental helmets that
can be quickly sanitized between uses, but that is a challenge I ask anyone who
reads this paper to explore. If we could
have Helmets on hand and ready to go with a rental bike it could help foster
the normalization of helmet use in the city.
Conclusion
Boston is currently in the process of transforming
into a community of cyclists. Helmet use
is only a part of what contributes to the overall public health mission for
cyclists, but with the right strategy and collaborations, a difference can be
made. Communication between advocacy
groups is necessary before the launch of any new campaign in order to gather as
much research from community peers.
Boston is fortunate to have a number of dedicated organizations focused
on the same overall goal and much can be learned from their experience. The biggest mistake the No Excuses campaign
made was not listening to the suggestions of fellow advocates. What resulted was an unimaginative attempt at
curbing irrational behavior that fell flat with its target. As more alternatives to the Health Belief
Model are implemented across the system, the public health community will start
to see more creative approaches to tackle growing epidemics.
References
1.
Centers for
Disease Control and Prevention (2009). Bicycle Related Injuries
2.
Lewis &
Tompkins, P.C. National Bicycle Accident
Statistics
http://www.lewisandtompkins.com/library/national-bicycle-accident-statistics.cfm
3.
Snell Safety
Education Center, Inc. (2009). Use Your Head, Wear a Helmet '09 [Brochure].
4.
National Survey
of Bicyclist and Pedestrian Attitudes, http://www.nhtsa.gov/
5.
Mass. Gen. Laws ch. 85, § 11B. Bicycles;
operation and equipment; regulations; federal product safety standards, effect;
races; violations; penalties. 2007.
6.
Boston Public
Health Commission (2012). Helmet Safety
Campaign.
7.
Centers for
Disease Control and Prevention. Youth
Risk Behavior Surveillance. MMWR 2012;61(No. SS-#).
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City of Boston. (2010). 2010 Boston Bikes
Annual Summary http://www.cityofboston.gov/bikes/statistics.asp
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National
Institute of Mental Health. (2001). The
Teen Brain: Still Under Construction. NIH
Publication No. 01-4929.
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Individual
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Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones
and Bartlett Publishers, 2007, pp. 35-49.
11. Hornik 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
2008; 98:2229-2236.
12.
The
National Academies Press. (2007). Preventing Teen Motor Crashes: Contributions
from the Behavioral and Social Sciences: Workshop Report. Washington, DC
http://www.nap.edu/openbook.php?record_id=11814&page=19
13.
Network of Employers for Traffic Safety
(2012). Bicycle Related Injuries and Fatalities.
15. HealthKnowledge.
(2007). Concepts of Health and Illness: Section 3. Labeling and Stigma.
http://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economics/4a-concepts-health-illness/section3
16.
Outdoor Industry Association. (2011).
2011 Outdoor Recreation
Participation Topline Report 2011. http://www.outdoorindustry.org/research/participation.php?action=detail&research_id=133
17.
Menschik D, Ahmed S, Alexander MH, Blum RW. (2008).
Adolescent physical activities as predictors of young adult weight. Arch
Pediatr Adolesc Med. Jan;162(1):29-33. doi: 10.1001/archpediatrics.2007.14.
PubMed PMID: 18180409.
18.
Bradley, Ishmeal. (2011). Ethical Considerations on
the Use of Fear in Public Health Campaigns. The NYU Langone Online Journal of
Medicine.
http://www.clinicalcorrelations.org/?p=4998
19.
Bikes Not Bombs.
https://bikesnotbombs.org/youth
20.
Boston Cyclists Union
Labels: Adolescent Health, Health Communication, Physical Activity, Pink
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