Saturday, December 22, 2012

Weak Statistics from Last Weekend: Ineffective Incident Data Mar BU Alcohol Safety and Awareness Campaign – Leif Brierley

In the fall of 2011, Boston University implemented a concerted effort to combat underage drinking and alcohol abuse by BU students. The campaign consisted of a larger police presence in neighborhoods and areas known for partying and alcohol consumption, an increased number of citations and arrests made in those areas, and the online publishing of statistics from each previous weekend on the University’s daily email newsletter, BU Today. While the current statistics1 describing the results of the efforts, called “Alcohol Enforcement Patrols: Statistics from Last Weekend”, suggest that the increased police presence and effort was producing some prohibitory effect, the campaign’s poor design ultimately undermined its central message of alcohol awareness and safety. Rather than promoting this message effectively, the campaign’s design relies on a controversial social psychology model, invoked negative psychological reactions from the student body, and neglected core components of communications theory in addressing the issue. As a result, the message of alcohol awareness and safety is blunted by a weak statistical projection of police data that is meaningless and useless to the BU student body. The University would be well served amending its campaign by reframing its efforts and publishing positive efforts on campus, utilizing sound communications theory, and recognizing the myriad of influences that affect a student’s decision-making process in regard to alcohol consumption.
Background information
First published under the headline “New Crackdown on Alcohol Abuse”, the campaign to “discourage dangerous drinking”2 kicked off on the first weekend of the Fall semester of 2011. In an article2 posted on BU Today, the efforts were described as a response to an alarming number of transports to the hospital in the previous academic year, when about 250 students went to the hospital for acute alcohol intoxication. As a result, the University decided to increase its police presence in known party neighborhoods, such as those located directly off-campus in Allston and Brighton. Officers began issuing more citations, breaking up more parties and patrolling more in those off-campus neighborhoods, all with the goal of controlling alcohol use by BU students. The Director of Student Health Services, Dr. David McBride, was quoted in the article saying, “We’re not trying to keep you from having fun, but you need to keep it under control”, describing the efforts as a responsibility that students must take upon themselves, that officers will enforce.
A major component of the campaign, designed to serve as a deterrent intentionally made visible to students, is the weekly publishing of police statistics as a feature called “Alcohol Enforcement Patrols: Statistics from Last Weekend” (AEP)(see Figure 1). Compiled from BU, Brookline, and Boston police activity logs from the previous weekend, the statistics appear weekly in the Thursday edition of BU Today, an email newsletter sent to all BU faculty, staff, and students each weekday. These statistics include the number of hospital transports, summonses for underage drinking, citations for public drinking, students taken into protective custody, students arrested, and parties broken up. The statics are displayed on a dull, cartoonish graphic of two red drinks cups, one of which appears to be spilling its contents. Dr. McBride describes the intention behind this publication in the following way:
“Hopefully, students will recognize that there’s going to be a higher police presence and perhaps make decisions based on that,” McBride says. By publicizing numbers, “it’s visible to students, so that before the weekend, they look and say, ‘Gosh, 50 people were cited for public intoxication or have to appear in court. Maybe I won’t go out this weekend; maybe I’ll do something on campus.’” 2

Figure 1: Example figure of BU’s “Alcohol Enforcement Patrols: Statistics From Last Weekend” Campaign.3

The publication has appeared consistently for since its first release in Fall 2011; however, its efficacy is relatively unknown. According to a recent BU Today article, the University has seen a dramatic decrease in the number of alcohol violations and a significant drop in hospital transports reported this Fall semester (2012) compared to Fall 2011. Dr. McBride has refrained from stating a direct correlation between the efforts and the reduced alcohol abuse; however, he has indicated that the University would like to think their efforts are associated with the results, while acknowledging the need for more data to make a more conclusive statement. To this date, the AEP Data continues to be published.
Criticisms of the Alcohol Enforcement Patrols: Statistics from Last Weekend Campaign
While the AEP campaign is certainly well intended, its design undermines its message of alcohol awareness and safety significantly. Three distinct arguments can be made why this approach is flawed in its design. First, the campaign appears to be based on the Health Belief Model (HBM), a controversial social psychology model that assumes intention leads to subsequent behavior and that disregards external social influences. Second, two psychosocial theories of behavior, the theory of Cognitive Dissonance and the theory of Psychological Reactance, may be at play and detrimentally affect the campaign’s reception by the intended audience (the students). Finally, the AEP campaign fails to utilize Communications Theory effectively, deadening the impact of yet another health-related message. These three main criticisms of the campaign significantly detract from University’s efforts to decrease alcohol abuse by its students. As a result, this intervention may constitute a waste of resources and serious misstep in the management of students’ safety and wellbeing by the University due to the campaign’s low potential value to the BU community.
The Health Belief Model
Originally formulated by US Public Health Service social psychologists, the Health Belief Model (HBM)4 was created to help scientists and public health professionals understand what factors influenced an individual’s motivation to get screened for disease5. The model assumes that individuals are the source of behavior, as it considers decision making at the individual level as the main influence on behavioral outcomes6. The HBM initially rested on four distinct factors, adding two more components later on. As a result, the HBM says that health seeking behavior is dictated by six factors: 1) Perceived susceptibility to a health issue 2) Perceived Severity of the consequences of the health issue 3) Perceived benefits of an action taken in prevention 4) Perceived barriers to taking that action 5) Cues to action – what influences spark the action5 and 6) Self-Efficacy7 – how adept the individual believes they are at being able to act. Essentially, this approach focuses on the individual’s ability to perceive themself in response to the health issue at hand, the intentions that develop in response to a situation, and how they behave after forming those intentions. Thus, the HBM represents a social cognition model of perception, intention formation, and action8.
In BU’s AEP campaign, the HBM appears to guide the framework of the campaign’s message. The campaign hinges on students perceiving health information, evaluating it, and acting to reduce their alcohol abuse. Specifically, the AEP presents alcohol abuse data so students can evaluate their own susceptibility and the severity of the consequences of drinking, consider the positive outcomes of not drinking and the hurdles that may impede a decision to not drink, and then use the results of a cognitive analysis of this information as a cue to act, to not drink. This analysis is directly in line with Dr. McBride’s quotation; the University hopes that students will use this information to inform their decision-making, and change their behavior and attitudes about drinking.
However, the University’s reliance on the HBM is a misinformed decision that relies too heavily on individual intentions leading to behaviors, neglecting social influences present in college settings. In effect, this approach blames the students solely for their drinking habits, a dangerous assumption indicating that the University may be committing the Fundamental Attribution error9. This error is a bias in which intentions behind behaviors are wrongly attributed to people with disregard to the social and interpersonal forces that contribute significantly to the formation of those behaviors10 11. This error has been cited as a key component of the HBM12, because the Fundamental Attribution error negates situational influences on behavior in favor of an individualistic intention-to-behavior model that may be misleading. Clearly, anecdotal evidence from popular culture serves to inform many students that the expectation to drink in college is high13; therefore, both societal and social pressures to consume alcoholic beverages in college environments most certainly factor into individual’s decision making regarding whether or not to consume alcohol14. The HBM clearly does not tell the whole story on alcohol abuse awareness because it fails to account for these major social pressures that influence individuals’ behaviors. Thus, the AEP campaign’s reliance on the HBM is a major oversight on the part of the University.
Cognitive Dissonance and Psychological Reactance
The AEP campaign also suffers because its central message fails to resonate with the student body. Rather, the campaign’s design allows the message to be easily dismissed by students, who may subconsciously react to it by actually increasing their alcohol abuse behaviors. The two theories that support these conclusions are psychological theories called Cognitive Dissonance and Psychological Reactance. Cognitive Dissonance theory predicts that when individuals partake in a behavior, such as underage drinking, that clashes with their existing beliefs about the behavior, such as that underage drinking is illegal or will have negative health consequences, those individuals experience dissonance or psychological tension. In order to reduce this dissonance, the person will then change their belief about the behavior because changing a belief or attitude is much easier than stopping or changing a behavior15 16. In that way, the individual is able rationalize their behavior through their new, modified belief, while defensively dismissing the negative potential outcomes of their behavior17.
It is not farfetched to believe that the AEP campaign could result in Cognitive Dissonance in BU students. As alluded to previously, students may already partake in underage drinking and alcohol abuse13; therefore, when presented with data suggesting the dangers and consequences of this behavior, they react defensively. Cognitive Dissonance has been displayed among various groups of individuals, to serve as a defense mechanism for other adverse health behaviors. For example, one study of smokers found that most smokers do not view themselves at an increased risk of heart disease or cancer, despite the known adverse health effects of smoking on those two conditions18. A similar reaction to a campaign pointing out the negative consequences of drinking is very possible, as students would adjust their beliefs to conform with their existing drinking behaviors. The potential for Cognitive Dissonance as a reaction to the AEP is therefore great.
Even more troubling is the idea that once students have defensively dismissed the statistics presented in the AEP via Cognitive Dissonance, they are likely to actually increase their adverse drinking behavior. The Theory of Psychological Reactance dictates this potential increase in alcohol abuse and misuse. Developed first in the 1960s19 and later expanded in the 1970s20, Psychological Reactance argues that individuals, when told what behaviors they can and cannot do, feel as though their freedoms are being inhibited, and thus react to regain control of those freedoms19. Often, this reaction includes reestablishing that freedom by actually partaking in the behavior that was being inhibited21. For example, students subjected to anti-marijuana advertising, which would inhibit their freedom to choose to use marijuana, actually expressed pro-drug attitudes in response to the advertisements21.
Here, the analogy is clear: by telling students the dangers of using a substance like marijuana or alcohol, causing students to infer that they should stop this behavior, an intervention may actually encourage an increase in that negative behavior because of Psychological Reactance. This scenario adds a dangerous element to the AEP campaign, in which the University could potentially see an increase in the number of adverse events related to alcohol as a result of their intervention. Clearly, the psychological concepts introduced by the AEP could significantly weaken the University’s efforts to curb alcohol abuse.
Communications Theory
Finally, the AEP campaign’s failure to use effective communications theory to transmit its message to the student body hinders the overall campaign effort significantly. Basically, the drab, nondescript graphic with police statistics (Figure 1), as well as the general release of the AEP through BU Today, fails to use any real tried and true methods of disseminating public health information. William J. McGuire’s work on the Theoretical Foundations of Campaigns22 is informative of the nature of effective communications. Essentially, he describes what makes campaigns and their messages effective via an input/output matrix that he calls the Communication/Persuasion Model. The elements of his matrix consist of input and output factors. Input factors include the source of the message, what the message says, and how it is received. The output elements can be simplified into categories including the likability of the message, the comprehension of the message, and the decision to act on the message because of the positive reception of it.
Importantly, each of these input/output elements must have certain characteristics to garner a desired response to a campaign message. Input factors hinge on effective message creation and dissemination. For example, the source of the message must be perceived as a trusted, likeable source22. Additionally, the message itself should contain variables such as humorousness and vividness. Finally, the message should not necessarily be broadcast over the channel with the largest bandwidth, because failing to target the message to the right audience will diffuse its perceived credibility, likability, and comprehension22. Essentially, the message will lose its output characteristics if it is not formulated or distributed properly.
Unfortunately, the AEP campaign fails to take McGuire’s advice to heart. The campaign, instead of presenting itself from a likeable, trusted source, is distributed by BU’s own news service, introducing the idea of a possibility of biased reporting and therefore mistrust to students. The graphics are not vivid or humorous, but are drab and data driven. And, because BU Today is the channel of delivery, the AEP campaign loses its precision, failing to target those select groups of students who may be more likely to need additional alcohol awareness and safety advisories. By failing to heed a key theory in communication, the AEP campaign loses much of its impact.
Conclusion of Criticisms
Clearly, the BU AEP campaign’s design is flawed, negatively affecting the campaign’s ability to share its message of alcohol awareness and safety with the BU student body. By relying on the HBM model, causing both cognitive dissonance and psychological reactance to occur, and wholesomely failing to use any aspects of effective communications theory, the AEP campaign is designed to fail. Without intervention, this intervention will not succeed at providing alcohol awareness and increasing safety for the student body.
A Proposed Remedy
Taken as a whole, the AEP suffers from one main problem that can be described as the sum of its parts: its message is poorly framed. Individuals are held responsible for bad drinking habits, the student body reacts by distancing itself from the health message, and the communication as a whole is a failure. The core value of the message, Responsibility (See Table 1), is presented as an ideal but unobtainable target: each week, students are inevitably showing up in the statistics presented by the AEP as indicators of unsafe behavior. The message of alcohol awareness and safety fails to resonate, and is ineffective.
Ultimately, the University is left with one clear remedy: reframe the health message as a positive effort, and promote this positive effort in the BU student community with effective communications tailored to help the students make good choices on the weekend. To that effect, the University could rebrand their campaign under a positive connotation as the “Be You” campaign. The main idea behind the campaign would be for the University to disseminate information on upcoming positive, safe activities that were open to the student body, alternatives to going out and abusing alcohol. Instead of focusing on the negative consequences of alcohol use and abuse in a dull graphic and BU Today article, the campaign would be a weekly video clip or soundbyte with a brief summary article attached to it, describing the various on and off campus events occurring each week for students. This effort would refocus the University’s message from one of negativity to one promoting positive endeavors for students, and highlight a campus culture not focused on alcohol but on student activity and livelihood.
How the “Be You” Campaign Can Successfully Counter the AEP Campaign
Importantly, the “Be You” campaign must not only replace the AEP campaign, but do so effectively. In order to be effective, the “Be You” campaign will need to reframe the message to one that employs Social Learning Theory, does not follow the HBM and commit the Fundamental Attribution error, and is communicated in an evidence-supported manner.
Establish New Behaviors to Establish New Attitudes
The AEP fails in part because it assumes a linear transgression of information to intention to behavior, which may not necessarily be accurate12 given the broad context in which the intervention is employed (a college campus). A major conceptual problem with many public health projects that employ the HBM is that they assume behavior change can only be accomplished once a person’s intentions have been changed8. This idea is a bit antiquated at this point, as research has shown that one of the best ways to get people to really change their attitudes is to start by getting them to participate in the desired behavior first. One model23 that demonstrates this concept effectively is Social Learning Theory. Developed by Albert Bandura in 1977, Social Learning Theory predicts that individuals will observe the behavior of others and then adopt favorable behaviors as their own patterns of action in response to similar problems and situations in their lives24. Because college students are highly susceptible to the influence of their peers in developing behaviors, including alcohol use patterns25, they may acquire behaviors more readily through imitation than through intentional attitudinal change26.
As a result, the “Be You” campaign would have to combat the strong influence of peers as displayed through the Social Learning Theory. One effective way to promote the sanctioned “Be You” non-drinking events would be to actually use Social Learning Theory for this specific purpose. The campaign could use student volunteers, preferably students who had great influence among the student body, such as athletes and student leaders, to promote the events. By that reasoning, many students would observe a particular pattern of behavior – model students attending these “Be You” events – and identify those events as reasonable activities, thereby increasing their own likelihood of attending. The goal of the campaign initially would have to be to get students to attend just one “Be You” event, which would be enough of an opportunity for the students to reinforce the idea24 that their behaviors (attending these non-alcohol activities) were indeed beneficial. Thus, the students would begin to adapt not only their behaviors, but also change their attitudes to accept that alternative activities to drinking as desirable uses of their time.
Reframing the College Experience
In order to counter the effects of Cognitive Dissonance and Psychological Reactance, the “Be You” campaign will need to reframe the message of the AEP campaign – one of sole personal responsibility for negative behaviors – to one that acknowledges the many choices for activities and socializing that college provides. Framing is a technique of public relations that repackages issues around a central idea to convey a certain meaning about that idea27 28. This central idea is referred to as the core value. The AEP campaign’s core value, Responsibility, factors into the AEPs frame, titled “Be Careful or Else” (see Table 1), in which the core position captures the essence of the responsibility the University is placing with its students: safety is your responsibility, and if you as a student do not behave safely, you will face medical, safety and disciplinary consequences. This harsh frame clearly is at the heart of the forces driving the feelings of Cognitive Dissonance and Psychological Reactance occurring in response to the AEP campaign. Students are turned off by the severity of the consequences that this decision places on them, especially when real outcomes such as arrests and hospital transports are highlighted. Here, the frame complements the two psychosocial theories nicely in illustrating why the student body could react negatively to the AEP campaign.
In order to effectively market the “Be You” campaign while maintaining its stance of mature decision-making (responsibility), the University will need to reframe its message. Framing is effective at inducing public opinion change, an important consideration if the University intends to redefine the college experience at BU to one not filled with alcohol and irresponsible decision-making. Indeed, one study showed that framing has been effective in affecting public opinion on alcohol policies29, and several others have demonstrated that message framing may influence not just public opinion, but individual behaviors30 31, too. By this logic, if the University focuses on forming a message that addresses the issue of responsibility by using a frame similar to that suggested in part B: Be You of Table 1, they increase their chances of being successful in redefining the true college experience at BU. Importantly, Frame B gives students the freedom to choose which activities to partake in – a serious distinction from Frame A, which serves to limit students’ behavior so they do not face negative consequences. Giving students the freedom to do as they please within some sanctioned activities, thereby increasing their self-efficacy32, will provide mutual benefits; students are apt to adopt this responsibility, and the University benefits from decreased alcohol abuse.
Under this reframed argument, students will have the chance to do truly what they desire in college, and not conform to the social norm of binge drinking and excessive partying. Changing the social norms of these behaviors will require long lasting and consistent framing efforts28 by the University. While student behavior and attitude change may not be instantaneous, the long-term investment by BU will be worthwhile if BU truly seeks to change the culture around drinking at the University.
Table 1. Frames present in the two contrasting campaigns. Note: A is for the AEP Campaign, B is for the “Be You” Campaign.
Core Position
Catch Phrases
Core Value
A: Be Careful or Else
It is your duty to be safe or else face the consequences
Only you can prevent forest fires
Don’t become another statistic
Ambulance Rides; Alcohol intoxication symptoms (vomiting, falling, poor recall, etc.); Angry University officials; Legal issues
B: Be You
BU gives you great choices, it’s your responsibility to make the most of them
Child in a candy store
Choose to Be You
Vast calendar of events; School dances; Band nights; athletic events; Meeting new friends; Discovering new interests

Getting the Message Out Effectively
Finally, in order to effectively spread the word on campus about positive events occurring, the message will need to utilize effective communications theory. In doing so, the message should first be sent from a trusted BU source, and not one subject to possible bias such as BU Today. The Student Activities Office, SAO33, would be an appropriate group to both gather and disseminate information about upcoming on-campus events. As the organization on campus dedicated to providing students with things to do, SAO already sends out an activities newsletter34 that would be a good start for the “Be You” campaign. However, currently, the newsletter would be ineffective as it stands, as it appears that only a few meager video newsletters have been archived on the SAO website. Clearly, the production of such a piece would require serious use of communications theory to develop a useful product.
Here, McGuire again provides a useful theory of communication that could be utilized in this situation, in complement to his previous postulates. First, the University should rely on his Communications/Persuasion Model22, and create their messages in accordance with his Input/output framework. Effective newsletters would have high likability and comprehension, and would be easily acted upon by students. One way to increase the likeability of a message is outlined in another of McGuire’s models. In his Social Attractiveness Model, McGuire contends that a message is most effective when it contains subjects who are similar, likable and familiar to the viewer35 36. This means that for their video messages, the University should use students as the subjects, who are well known to the student body, likeable as individuals, and have similar appearances to the average student. A reasonable subject could be a student-athlete, who presumably would be both well known from their athletic performance, likeable because of their general public personality, and similar in appearance because of their similar age and status in the community. Here, the university could have the athlete promote on-campus events such as sporting events, and students would have a reason to tune in. Likeability and comprehension of the message of positive events occurring on campus would increase, and students would be able to easily act on the events by attending the games. The message as a whole would therefore be a success.
                        Generally, if the University follows the recommended changes to its current AEP campaign, and adopts the suggested rebranding, the “Be You” campaign will be poised for success as a measure to combat alcohol abuse on campus. The AEP is not a successful campaign design because it relied on a faulty, individually focused model (the health belief model), results in psychological reactions (Cognitive Dissonance and Psychological Reactance) that serve to disenfranchise students from the message of alcohol safety and awareness, a message that is poorly communicated to the student body. The “Be You” campaign provides a needed remedy for these problems. It acknowledges social influences on behavior and attitudes, and hopes to manipulate them by using peer models to steer student perceptions of non-alcohol events; it deflects the problems of reactance and dissonance by reframing the entire message of the campaign to one of freedom to choose sanctioned University events; and, it uses effective communications theories to broadcast the campaign so that students are able to access information about these alternative events. All in all, the “Be You” program would empower students to make great choices, something that the AEP campaign fails to do entirely.
If the University is serious about reducing the number of alcohol-related incidents produced by members of its student body each week, BU must update its campaign to one broadcasting positive messages that resonate with the student body and provide safe alternatives to the adverse behavior of underage and binge drinking. Additionally, the University must continue its efforts at educating the student body on alcohol awareness through other means. One BU Today article pointed out that Dean of Students Kenneth Elmore has already emailed students about University alcohol policies, and that President Robert Brown addressed the issue of alcohol awareness in his matriculation speech2. These types of efforts, when coupled with a positive, activity-based and empowering campaign like the proposed “Be You” campaign, have greater potential for success than current efforts. Therefore, it is recommended that BU adapt its current alcohol awareness and safety campaign to the proposed “Be You” program.
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