tag:blogger.com,1999:blog-15727760510322366172023-11-15T10:00:34.359-08:00Challenging Dogma - Fall 2012Michael Siegelhttp://www.blogger.com/profile/09937031813339167454noreply@blogger.comBlogger69125tag:blogger.com,1999:blog-1572776051032236617.post-12034628950198071782013-01-30T12:53:00.003-08:002013-01-30T12:53:59.849-08:00Smackdown Of FatSmack: A Critique Of An Anti-Obesity Ad Campaign That Fails in Advertising Theory – Page O’Leary<br />
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Smackdown Of FatSmack: A Critique Of An
Anti-Obesity Ad Campaign That Fails in Advertising Theory – Page O’Leary<o:p></o:p></span></b></div>
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<br /></div>
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Introduction<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> In the past twenty years obesity rates in the United
States have risen dramatically.
Currently more than 35% of U.S. adults and 17% of children and
adolescents age 2-19 are obese (1). From
1980 to 2008 the rate of obesity in adolescents age 12-19 increased from 5% to
18%, and rising obesity rates were accompanied by increased risk for chronic
disease including heart disease and type 2 diabetes (3). The costs associated with rising obesity
rates are astronomical. Health care
costs related to obesity and obesity related chronic disease exceeds $147
billion per year nationally (2).<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Between
the damaging health effects and associated health care costs of rising obesity
rates, obesity has become the focus of many public health campaigns. Research has shown that obese children and
adolescents are more likely to grow up to be obese adults and to suffer the
negative health effects associated with obesity, so many public health
interventions have focused on children and adolescents in an attempt to
decrease future obesity rates and improve the overall future health of the
country (3).<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Other
efforts to target anti-obesity public health campaigns have focused on the
causes of obesity. The most commonly
accepted cause of obesity is energy imbalance caused by the consumption of more
calories each day than calories that are burned each day. The prevalence of processed foods, refined
grains and added sugars in the modern American diet has been blamed for the
increase in caloric consumption leading to this imbalance. Specifically, intake of added sugars, as high
fructose corn syrup, has been shown to have increased 1000% between 1970 and
1990, and is suspected to be a major contributor to the r<a href="" name="_Ref216933739">ise
in obesity rates in the U.S. (4)</a>. The
2010 Dietary Guidelines for Americans, published by the U.S. Department of
Agriculture and the U.S. Department of Health and Human Services identified
soda, energy drinks, and sports drinks as the single greatest contributor to
sources of added sugars in the diets of the U.S. population ages 2 years and
older (5). Dietary added sugars provide
“empty calories,” that increase caloric intake without contributing nutritional
value. Additionally, it has been shown
that calories from beverages do not satiate hunger (4,6). A study of overweight teens showed that
decreasing intake of sugar sweetened beverages lead to weight loss and lower
BMI, with participants that started with the greatest BMI showing the greatest
weight reduction (7).<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">With
these facts in mind, one approach to anti-obesity public health campaigns has
been to educate the public, and specifically children and teens, about the
empty calories in sugar sweetened beverages.
In 2011, the city of Boston launched a public health campaign intended
to do just that. The campaign, called
FatSmack, featured a TV commercial (http://fatsmack.org/media/), four posters (http://fatsmack.org/media/)
and a web site (http://fatsmack.org) aimed at teens. The ads show healthy weight attractive teens
drinking from sugar sweetened beverages and getting hit in the face with a
gelatinous blob meant to represent fat, accompanied by the print message “Don’t
get Smacked by Fat. Calories from sugary
drinks can cause obesity and Type 2 diabetes” (8). The obvious message of the campaign is that
the sugar in sugar sweetened beverages can contribute to obesity and the
obesity related complication<a href="" name="_Ref216941237">s of diabetes and heart
disease (8)</a>. The website features a
rotating banner of factoids related to the message, including: the amount of
money that Coca-Cola spent on advertising in 2008 ($2.67 billion), the number
of teaspoons of sugar in a 20 oz. soda (16 or more), the percentage of
overweight or obese students in the Boston public school system (40%), and the
number of calories per day that youth age 12-19 consume from sugar sweetened beverages,
per day (300 calories) (8). The web site
also contains web pages devoted to Sugary Drink Facts, as well as The Beverage
Industry, with information about how the beverage industry markets to teens (9,10).<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">FatSmack
is a well-intentioned campaign that seems on the surface like it would appeal
to teens with its young, hip looking models in the ads, but upon closer
inspection it is found to be lacking in behavioral theory and execution, which will
lead to failure to connect with the target audience and have the desired effect
of getting teens in Boston to reduce their sugar sweetened beverage
consumption.<o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Critique
Argument 1 <o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> The primary failure of the FatSmack campaign is its
reliance on the Health Belief Model (HBM), one of the founding theories on
which traditional public health efforts are based<a href="" name="_Ref216942239"> (11)</a>. The HBM was developed in the 1950s to
describe the decision making process about health (12). The theory posits that health seeking
behavior in the individual is motivated by four factors: perceived
susceptibility, perceived severity, perceived benefits of an action, and
perceived barriers to taking that action (11).
Amendments to the initial model include cues to action, needed to motivate
the individual to act, and the concept of self-efficacy, or an individual’s
belief in their ability to take an action (11).
Public health interventions based on the HBM attempt to influence
people’s behavior by affecting one of the six factors. Basically, the theory suggests that by
educating individuals about their susceptibility to, or the severity of, a
health outcome, the benefits of an action, lowering perceived barriers to
taking a healthy action, providing cues to motivate individuals to action, or
increasing the individual’s sense of self-efficacy about the action, the
behavior of the individual can be changed (11).
The HBM assumes that we can influence individual health behaviors by
predicting an individual’s attitude toward health related behaviors and
implementing an intervention designed to change these attitudes (13). The effectiveness of the HBM is limited by
the assumption that behavior is reasoned, the lack of designation of a
separation between the intention to act and the actual execution of the action,
and by the focus on changing behavior on the individual level rather than on
the group level.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> The design of the FatSmack campaign makes the assumption
that by educating teens that about the risks of consuming sugar sweetened beverages
(obesity, diabetes) teens will then see that the benefits of forgoing sugary
drinks outweigh the risks of drinking sugary drinks, and will therefore skip
the soda and opt for water or some other sugar free beverage. The web site is full of data about soda
consumption, rates of obesity, and obesity related illnesses. The FatSmack
campaign assumes that teens will weigh the risks and benefits of consuming
sugar sweetened beverages and make a rational decision about how to act based
on that knowledge. However, teens are still developing
cognitively and are not capable of rational thought to the extent that mature
adults are (13). Furthermore, studies
have shown that when consumed, sugar elicits the same response in the brain as
narcotic drugs, so the drive to drink sugary beverages goes far beyond the
rational decision to consume or not to consume (14). Both of these factors will influence the
thought process related to beverage choice, and neither supports the theory
that teens will make a decision based on rational thought. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">The
campaign also fails to take into account other reasons that teens in Boston
might be drinking soda. The campaign overlooks the influence of social groups
and peers on the decisions made by teens, or that teens may want to change
their behavior but not be able to because of their circumstances. Teenagers are particularly susceptible to
peer pressure, so much so that even if a teen is aware that the consumption of
sugar sweetened beverages can contribute to the consumption of excess calories,
it is an abstract idea that may be very motivating in the face of a group of
peers who are choosing sodas and other sugar sweetened beverages (19). In addition to neglecting the social
influences on teen behavior, this construct fails to take into account the
political, environmental and personal contexts that influenc<a href="" name="_Ref216945387">e the behavior of an individual (15)</a>. It may be that soda or other sweetened
beverages are what is available at the markets or bodegas where teens are
buying beverages, or that money is a factor and soda is the least expensive
choice available.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Lastly,
reliance on the HBM as the basis for a public health campaign focuses all of
the effort on educating the individual to produce behavior change on the
individual level. Instead of trying to
change behavior one person at a time, the campaign could have the power to
influence the opinions of the masses, if it were designed based on a
group-behavior model such as advertising theory. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Critique
Argument 2<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> Another shortcoming of the FatSmack campaign is that it
fails to take advantage of advertising theory.
Advertising theory suggests that advertisements sell products not with
facts or reason, but by convincing the audience that their product will lead
the audience to achieve their aspirations.
The message in advertising theory is then supported with stories or images
that reinforce the promise (16).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> Advertising theory is a group-level alternative model
which attempts to overcome the shortcomings of the traditional behavior theory
models by approaching behavior change at the level of the population rather
than the individual, and by playing on people’s irrationality and dynamicity to
persuade them to make behavioral changes, rather than assuming that people
behave rationally and relying on their rationality to lead to behavior change. Advertising theory postulates it is possible
to change people’s knowledge and attitude by changing their behavior
first. Rather than using rational
thought to convince them to change, advertising theory seeks to motivate people
to change by playing to visceral desires and base aspirations, and assumes that
once the behavior has changed, the attitude about the behavior will change as
well. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> FatSmack is an advertising campaign that fails to employ
any of the strengths of advertising theory.
Rather than using the advertisements to appeal to the base desires of a
teenager to motivate them to give up sugary beverages, the ad campaign instead
tries to convince teens that drinking sugary beverages is bad with comical and
almost nonsensical images of hip-looking normal weight teens making cringing/laughing
faces while holding a sugar sweetened beverage and getting hit in the face with
an amorphous blob of goo intended to represent fat, accompanied by the message
that sugar in drinks can lead to obesity and diabetes. The ads try to use rational arguments to
convince teens to change their behavior, instead of using the power of media to
play on teens’ desires and emotions. These
ads contain no promise to the consumer that giving up sugar sweetened beverages
will lead to contentment and fulfill their aspirations. Furthermore, the representation of teens in
the ads is goofy, and there is little to link teens viewing the print ads or
the commercial to the teens represented in the ads.<o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Critique
Argument 3<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> Another way in which the FatSmack campaign fails to take
advantage of alternative models of health change is that it fails to create a
sense of ownership or belonging for viewers, and as such does not get buy-in
for the message that that the campaign is trying to deliver. The concept of ownership says that once a
person feels like they own something, the value of that thing goes up. Traditionally public health campaigns are at
odds with ownership because the goal of the campaign is to get people to give
up an unhealthy behavior. Even though
people might rationally know that a behavior is unhealthy, if they feel
ownership of the behavior they will be motivated to keep it, as a means of
maintaining control over their lives.
They will react with cognitive dissonance to rationalize their unhealthy
behavior, in the end strengthening their connection to the unhealthy
behavior. By trying to convince teens to
give up drinking sugar sweetened beverages, the FatSmack campaign may in fact
be reinforcing that behavior (17).<o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Proposed
Intervention – Hydr8 and <i>El Hydratado</i><o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> The proposed intervention is designed to reduce teen
consumption of sugar sweetened beverages while taking into account the
shortcomings of the FatSmack campaign.
The format of the intervention will be similar to that of FatSmack,
featuring an Internet/TV/Print ad campaign that promotes drinking water and
non-sugared beverages. However, rather
than educating teens about the health risks associated with drinking sugar
sweetened beverages, it will focus on drinking water or non-sugar sweetened
beverages as a way for teens to assert their independence from beverage
companies/advertisers, to give themselves the freedom to live the life they
want without obesity or diabetes preventing them from attaining their
aspirations. The ad campaign will use
Framing Theory to create a message for teens that associates drinking
non-sugared beverages with the core value of freedom. The video advertisements will then use
Advertising Theory to package the core value of freedom with the promise that
drinking non-sugared beverages will enable them to achieve their aspirations,
supported with images and music that tie back into the core value of
freedom. Lastly, the new campaign will
create an identity, <i>El Hydratado</i>, for
teens that choose non-sugar sweetened beverages. This community will address peer pressure and
ownership by creating an identity for teens that choose water over sugar
sweetened beverages, and provide a nucleus around which the movement can build
buy-in and gain momentum.<o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Defense
of Intervention 1<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> Rather than educating teens about the detrimental health
effects of drinking sugar sweetened beverages and then expecting them to
rationally weigh the risks and benefits and choose to give up sugar sweetened
beverages, the Hydr8 campaign will develop ads that appeal to the core value of
freedom to motivate teens to change their behavior. Freedom is the strongest core value, and
teenagers in particular are drawn to things that give them a sense of freedom
as they mature and try to develop a sense of individuality and personality
while making the transition from childhood to adulthood. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> The Hydr8 campaign will present the core position that choosing
water or non-sugar sweetened beverages will give teens freedom from
manipulation by beverage companies and retailers, who strive to influence teens
to buy their products for the monetary benefit of the seller, and will give
teens freedom from the constraints of health issues such as obesity and type 2
diabetes that can be caused in part by over consumption of calories from sugar
sweetened beverages. The core position
will be strengthened by catch phrases repeated in the print and video ads such
as “you choose” and “be free,” along with images that link teens drinking water
with freedom to choose and rebellion from corporate control. Together, these will tie the core position to
the core value of freedom, which all teens can relate to.</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 200%; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">A
similar approach was used in Florida’s “Truth” anti-smoking campaign, which
strove to appeal to the teen core value of rebellion, taking that away from
tobacco companies and using it to strengthen their anti-smoking campaign (18). The Truth campaign succeeded in lowering teen
smoking rates by 7.4 percentage points in middle school students and 4.8
percent in high school students. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Defense
of Intervention 2<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> The Hydr8 campaign will rely on Advertising Theory to
influence the population of teens in Boston, using ads that make the promise
that they will achieve their goals if they choose water over soda. By crafting subtle and creative ads that make
the audience feel that choosing water over soda will give them freedom and help
them to achieve their goals, the advertisements will get teens to change their
behavior before they change their beliefs about sugared beverages and their
health. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Both
print and video ads will feature teenage subjects that average teenagers can
relate to choosing water over soda and having totally fantastic but relatable
experiences. The video ads will include
music (Nick Drake, of course) and imagery that support the promise of the
ads. The promise, imagery and music will
all tie in to the core value of freedom, which will hold together the various
aspects of the new ad campaign. The
subjects in the ads will be the American “everyteen” with a range of body weights
from slim to obese, so that the intended audience of the commercials and ads
will see themselves in those that are delivering the message, which will
reinforce the strength of the ad campaign by self-referencing.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">By
using Advertising Theory, the Hydr8 campaign will reach a large audience and
get teens to change their behavior around drinking sugar sweetened beverages
before they adopt the attitude that sugar sweetened beverages are bad for their
health.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Defense
of Intervention 3<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> Lastly, the new campaign will create an identity for
water and non-sugar sweetened beverage drinkers that creates a sense of
ownership and buy-in for teens. This
will be similar to a successful anti-smoking ad campaign in Massachusetts, The
84 (</span><a href="http://the84.org/"><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">http://the84.org</span></a><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">),
which created an identity for non-smoking teens and a group for them to belong
to (19). Teens will be invited to become
part of “<i>El Hydratado</i>”, The Hydrated
in Spanish, a group that is identified by the decision to drink water or
non-sugar sweetened beverages over soda, sweet teas, sports drinks and other
sugar sweetened beverages. Creating an
identity for teens that choose non-sugared beverages will give them a sense of
ownership, which will necessarily strengthen their commitment to the
cause. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Another
way that <i>El Hydratado</i> will serve to
reinforce member commitment to choosing non-sugared beverages is by getting
members involved in the movement.
People’s connection with a cause is strengthened when they are given a
task to do in support of the cause. Members
of <i>El Hydratado </i>will be encouraged to
take a pledge not to let beverage companies take away their freedom by
manipulating them to buy sugar sweetened beverages, and schools will be enlisted
to start <i>El Hydratado</i> clubs that will
host events for members and be involved in the process of schools transitioning
to healthier beverage choices in vending machines and in cafeterias. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> Creating an identity and group for teens that choose not
to drink sugar sweetened beverages will provide a nucleus around which the
non-sugar sweetened beverage movement in teens can form. If this movement becomes popular enough, other
teens may be influenced to follow their example just by virtue of the existence
of the group (17). Members of <i>El Hydratado</i> will be trained at section
meetings about how to set a good example and “nudge” their peers toward
choosing water or other non-sugar sweetened beverages in school and at
extracurricular activities. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Conclusion<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> The FatSmack campaign, launched by the Boston
Department of Public Health in 2011, aims to reduce sugary beverage consumption
in Boston teens with a print and video ad campaign that showed teens drinking
soda getting hit in the face with blob of gelatinous goo meant to represent
fat. The images are accompanied by the
message “Don’t the Smacked by Fat. Calories from sugary drinks can cause
obesity and Type 2 diabetes.” The effectiveness
of the existing ad campaign is diminished by its construction based on the
Health Belief Model, and failure to put to use alternative, group level
behavioral models of advertising theory and ownership. The proposed modified intervention, Hydr8,
would have the same intended effect as the FatSmack campaign, but would use
Framing and Advertising Theory to emotionally motivate the target audience, and
create an identity for teens that choose not to consume sugary beverages to
give them a sense of ownership and build momentum for the movement. By adopting these alternative approaches to
public health intervention the Hydr8 campaign would have a greater likelihood
of success in reducing the amount of sugar sweetened beverages consumed by
teens in Boston.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">REFERENCES<o:p></o:p></span></b></div>
<div class="MsoEndnoteText" style="margin-left: .25in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif";">Center
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Center for Disease Control and Prevention.
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Verdana; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: JA; mso-fareast-theme-font: minor-fareast;">Finkelstein E, Trogdon J,
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: JA; mso-fareast-theme-font: minor-fareast;">Centers for Disease Control
and Prevention. O<i>verweight and Obesity Consequences.</i> Atlanta, GA: Center for Disease Control and
Prevention. </span><a href="http://www.cdc.gov/NCCDPHP/DNPA/obesity/childhood/consequences.htm"><span style="color: #245026; font-family: "Georgia","serif"; mso-bidi-font-family: Arial; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: JA; mso-fareast-theme-font: minor-fareast; text-decoration: none; text-underline: none;">http://www.cdc.gov/NCCDPHP/DNPA/obesity/childhood/consequences.htm</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif";">Bray
JA, Nielsen SJ, <i>et al</i>. Consumption of high fructose corn syrup in
beverages may play a role in the epidemic of obesity. <i>Am J
Clin Nutr</i>. 2004; 79:537-43.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif";">U.S.
Department of Agriculture and the U.S. Department of Health and Human
Services. <i>Dietary Guidelines for Americans 2010</i>. Washington, DC: U.S. Department of
Agriculture and the U.S. Department of Health and Human Services, 2010.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="color: #1a1a1a; font-family: "Georgia","serif"; mso-bidi-font-family: "Lucida Sans Unicode"; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: JA; mso-fareast-theme-font: minor-fareast;">Berkey CS, Rockett HRH, Field AE, Gillman MW, Colditz GA. Sugar-added
beverages and adolescent weight change. <i>Obesity
Research</i> 2004;12:778–88.</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: JA; mso-fareast-theme-font: minor-fareast;">Ebbeling CB et al.
Effects of decreasing sugar-sweetened beverage consumption on body weight in
adolescents: A randomized, controlled pilot study. <i>Pediatrics</i> 2006; 117:
673-680.</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif";">Boston
Department of Public Health. Fat
Smack. Boston, MA: Boston Department of
Public Health. </span><a href="http://fatsmack.org/"><span style="font-family: "Georgia","serif";">http://FatSmack.org</span></a><span style="font-family: "Georgia","serif";">. <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">9.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Georgia","serif";">Boston
Department of Public Health. Fat
Smack. Boston, MA: Boston Department of
Public Health. </span><a href="http://fatsmack.org/drinking-sugar/"><span style="font-family: "Georgia","serif";">http://fatsmack.org/drinking-sugar/</span></a><span style="font-family: "Georgia","serif";">.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">10.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif";">Boston Department of Public Health. Fat Smack.
Boston, MA: Boston Department of Public Health. </span><a href="http://fatsmack.org/be-smart/"><span style="font-family: "Georgia","serif";">http://fatsmack.org/be-smart/</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">11.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Georgia","serif";">Edberg,
M. Individual Health Behavior Theories (pp. 35-47). In: Edberg, M. <i>Essentials
of Health Behavior</i>. Sudbury,
MA. Jones and Bartlett Publishers, 2007.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">12.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: JA; mso-fareast-theme-font: minor-fareast;">Janz NK, Becker MH. The health belief model: a decade later. <i>Health Education and Behavior</i> 1984;
11(1):1-47.</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">13.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: JA; mso-fareast-theme-font: minor-fareast;">Santrock JW. Physical and Cognitive Development in Adolescence (370-372).
In: Santrock JW ed. <i>Life-Span Development</i>.
McGraw Hill: New York, 2011.</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">14.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif";">Fortuna JL. The obesity epidemic and food addiction:
clinical similarities to drug addiction.
<i>Journal of Psychoactive Drugs</i>. 2012;44(1):54-63.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">15.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Georgia","serif";">Thomas
LW. A critical feminist perspective of
the health belief model: Implications for nursing theory, research, practice
and education. <i>Journal of Professional Nursing</i>.
1995; 11:4(246-252).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">16.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="color: #1d324f; font-family: "Georgia","serif"; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: JA; mso-fareast-theme-font: minor-fareast;">Evans WD, Hastings G. <i>Public Health Branding</i>. Oxford University Press; 2008. Available
at:
http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199237135.001.0001/acprof-9780199237135.
</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">17.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial; mso-bidi-font-style: italic; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: JA; mso-fareast-theme-font: minor-fareast;">Brehm,
JW. Psychological Reactance: Theory and
Applications. <i>Advances in Consumer
Research </i>1989; 16:72-75.</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
<div class="MsoEndnoteText" style="margin-left: .25in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">18.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Helvetica; mso-fareast-font-family: "MS Mincho"; mso-fareast-language: JA; mso-fareast-theme-font: minor-fareast;">Hicks J. The strategy behind Florida’s “truth” campaign. <i>Tobacco Control</i>. 2001;10:3-5.</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
<div class="MsoEndnoteText" style="margin-left: .25in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">19.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif";">The 84.
<i>The 84 home page</i>.
Massachusetts: The 84. </span><a href="http://the84.org/"><span style="font-family: "Georgia","serif";">http://the84.org</span></a><span style="font-family: "Georgia","serif";">. <o:p></o:p></span></div>
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Eric A Strattonhttp://www.blogger.com/profile/02213610553752385746noreply@blogger.com1tag:blogger.com,1999:blog-1572776051032236617.post-59497631705785349392013-01-30T12:53:00.000-08:002013-01-30T12:53:19.211-08:00Scaring Our Children: A Critique of Georgia’s Attempt to Fix the Childhood Obesity Epidemic – Yvonne Morales<br />
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<b><span style="font-family: "Georgia","serif";">Scaring Our Children: A
Critique of Georgia’s Attempt to Fix the Childhood Obesity Epidemic – Yvonne
Morales</span></b><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Introduction<o:p></o:p></span></b></div>
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<br /></div>
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<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">The
fact that childhood overweight and obesity is now an epidemic is no longer
news. Results from the 2007-2008 NHANES report found that childhood around
16.9% of children and adolescents 2 to 19 years old are obese (1). The number
of obese children has tripled since 1980 (2). The state of Georgia is one of
the hardest hit by this epidemic, only falling behind Mississippi. Four in ten
children are either overweight or obese in the state, the second highest in the
country (3). Overweight and obese children are now suffering from diseases we
use to think were only seen in adults (3). Children are suffering from joint
pain, sleep apnea, hypertension, liver disease, high cholesterol and Type 2
Diabetes, which we use to call adult onset diabetes (3). The severity of the
physical consequences of overweight and obesity action needs to reach a wide
audience.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Georgia","serif";"> Across the United States several
strategies have been implemented to help combat childhood obesity. Common food
policies implemented include altering the relative price of foods at schools,
shifting the exposure to food and trying to improve the image of healthy food
(4). Other strategies including increasing taxes on foods considered
“unhealthy” and increasing taxes on these same foods have been considered (4).
In Georgia the Children’s Healthcare of Atlanta Pediatric Hospital has taken
matters into their own hands and created a 5 year 25 million dollar program,
strong4life, aimed at reducing childhood obesity in the state (5). <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Georgia","serif";">This program started with the launch of a
media campaign, named “Stop Childhood Obesity”, aimed at raising awareness
about childhood obesity, which has created a lot of controversy nationwide (5).
Using the tagline “Stop Sugarcoating It, Georgia” the campaign, which includes
print and video ads, seeks to shock its citizens into action (5). The program
goes beyond this ad campaign and includes a movement they named strong4life and
other ads campaigns that were rolled out after the “Stop Childhood Obesity”
campaign (3). For the purpose of this critique only the ad campaign launched as
the first phase of the initiative will be discussed. In late 2011 and early
2012 when the campaign was launched a great deal of controversy was created.
Some praised its boldness and directness while other criticized it for making a
sensitive issue worse (5). The ads are shocking depicting sad little boys and
girls that are either overweight or obese in an effort to raise awareness to
childhood obesity. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Georgia","serif";">The campaign was very successful in
getting people talking about the issue. A Google search for “Georgia childhood
obesity ads” yields 322,000 results in 0.48 seconds. The campaign is so recent
that we still don’t have any evidence on its ability to change what it set out
to do yet many critiques agree that the possibility that it will do more harm
than good is real (5). Even though it caused a stir the ad campaign fails to
properly combat childhood obesity by alienating its target audience, failing to
provide a viable model for children to follow and fails to create community
awareness to the issue.<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Georgia","serif";">Critique 1: Stigmatizes
overweight and obese children <o:p></o:p></span></b></div>
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<br /></div>
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<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">One
of the print ads for the campaign stars an overweight girl who seems to be
around 9 years old. She is staring into
the camera arms crossed, a banner runs at the bottom of the page, “WARNING:
It’s hard to be a little girl if you’re not” (5). This is one of the images
being plastered on billboards and online in Georgia. The other images are
accompanied by the caption, “My fat may be funny to you but it’s killing me”,
and “Fat prevention begins at home. And the buffet line” (6). The ads aimed at
propelling parents and children into action may be instead further stigmatizing
overweight and obese children. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">Stigmatizing includes but is not limited
to verbal teasing, physical bullying and relational victimization (7). Studies
have shown that overweight and obese children are already the victims of bias
and stereotyping by peers, educators and even parents (7). This has been well
documented in scientific literature for more than 40 years (7). In a seminal
study by Richardson et al in 1961 640 school children 10 and 11 years old were
instructed to rank the pictures of six children in order of whom they would
rather be friends with (7). The pictures included children with disabilities,
and overweight child and an average child with no disabilities (7). On average
the overweight child was ranked last and deemed least likeable (7). Many other
studies have confirmed these findings (7). Stigmatizing associated with depression,
low-self esteem, body dissatisfaction and difficulty establishing interpersonal
relationships (7). So instead of pushing these children into action they are
being pushed further into a cycle of low self-esteem, depression and further
weight gain. <o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Georgia","serif";">Critique 2: Fails to promote
self-efficacy <o:p></o:p></span></b></div>
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<br /></div>
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<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">One
of the video ads titled “Video Games” that forms part of the campaign stars Jaden,
a young African-American boy, who likes to play video games, by himself, so he
doesn’t have to be around the other kids that make fun of him (8). The ad is
very effective in showing how lonely being overweight or obese can be. Most
children that are overweight or obese already know this. The campaign “Stop
Childhood Obesity” seems to be based in part on the health belief model. This
model stipulates that there are six main constructs that propel people into
action (9). These include perceived susceptibility, perceived severity, perceived
benefits of taking action, perceived barriers, cues to action and self-efficacy
(9). Self-efficacy refers to a person’s belief in his or her ability to take
the action (10). The ad depicts Jaden in a dark light, and he talks about how
he retreats to his video games so he doesn’t have to be around other kids.
Jaden is not being given the tools or even told that he can change his
situation. It seems he is condemned to playing video games, since “being fat
takes the fun out of being a kid” (8). Every single ad that forms part of this
campaign ends on a negative not or makes you feel sad. If as an adult looking at this you don’t feel
empowered to make a change, children will not either. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> This campaign was designed to raise
awareness and create a buzz around the issue. It accomplished that but, how
effective is an intervention that fails to empower those that they intend to
help. Another huge issue with the campaign ads that only depict children in
them is that they make it seem that this is an individual issue. Given the large range of factors that
contribute to childhood obesity it is clear that this is not an individual
issue (11). Those behind the campaign, Children’s Healthcare of Atlanta, do
admit that what they want to do is push parents into action saying that they
need to be pushed out of a state of denial (12). Yet, they are not transmitting
a message that promotes self-efficiency to parents either. None of these ads
even suggests a course of action to be taken, we are just asked to stop
sugarcoating it. Studies, like the one conducted in Australia by Lewis et al.
have shown that obesity public health campaigns can cause more harm than good
when targeted to adults (13). It would be interesting to study the effect these
ads are having on parents. They are probably having similar effects, which
included feeling stigmatized and blamed for their situation (13). <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Critique 3: Fails to create
a model for children to follow<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";">A TV ad shot in black and white stars
Bobby and his mother, they are sitting face to face on two foldable chairs.
Bobby asks his mom point blank, “Mom, why am I fat (14) ?” The conversation is
set in the same tone all the other ads portray, dark, cold and seemingly hopeless.
By bringing in Bobby’s mother into the picture the campaign is bringing in the
environment into the picture. The Social Cognitive Theory (SCT) describes the
dynamic in which personal factors, environmental factors and human behavior
influence each other (10). The SCT says that there are three main factors that
will increase the probability that a person will change a health related
behavior (10). These factors are self-efficiency, goals and outcome
expectancies (10). This theory later evolved to the Social Learning Theory that
postulates that people learn by observing others, this is where this campaign
fails completely (10). <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Georgia","serif";">Bobby isn’t given even a suggestion or anything
that resembles an answer (14). We are just told, “75% of Georgia parents with
overweight kids don’t recognize the problem” (14). So even if we look at the ad
from the perspective of a parent that may have an overweight child and doesn’t
recognize it we are not told how to do this. There is no suggestion of behavior
to model at all. This is another huge missed opportunity. If we want to get
parents on board with the program we have to show them where the door is. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";"><br />
Proposed Intervention<o:p></o:p></span></b></div>
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<br /></div>
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<span style="font-family: "Georgia","serif";">Successful interventions need to have
impact on the individual and societal levels (11). Relying solely on children
or even children and their parents to solve the childhood obesity crisis would
be wasting some of the most important resources we have as a society, each
other. An effective intervention that
will help combat childhood obesity in state like Georgia where the prevalence
is high is to include everyone in the fight, not alienate those affected and
make them feel like they are to blame. Yes, there is some blame to assign but
this will not solve the problem. Working together and making the solution as
easy as possible is the way to go.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Georgia","serif";"> A great example of a campaign doing
just this is the do® groove campaign created by Blue Cross Blue Shield of
Minnesota (15). This campaign targets adults but could serve as a great model
for a children’s campaign. The campaign features TV, print and online ads that
promote a positive message towards achieving meaningful weight loss. The ads
for the do® groove campaign include taglines like, “walk a mile in your own
shoes”, “we hear the Joneses have been exercising”, “Groove. Breathe. Repeat.”,
“put some step in your spring” among others (15). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">The TV ads star everyday people sharing
their successful weight loss stories weight loss stories (15). The factor that
is key here is that the people sharing their stories are not now super skinny
health fanatics. They are people that are still in the trenches still
struggling with the problem (15). Modeling a program for children that provides
relatable models for both parents and children and empowers them to take action
could be more successful that scaring children and pointing the blame at
parents. A great way that the do® groove ads used advertising theory is that
added a comedic element to the TV spots that is consistent throughout. The same man appears at the end of all the
ads, he stars in one, and invites everyone sharing their story to “groove” with
him. Ending the spot with an uplifting moment even if the story might not have
been. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The Stop Childhood Obesity campaign
makes good use of advertising theory and marketing theory. These strategies
should be continued in the new campaign, with a different tone. The ads in
Georgia were very effective at getting the community talking. Every media
outlet picked up the story and discussed at length. This is a great way to et
even more exposure and even free advertising for the campaign. Finding a
creative way to accomplish this in a more positive tone will be hard since
usually this type of attention goes to controversial topics (5). Making use of
creative agencies and experts in advertising could help achieve this goal. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Defense 1: Providing a
model to follow<o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> In the stop childhood obesity
program that I am proposing TV ads would feature children that have been
successful at losing weight. This will provide children with a model from which
they can learn. According to the Social Learning Theory observational learning
or modeling is behavioral changes that occur by watching the actions and
outcomes of other’s (10). Portraying children that have been successful or are
currently trying to lead a healthier lifestyle is important. The current
campaign in Georgia doesn’t give children a better model to follow. Overweight
and obese children need to see that changing is possible and shown how to do
it. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> A second model that also needs to be
provided is a parental model of how to help your child lose weight. Many
parents don’t know how to help their children. Instead of casting them in the
role of enabler or cause like they do in the Stop Childhood Obesity ads we can
cast them in the role of support or better yet example. Getting parents to lead
a healthy lifestyle will at the same time help children lead a healthy
lifestyle. In other words providing parents a model on how to be good role
models for their children. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Defense 2: Create a sense
of community<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";"> <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">The
initiative should create a sense of community; we got into this problem
together we will fix it together. The cause of childhood obesity can be simplified
to an excess delivery of calories (11). How we ended up having children that
consume an excess amount of calories and don’t exercise enough is extremely
complicated (11). So blaming the current generation of children and their
parents for letting their weight get out of control is absurd. The current
obesity epidemic is the result of many factor coming together is a sort of
perfect storm. Many of these factors that caused the childhood obesity
epidemics are environmental. If the
cause of the problem lies in the community so can the solution. According to
the Social Cognitive Theory there is a dynamic process in which personal
factors, environmental factors and behavior influence each other (10). Changing
one of the three factors will later cause changes in the other two. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Defense 3: Create a sense
of self-efficacy <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">One
really important thing that creating a sense a community and providing both
children and parents a model to emulate does is that it creates a sense of
self-efficacy. Each of these factors act together to empower both children and
their parents. Some consider self-efficacy the most important personal factor
that leads to behavior change (10). Its the factor that appears in every
behavior change model (10). If self-efficacy is created this will eventually
lead to action. In order for this to happen the campaign has to provide easy to
follow and easy to access steps for both children and parents to take. Again
looking at the do® groove campaign as an example they have a tab on the website
called “Get Started Now” (15). Here people can find 3 easy steps that will get
them on their way to a healthier lifestyle (15). A similar approach can be
taken and adapted to children. There is still a lot to learn about how to
motivate children to lose weight without causing eating disorders in the
process (6). So instead of asking people to find their healthy weight like on
the do® groove website children could be asked to set other type of achievable
goals which are important to change behaviors (10). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Conclusion<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The childhood obesity epidemic is a
real problem that must be dealt with now. The Children’s Healthcare of Atlanta
Pediatric Hospital has that much right there is no more time to waste when it
comes to confronting the issue and finding a solution. The way they are going
about this is going to cause more harm than good. Further stigmatizing an
already vulnerable population without proving actions to be taken can make the
problem worse. We can stop sugarcoating
the issue without scaring a generation of vulnerable children. The Do® groove
campaign created by Blue Cross Blue Shield of Minnesota does this for adults
(15). A similarly positive and serious campaign can be crafted for children.
Empowering them during a very vulnerable stage of life can create better end
results. We need to stop sugarcoating the issue across the country; we just
have to be careful not to create a bigger problem. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-family: "Georgia","serif";">References<o:p></o:p></span></b></div>
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Gray, E. (2012, January 3). Georgia Anti-Obesity
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">National Cancer
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Childhood Obesity: “Why am I Fat?”</span></i><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"> (2011). Retrieved from </span><a href="http://www.youtube.com/watch?v=ysIzX_iDUKs&feature=youtube_gdata_player"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">http://www.youtube.com/watch?v=ysIzX_iDUKs&feature=youtube_gdata_player</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia; mso-fareast-language: EN-US;">15.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">What is Do Groove, How Can it Help You Get
Healthier & more. (n.d.). Retrieved December 13, 2012, from </span><a href="http://www.do-groove.com/about"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">http://www.do-groove.com/about</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><o:p></o:p></span></div>
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Eric A Strattonhttp://www.blogger.com/profile/02213610553752385746noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-4572069746448218242013-01-30T12:48:00.000-08:002013-01-30T12:48:40.318-08:00Banning Large Sodas to Decrease Obesity- A Critique on New York Soda Ban- Disha Shah<br />
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<b><span style="color: #222222; font-family: "Georgia","serif"; font-size: 14.0pt; line-height: 200%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Banning Large Sodas to Decrease Obesity-
A Critique on New York Soda Ban- Disha Shah<o:p></o:p></span></b></div>
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<b><u><span style="color: #222222; font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Introduction:<o:p></o:p></span></u></b></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Obesity
is one of the most daunting challenges for the public health, worldwide.
Obesity rates in the United States are among the highest in the
world. According to CDC, during the past 2 decades, there has been a dramatic
increase in the obesity trend in the United States. More than one-third of U.S.
adults (35.7%) and approximately 17% of children and adolescents aged 2—19
years are obese.<sup>1</sup><b><span style="color: #222222; mso-font-kerning: 18.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">The prevalence of obesity in New York State is
24.5%.<sup>2</sup> As a step to control obesity, Mayor Bloomberg imposed a ban
on super-sized sugary beverages larger than 16oz in public places such as
restaurants, food carts, movie theatres, and delis. The ban won’t impact fruit
juices, milkshakes, diet sodas or alcoholic drinks.<sup>3</sup></span><span style="background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif; font-size: 12pt; line-height: 200%;"> </span><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial;">Enforcement would be conducted by an existing corps of city restaurant
inspectors. A violation of the law would lead to a $200 fine<span style="background-position: initial initial; background-repeat: initial initial;">.</span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"> This type of ban is first of its kind, and is
becoming a growing national debate.</span><span style="background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif; font-size: 12pt; line-height: 200%;"> The city pioneered in banning trans-fats, and it subsidizes
fruits and vegetables for the poor through its Health Bucks program</span><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">.<sup>5</sup> The intention behind this soda ban is
to cut the intake of excessive calories from the large sized soda, thus to
control obesity. Thomas Farley, commissioner of New York City’s Health
Department, writes that if the new regulation “leads to New Yorkers simply
reducing the size of one sugary drink from 20 ounces to 16 ounces every other
week, it would help them avoid gaining some 2.3 million pounds a year.”<sup>3 </sup>Thomas
Farley may be right here, but there are so many alternatives to a supersized
soda, which might be responsible for obesity, and which are not addressed by
this ban.<o:p></o:p></span></div>
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<b><u><span style="color: #222222; font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Critiques: <o:p></o:p></span></u></b></div>
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<!--[if !supportLists]--><b><span style="color: #222222; font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #222222; font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Does Not Create a Sense of Perceived Susceptibility:<o:p></o:p></span></b></div>
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<span lang="EN-IN" style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial;">To start with
the flaws, the proposed ban on large, sugary drinks actually is not really a
ban on anything. According to the ban, people will not get the choice of drinks
larger 16oz. A large drink of soda (34 oz.) has about 108g of sugar.<sup>4 </sup>A small sized drink (16 oz.) has about
39g of sugar. People still aren’t completely prevented from drinking
soda. It doesn’t cover beverages sold in supermarkets or most convenience
stores (which are not regulated by the city). Drinks are also exempt if they
contain more than 50 percent milk (so people are permitted to have a large
Frappuccino with whole milk and sugar, which might contain more calories than a
large soda). Alcoholic beverages are not included in the ban as well.
"This is the largest single driver of the obesity epidemic," said Dr.
Thomas Farley, health commissioner of the city. "It is the largest source
of added sugars to our diet."<sup>6</sup> So what about the sugar content
in 16 oz. drinks? Is it safe to consume 16 oz. soda? Or is it safe to have 2-3
donuts on a daily basis? So looking to all these aspects, the ban on large
drinks is not a ban at all. According to Health Belief Model, </span><span lang="EN-IN" style="font-family: "Georgia","serif";">perceived susceptibility, also
called perceived vulnerability, refers to one's perception of the risk or the
chances of contracting a health disease or condition.<sup>9</sup> One of the important determinants is whether or not a
person believes that the problem could happen to him or her. If people think
that they cannot get a particular disease or have a particular problem, they
often will not take an action to prevent it. By imposing a ban on large drinks,
people are not informed about the harmful effects of the smaller portions of
drinks which can be equally responsible to be one of the factors contributing
to obesity. Also, other high calorie food are not being identified as risk
factors and people are not made to understand that they are susceptible to
obesity if they drink ‘soda’ and not if they drink ‘large soda’.<o:p></o:p></span></div>
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<!--[if !supportLists]--><b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 115%;">Invokes
Psychological Reactance:<o:p></o:p></span></b></div>
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<span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Psychological reactance is an aversive
affective reaction in response to regulations or impositions that impinge on
freedom and autonomy.<sup>10 </sup><span style="background: white;">Psychological
reactance occurs in response to threats to perceived behavioral freedoms. If a
person’s behavioral freedom is reduced or threatened, the person will become
motivationally aroused. Because of the fear of losing the freedom of that
particular behavior, they get motivated to restore their freedom, by doing
exactly opposite of what is desired. This brings them a sense of
‘re-establishing’ their freedom and regaining back the control of their lives.<sup>13</sup>
This ‘boomerang effect’ is psychological reactance.<o:p></o:p></span></span></div>
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">According to the above
explanation for invoking reactance in the masses, it can be concluded that this
policy has all the ingredients to invoke the reactance in the target
population. </span><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">6 in 10 New York residents were
in opposition of this ban.<sup>11<o:p></o:p></sup></span></div>
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">This policy is actually not a ban, just a cap on
large sodas. But it has been framed as a ‘ban’. This is one of the factors
giving rise to ‘liberty issues’ and ‘freedom to choice’ in the target
population. The soda companies will be affected directly by this policy. The
American Beverage Association, whose members could stand to lose millions of
dollars in revenue if the mayor’s plan is approved, has argued that there is
little correlation between soft drinks and obesity. </span><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">The
industry group has led a big-budget public-relations effort urging New Yorkers
to “make their own choices” on soda. These commercials are being aired on local
television and radio. <span style="background-color: white; background-position: initial initial; background-repeat: initial initial;">This has added
to contribute in the psychological reactance.<o:p></o:p></span></span></div>
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Many researches show that when people are restricted
or told to exhibit certain behavior, they choose to do exactly the opposite of
what they are being told.<sup>12</sup> <o:p></o:p></span></div>
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">This is one of the major flaws of this
intervention. It completely violates the psychological reactance theory. </span><span style="background: white; font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial;">“I know what’s best for you” kind
of attitude has created an image of ‘nanny Bloomberg’.<sup>14</sup></span><sup><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif; font-size: 12pt; line-height: 200%;"><o:p></o:p></span></sup></div>
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<span style="background: white; font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial;">In general, policy makers should
be aware of reactance and should recognize that individuals may respond in a
counterproductive manner to policies that appear to threaten their ability to choose
freely.</span><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><b><span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Violates the Social
Cognition Theory<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial;">According
to social cognition theory, self efficacy and environmental factors<b><i> </i></b>play
an important role in determining whether a person will change health behavior. In
this case, environmental factors are not in favor of the desired behavior. The
change does not make a favorable environment for the public to show the desired
behavior. <span style="background-position: initial initial; background-repeat: initial initial;">It's important to look at
where people acquire such large drinks. An average New Yorker does not go to a
movie theatre often, and attends sports venues even less regularly. In fact
going to a grocery or a convenient store are much more common occurrences. So
there is every possibility of the city resident buying his/her drink from such
stores<b><i> </i></b>and gulp as much as soda he/she wants relaxing at home. The
ban does not consider the complexity of how and why people acquire food and
drink, and instead applies a simplified solution to a layered problem. It does
nothing to do the self efficacy of the people or does not consider creating a
‘healthy’ environment. Thus, it is likely, that the desired behavior cannot be
obtained in the target population. Self efficacy which means strong intention,
knowledge and skills to carry out likely behavior is a strong determinant of
human behavior. This behavior is reinforced when there are no or very less
environmental constraints and rewards for change in behavior. By introducing
ban, the self efficacy of the people is being questioned. ‘Ban’ seems to be
more like an enforcement, which in social sciences can be called a ‘punishment’
without obvious rewards. Punishment is less effective than reinforcement for
teaching and modifying behavior.<sup>8</sup></span></span><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">
Moreover this policy fails to reach at the core of the issue by not being able
to change core belief of the target population. They are not able to achieve
this because still there are plenty of catchy advertisement floating all over
media which lure them to buying more and more of unhealthy drink. Have they been
able to add a knowledge element simultaneously such as making it compulsory to
show that drink consumed in large portions is harmful to health just like it is
mentioned on the cigarette packs.</span><span style="background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif; font-size: 12pt; line-height: 200%;"> Therefore, it is pretty much less likely to
impact New Yorkers in reducing obesity. On the contrary ban portrays something
which restricts freedom and people tend to believe that their choices are
controlled by higher authority and this will cause fewer acceptances and
eventually will not modify behavior which is primary goal for introducing this
policy.</span><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
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<b><u><span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Conclusion:<o:p></o:p></span></u></b></div>
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<span style="background: white; font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Arial;">Articles published in some of the medical
journals suggest that rising levels of obesity may be linked to increases in
soft drink portion sizes; this implies that reducing the consumption of sugary
beverages may lead to better health outcomes. However, the manner in
which Mayor Bloomberg is attempting to achieve this goal ignores a number of
important insights from behavioral science. It
stimulates rebellion and distrust with elected officials. If we want people to
drink less soda then we have to make people not want it and not telling them
that they can’t have it.</span><b><u><span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;"><o:p></o:p></span></u></b></div>
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<b><u><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Counter-proposals for the critiques:<o:p></o:p></span></u></b></div>
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<!--[if !supportLists]--><b><span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Counter-proposal for critique 1: <o:p></o:p></span></b></div>
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<span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">As stated in critique 1, a state of
perceived susceptibility is not being demonstrated by this policy. There have
been researches conducted which demonstrate that perceived susceptibility leads
to a desired behavior.<sup>15<o:p></o:p></sup></span></div>
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<span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">To develop a perceived susceptibility
amongst people regarding the fact, that high calorie drinks such as soda, can
lead to obesity, number of things can be done. One way is to create a graphic
warning (and not verbal message) on the soda cups. For example, the large cups
of soda should portray a fat, obese family with a sad pictorial representation
of heart. And on small cups, a slim, healthy family with a smiling heart. In this way, the message can be conveyed
implicitly and obesity can be projected as a ‘cardio-vascular hazard’ and not
just ‘being fat’. <o:p></o:p></span></div>
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<span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;"> This can be mandated to all the large sized
high-calorie drinks and not just soda. Thus, it will be considering for all the
drinks which contribute to obesity and not just soda. Pictures can help to increase
the message’s accessibility by people with low levels of literacy and can help visualize
the actual message to be conveyed. Color pictures can be used to make it more
effective and attractive. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">These types of graphic warnings are
made mandatory on the cigarette packs. Researchers have shown that these
warnings are actually effective to decrease the rates of smoking.<sup>16<o:p></o:p></sup></span></div>
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<!--[if !supportLists]--><b><span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Counter-proposal for critique 2:<o:p></o:p></span></b></div>
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<span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">As stated in critique 2, a ‘ban’ can
induce a reactance in the target population, even though it is not ban but just
a cap. There are many possible actions which can be taken to decrease the
reactance. One simplest way is taxation on the sugary beverages. This type of
‘soda tax’ has already been imposed in certain states in US and has been
effective.<sup>17</sup> Such tax can be imposed on all high calorie drinks and
not just soda.<sup> </sup>Another option is increasing the price of drinks and
discontinuing the increase volume discounts. <o:p></o:p></span></div>
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<span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Along with this, messages should be
effectively conveyed with the help of popular celebrities regarding relation
between high calorie diet and obesity. </span><span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">The media and especially actors and actresses
have a huge influence on today’s youth. If these celebrities are sought to
educate the masses what is right for their health, it will have a much higher
impact and will be acceptable as they are not forced but are shown a direction
towards healthy living from their role model.</span><span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;"><o:p></o:p></span></div>
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<span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Simultaneous implementation of these
steps may lead to decrease the psychological reactance as well as see the
desired behavior. <o:p></o:p></span></div>
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<!--[if !supportLists]--><b><span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Counter-proposal for critique 3:<o:p></o:p></span></b></div>
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<span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Self efficacy
and environmental factors play an important role in determining behaviors of
the population. So it is very important to look at the issues pertaining to the
self efficacy and environmental factors when planning to change the behavior of
the populations. Here the word ‘ban’ causes havoc as it is in direct conflict
to the behavior we want to achieve. This causes negative reinforcement as it
tend to make people think that they are being controlled and they do not have
right to choose what they want. Instead of banning the choices that people
want, one should focus on adding a knowledge element so that it can help people
make better choices. Environmental factors can be controlled by imposing a soda
tax. So, people have to pay more at all the places from where they can get a
soda, and not just movie theatres or a restaurant.<o:p></o:p></span></div>
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<span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Regarding self efficacy, it has been found that self efficacy
operates best in concert with general life style changes, including physical
exercise and provision of social support. Self-confident clients of
intervention programs were less likely to relapse to their previous unhealthy
diet. Chambliss and Murray (1979) found that overweight individuals were most
responsive to behavioral treatment where they had a high sense of efficacy and
an internal locus of control. Other studies on weight control have been
published by Bagozzi and Warshaw (1990) and Sallis, Pinski, Grossman, Patterson
and Nader (1988).<sup>18 </sup> Self
efficacy can be increased by increasing
self-confidence of the people. One way to do this is to start a campaign
named “I can do it by myself!” Through such campaigns, the obese and
over-weight people can be motivated to reduce their weight and improve their
life style by giving them real life examples from people who have been
successful in doing so. Also, the people who achieve their goals can be
rewarded (like replacing the previous people in the campaign commercials). This
can act as a positive reinforcement. <o:p></o:p></span></div>
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<span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Exercise should be made a part of school curriculum. It should be
made compulsory in every school for the students to take part in any form of
exercise, such as yoga, dance, or other gymnastics. This way, we can make them
efficient to live a healthy life style from their childhood.<o:p></o:p></span></div>
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<span style="font-family: Georgia, serif; font-size: 12pt; line-height: 200%;">Thus, it should be our fight against “obesity” and not “soda
consumption”.<o:p></o:p></span></div>
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<b><u><span style="color: #222222; font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"> References:<o:p></o:p></span></u></b></div>
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<div class="MsoListParagraphCxSpFirst" style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">Obesity and Overweight for Professionals: Data and Statistics: Facts -
DNPAO - CDC. (n.d.).<em>Centers for Disease Control and Prevention</em>. Retrieved from </span><a href="http://www.cdc.gov/obesity/data/facts.html"><span style="background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">http://www.cdc.gov/obesity/data/facts.html</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">Obesity and Overweight for Professionals: Data and Statistics: Adult
Obesity - DNPAO - CDC. (n.d.).<span class="apple-converted-space"> </span><em>Centers for
Disease Control and Prevention</em>. Retrieved from </span><a href="http://www.cdc.gov/obesity/data/adult.html"><span style="background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">http://www.cdc.gov/obesity/data/adult.html</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="color: #222222; font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Georgia","serif";">N.
(2012, September 14). Why Soda Ban Will Work In Fight Against Obesity; Food
Regulations Have Proven Record. Forbes.</span><span style="color: #222222; font-family: "Georgia","serif"; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">How Much Sugar in Sodas and Beverages? (n.d.).<span class="apple-converted-space"> </span><em>Sugar
Stacks - How Much Sugar Is in That?</em>. Retrieved from
http://www.sugarstacks.com/beverages.htm</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="background: white; color: #222222; font-family: "Georgia","serif"; mso-bidi-font-family: Arial;">D. (n.d.). New York
City looks out for health of its own; It's a shame the notion that governments
should promote well-being is so derided.<span class="apple-converted-space"> </span><em>newsday</em>.</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="background: white; color: #222222; font-family: "Georgia","serif"; mso-bidi-font-family: Arial;">Large-size soda pop
likely to be banned in NYC. (n.d.).<span class="apple-converted-space"> </span><em>korea times</em>.</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">7.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">New Yorkers for Beverage Choices | The Facts.
(n.d.).<span class="apple-converted-space"> </span><em>New Yorkers for Beverage Choices</em>.
Retrieved from </span><a href="http://nycbeveragechoices.com/the-facts/"><span style="background: white; font-family: "Georgia","serif";">http://nycbeveragechoices.com/the-facts/</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">8.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">Leach, D. (n.d.). Using Positive Reinforcement to
Increase Desired Behaviors | Butterfly Effects. Retrieved from </span><a href="http://www.butterflyeffects.com/articles/using-positive-reinforcement-to-increase-desired-behaviors"><span style="background: white; font-family: "Georgia","serif";">http://www.butterflyeffects.com/articles/using-positive-reinforcement-to-increase-desired-behaviors</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">9.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">Theories and Approaches. (n.d.). Retrieved from </span><a href="http://recapp.etr.org/recapp/index.cfm?fuseaction=pages.theoriesdetail&PageID=13"><span style="background: white; font-family: "Georgia","serif";">http://recapp.etr.org/recapp/index.cfm?fuseaction=pages.theoriesdetail&PageID=13</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">10.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">Psychological reactance theory Psychlopedia
psych-it.com.au. (n.d.). Retrieved from </span><a href="http://www.psych-it.com.au/Psychlopedia/article.asp?id=65"><span style="background: white; font-family: "Georgia","serif";">http://www.psych-it.com.au/Psychlopedia/article.asp?id=65</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">11.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">Grynbaum, M. (2012, August 22). 60% in City
Oppose Bloomberg’s Soda Ban, Poll Finds.<span class="apple-converted-space"> </span><em>the new york times</em>.</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">12.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">Abel ,
Barksdale. (2012). Freedom of choice and adherence to the health regimen for
african americans with hypertension.<span class="apple-converted-space"> </span><em>Ans Adv nurs sci</em>. Retrieved from </span><a href="http://www-ncbi-nlm-nih-gov.ezproxy.bu.edu/pubmed/22918261"><span style="background: white; font-family: "Georgia","serif";">http://www-ncbi-nlm-nih-gov.ezproxy.bu.edu/pubmed/22918261</span></a><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">.</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">13.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">Quick BL,
Bates BR. (2010). The use of gain- or loss-frame messages and efficacy appeals
to dissuade excessive alcohol consumption among college students: a test of
psychological reactance theory.<span class="apple-converted-space"> </span><em>J Health Commun</em>. Retrieved from </span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<a href="http://www-ncbi-nlm-nih-gov.ezproxy.bu.edu/pubmed?term=20812123"><span style="background: white; font-family: "Georgia","serif";">http://www-ncbi-nlm-nih-gov.ezproxy.bu.edu/pubmed?term=20812123</span></a><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">.<o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">14.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">'Nanny
Bloomberg' Ad In New York Times Targets N.Y. Mayor's Anti-Soda Crusade. (2012,
June 4).<span class="apple-converted-space"> </span><em>Huffington post</em>. Retrieved from </span><a href="http://www.huffingtonpost.com/2012/06/04/nanny-bloomberg-ad-in-new_n_1568037.html"><span style="background: white; font-family: "Georgia","serif";">http://www.huffingtonpost.com/2012/06/04/nanny-bloomberg-ad-in-new_n_1568037.html</span></a><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">.</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">15.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">Rahman M,
Berenson AB, Herrera S. (2012). Perceived susceptibility to pregnancy and its
association with safer sex, contraceptive adherence and subsequent pregnancy
among adolescent and young adult women. Retrieved from </span><a href="http://www-ncbi-nlm-nih-gov.ezproxy.bu.edu/pubmed/23083528"><span style="background: white; font-family: "Georgia","serif";">http://www-ncbi-nlm-nih-gov.ezproxy.bu.edu/pubmed/23083528</span></a><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">.</span><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">16.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="background: white; font-family: "Georgia","serif"; mso-bidi-font-family: Arial;">TOBACCO WARNING LABELS: EVIDENCE OF EFFECTIVENESS. (n.d.).<em>www.tobaccofreekids.org</em>.
Retrieved from http:// </span><a href="http://www.tobaccofreekids.org/research/factsheets/pdf/0325.pdf"><span style="background: white; font-family: "Georgia","serif"; mso-bidi-font-family: Arial;">www.tobaccofreekids.org/research/factsheets/pdf/0325.pdf</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">17.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">Why Mike
Bloomberg’s 'Soda Ban' Could Actually Work. (2012, September 14).<span class="apple-converted-space"> </span><em>the
daily beast</em>. Retrieved from </span><a href="http://www.thedailybeast.com/articles/2012/09/14/why-mike-bloomberg-s-soda-ban-could-actually-work.html"><span style="background: white; font-family: "Georgia","serif";">http://www.thedailybeast.com/articles/2012/09/14/why-mike-bloomberg-s-soda-ban-could-actually-work.html</span></a><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">.</span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">18.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia, serif;">Ralf
Schwarzer & Reinhard Fuchs (n.d.). Self-Efficacy and Health Behaviours.<span class="apple-converted-space"> </span><em>Userpage
< ZEDAT < ZEDAT - Hochschulrechenzentrum</em>. Retrieved from </span><a href="http://userpage.fu-berlin.de/~gesund/publicat/conner9.htm"><span style="background: white; font-family: "Georgia","serif";">http://userpage.fu-berlin.de/~gesund/publicat/conner9.htm</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
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Eric A Strattonhttp://www.blogger.com/profile/02213610553752385746noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-56149243989466797072013-01-30T12:42:00.003-08:002013-01-30T12:42:47.391-08:00How Drug Abuse Resistance Education Did Anything But Educate Our Youths to Resist Abusing Drugs - Kevin Rix<br />
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<b><span style="font-family: "Georgia","serif";">How Drug Abuse Resistance
Education Did Anything But Educate Our Youths to Resist Abusing Drugs - Kevin Rix<o:p></o:p></span></b></div>
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<b><span style="font-family: "Georgia","serif";">Introduction<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";">A program that is used in 75% of school
districts in the United States and 43 countries throughout the world in most
cases would be widely considered as one of the most effective public health
programs (1). In the case of the Drug Abuse Resistance Education (D.A.R.E.)
program which was established in 1983 by Police Chief Daryl Gates of the Los
Angeles Police, it may be one of the most widely spread failures that has ever
existed, and it is still being used today (1). The premise of D.A.R.E. was to
have police officers come into schools over a ten-week period and teach students
about the dangers associated with the use of illegal drugs. According to
D.A.R.E., the group has reached over 36 million students world wide, and 26
million students in the United States (1). Though they’ve been able to reach
this many students most research would suggest that this is not a positive
thing. In 2001, the United States Surgeon General released a statement that
categorized D.A.R.E., as an “ineffective primary prevention program”, and that
D.A.R.E. was counterproductive in some communities, which caused graduates to
be among the groups who tended to use drugs (4). This became so alarming that
as of 2004, D.A.R.E. America is under investigation to lose all governmental
funding, because the U.S. Department of education prohibits funding ineffective
drug prevention programs, and since this report, D.A.R.E. has lost nearly 80%
of its federal funding (15).<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> In a 1992 study performed at the
University of Illinois at Chicago, graduates of the D.A.R.E. program were found
to be at much higher rates of using illegal drugs (2). This was especially
prevalent in the use of marijuana, which saw 10.2 percent of 8<sup>th</sup>
graders in 1991 reported using marijuana to 19.9 percent in 1995 (2). The
increase in marijuana use flies directly in the face of the D.A.R.E. program at
its apex, with students who were exposed to the program in the late 1980s. In 1998, psychologist William Colson stated,
“As they get older, [students] become very curious about these drugs they’ve
learned about from police officers (3). The use of police officers as the
messengers was one of the largest of
many mistakes the D.A.R.E. program used in trying to prevent kids from using
drugs, because it provided adolescents with a speaker they could not relate to,
who could not be a model for them to think about during tough times, and
essentially was telling them what to do.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Critique 1- Do Kids Want To
Listen to Cops?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">At
first glance, having an authority figure who is able to not only explain the
dangers of using drugs to kids, but also the legal repercussions that they
could face one day if they decided to use drugs. For the most part, police
officers are role models for young kids, with position in society school
departments would look at them as a group that would be ideal to talk to their
developing students on why the use of illegal drugs is going to hinder them in
the long run. The major problem and concern is that the use of police officers
are not directly relatable to the students they are trying to convey a message
to. By using police officers as the main
communicators of the message of trying to prevent kids from using drugs,
proponents of the D.A.R.E. program do not adhere to a primary factor in
communication theory, of making the speaker relatable or likeable.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The youth population is among the
toughest to reach and relate to in the United States. In most studies
conducted, the student’s perspective on how they felt the D.A.R.E. program was
being carried out was overlooked, in favor for how the teachers in their classroom
were seeing it. In a study in the Journal of Alcohol and Drug Education,
researchers looked at “Educator perceptions of the D.A.R.E. officer”, to see
how those who were delivering the message were received in schools (5). This
study showed that the D.A.R.E. program was being seen in a positive light
overall, and that approximately 2/3 of educators viewed the D.A.R.E. program as
being positive (5). The major problem with this is that it is the educator’s
perspective. Teachers evaluated this program based upon how they perceive
teaching should go about. This failed to measure student’s perception of the
officer’s in their classroom and how they believed their education was going.
The message being delivered was a positive one of not taking drugs, but the students
were not hearing it from someone they could relate to. A police officer in a
classroom setting is another adult teacher to the students. Students exposed to
the D.A.R.E. program were mostly in the elementary school level, and those
students would grow up to find the drugs they learned about as kids to see the
effects they had for themselves (6). The inability for a police officer to
relate to a group of nine to thirteen year olds caused the D.A.R.E. program fail
the first basic of “communication theory”. Likeability is the first step to
being successful at getting a person to change his or her mind about something,
D.A.R.E. assuming a cop is likeable enough as a person, did not realize that
likeability meant that the kids enrolled in the program needed to accept a
police officer not only as a messenger, but someone the students felt would
want to like on a personal level.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Critique 2- You know what
will get kids on our side…. Taking away Freedom<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> In the process of getting youths to
avoid using illegal drugs, the D.A.R.E. campaign capitalized on the idea that
if the kids were to sign a pledge saying they wouldn’t use drugs, then all the
kids the would feel morally obligated to not use drugs. The major problem with
the decisions of the D.A.R.E. campaign was that by having the kids sign this
pledge, the students were not gaining anything, just losing freedom. D.A.R.E.
is a program that is run in the classrooms in the elementary to middle school
level. Each student enrolled in the classroom is forced to sign the petition
and in return get a free t-shirt that says “D.A.R.E. To Resist The War On
Drugs”. Students being told that they are going to be drug free, without making
the choice for themselves goes completely against the Psychological Reaction.
The people running the D.A.R.E. program failed to give the kids freedom to
choose whether they would be drug free, and told the kids these drugs are
something you can’t have. Comparatively, <i>The
84</i> took the exact opposite approach to getting youths to remain cigarette
free. <i>The 84 </i>is a group composed of
Massachusetts teenagers who comprise the 84% of Massachusetts teenagers who
choose not to smoke (7). The key in this group, and how they differ from the
D.A.R.E. program was that it empowers the adolescents to choose not to smoke,
and become a part of a group much larger than themselves. By providing the
group to make decisions for themselves, they remove the psychological reaction
of being told they can’t have something. With <i>The 84</i>, no student is told they cannot have a cigarette; each
student makes a conscious decision to say that they will not be a smoker,
because they know it is bad for them, even though smoking is an available
option.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> This point ties into the idea that
scarcity will only increase the desire of a group to get something. In an
article by Wu and San-san in the Journal of American Academy of Business, they
found that, “scarcity enhances value… directly through enhancing quality and symbolic
benefits thinking” (8). For signers of the D.A.R.E. pact, illegal drugs are not
scarce in the idea that they cannot be easily acquired, they are instead scarce
in the fact they have been told to not use them, and then signed a pledge at a
younger age saying that they will not use them. This is directly related to the
idea that people want what they cannot have. The D.A.R.E. pledges based upon
their pledge agreement have created a scarce, “forbidden fruit”, limiting their
own personal freedom and choices, because a police officer has come in, told
them it was bad, and made them sign something. In a study conducted titled,
“Forbidden Fruit and the Prediction of Cigarette Smoking”, researchers looked
at the association prospective use of cigarettes and the idea of the forbidden
fruit (9). The study suggests that, “adolescents who believed that society
views smoking as an adult appropriate behavior that is not youth appropriate,
but who personally approved of youth smoking were two and half times more likely
to smoke cigarettes (9). This same concept can be used to describe how the
D.A.R.E. program created a situation where drugs became the forbidden fruit.
The important point to take away from this article is that when an adolescent
perceives that society is telling them what is appropriate for them, without
regard to how they feel about the topic, they are more likely to partake in
that action. With the D.A.R.E. program they put this idea right in the face of
the children, by having their teachers and a police officer essentially say,
“we don’t want you to do this, so you shouldn’t and won’t”.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Critique 3-</span></b><span style="font-family: "Georgia","serif";"> <b>Who
are the Students suppose to be modeling?<o:p></o:p></b></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">A
third major problem with the D.A.R.E. campaign is that it ineffectively creates
a model for students to follow or even see. Social learning theory states that,
the emphasis needs to be on “the importance of observing and modeling the
behaviors, attitudes, and emotional reactions of others” (10). In other words,
people will do what they see, not what they hear. The D.A.R.E. program relies
heavily on the statistical figures that officers can present to kids, not a
person or group of people who can come in and show the kids why using illicit
drugs isn’t a positive thing do. By relying on data to influence an adolescent’s
decision to use or not use drugs, the D.A.R.E. program limited themselves with
what information a student would used when actually put into the situation of
choosing to use drugs or not. When actually placed into a situation,
adolescents model their behavior around those who are important to them.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> By not having an effective model for
students to follow or copy, the model that adolescents follow is often what
their peers are doing (12). In some cases the modeling may even be, what they
perceive their friends are doing (13). In a study that looked at the trajectory
of peer influences on the projection of drug use, researchers found that
marijuana use was most influenced by peers at the middle school level
(11). This speaks directly to the
ineffectiveness of D.A.R.E.’s ability to create a model for students to follow.
According to the paper, the group that is most affected by peer influence, is the
group that D.A.R.E. just had their officers talk to, the years prior. D.A.R.E.
relies on the policeman delivering the message, to be the model for the
children. Police officers are a good profession for kids to aspire to, but they
are not a model for kids to think about when put into the situation of deciding
if they want to use drugs. Due to this, the D.A.R.E. program is essentially
without a model all together. Without an important person in the adolescent’s
life to model him or herself after, they rely on the automatic response humans
have associated with social learning theory (14). D.A.R.E. failed to recognize
that just because the person who began the program was a police officer, did
not mean that students everywhere would want to model their decisions around
police officers. D.A.R.E.’s focus remained that if students would see a police
officer in their classroom relating to them, they would want to do not only
what was best legally, but when faced with a decision, they would think back
solely to what the police officer had taught them, as the reasoning for why
they would say no to drugs instead of just reacting as people do.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Proposed Intervention-The
High School in Your School Intervention<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> In seeing how the use of police
officers consequently has essentially not only lead to the demise of the
D.A.R.E. program, due to their inability to follow basics of social learning
theory, communication theory, and psychological reactance a new intervention
that uses these theories with the addition of advertising theory and social
expectations theory can be put into place to improve on the idea of preventing
adolescents from using illegal drugs. This intervention titled, “The High
School in Your School”, is a program that focuses on using high school age
students as the main message carriers that give a slightly older demographic the
same information on not using drugs, but making it much more meaningful to the
students receiving the message.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The premise of the program is to
first create a community of high school students in a program in which they
become knowledgeable of drug use, as well are able to share stories with one
another about their own experiences around drugs. The purpose of this group
would be to not only know the dangers of drug use, but at the same time being
able to explain that each member has had some kind of story to tell behind it
in their lives. The students in the high school, during the school day would
then travel to local middle schools, the age in which peer influence on drug
use seems to be the highest (11, 12, 13). The group entitled “STUD” which
stands for “students together understanding drugs”, would then go into the
school dressed in their regular clothes and tell stories to the students on how
they have said no to using drugs, and how just a few years ago they were right
where the students are sitting now, and successes they’ve had since leaving
middle school. They would explain that realistically the drugs are out there,
and it’s not about telling the student to never use drugs, but how when they
are in a situation where using a drug could arise they are able to resist and
say no by their own choice. The students in the middle school class would then
all be able to ask questions of the high school students that not only focus around
what the drugs themselves do, but anything they wanted to know about the lives
the high school students have lived since refusing to use drugs. Each student
would then be given the opportunity to join the high school students in
becoming “STUDs” without signing anything, but to be able to call themselves
equals with the high school students. Each student would be given a shirt saying,
“I’m a Stud”, as part of their new membership to the group. Then when they
finish, middle/junior high school in one or two years, they will be able to
join the “STUDs” and come back and talk to whoever is sitting in their seat
then. The high school students would then act as an outreach for any student
who they’ve spoken with to come and talk to them about anything.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Defense 1- The Proper Role
Model<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The use of high school age students
is key to the success of this program, because of the level of comfort they
will be able to establish while talking to the middle school age students.
Unlike the D.A.R.E. model, using a officer of the law many years the age of an
elementary school student, the “STUD” program capitalizes that the presenters
are only a few years superior in age, students themselves who are going through
trials and tribulations as teenagers just as the students who are sitting
there. By using a group that the adolescents can view as their peers, harness
the major aspect of communication theory and the use of human persuasion, that
the presenter delivering the message is likeable. The program is designed to
use local high school students as the messenger; in most local communities
there would be at least one face that each student would be able to relate to
personally, whether it be a neighbor, sibling, or just someone they know. The
program would succeed in creating a face for which the students will be able to
model themselves after; there would be a real person who they could talk to
regarding any situation that arises in the future.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> In a study conducted on peer
relationships and levels of acceptance, it was found significant that students
who found themselves socially accepted by their peers were less likely to face
depression and less likely to put themselves in harmful positions including the
use of drugs as a method of coping (16). Establishing a system where an older
generation student already is there to provide a level of acceptance to the
student facilitates the idea of reciprocity. The older high school student
would be there to give the younger student the acceptance that all students
desire, while the younger student would feel the responsibility to do something
for the high school student, and in this case, not use drugs (17). This
program, is designed to not only tell students they shouldn’t use drugs, but to
show real life examples of people who were able to not use drugs in a very
similar situation and prosper. This reflects the ultimate idea of modeling,
because they are able to see an end result, without needing to go through the
situation for themselves yet.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Defense 2- Fulfilling Their
Desires<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The second major advantage that this
plan offers that the D.A.R.E. project is unable to offer effectively is the use
of advertising theory. The basics of advertising theory are that the product
being offered fulfills the deepest desires of the person you are trying to
target. In this situation, the people you are targeting are really not thinking
about their deepest desire, which is social acceptance and the product being
sold is being part of this saying no to drugs group. The underlying message is
that if you remain drug free, and you remain a “STUD”, then you will be more
popular and more successful than if you decide to use drugs.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The first key to advertising theory
in this program is the use of stories being told by high school students. Using
stories instead of using the facts about the damaging effects of drug use
creates images in the mind of the students they are trying to talk with. It
enables the student to visual not only the person telling the story in the
situation, but placing him or herself in the story as well. In a paper by Chiu,
Hsieh, and Kuo, they looked at the proper way to align stories with the product
they were trying to sell. They found that the authenticity of a story was more
important to consumers than the actual product being sold, and that if people
were able to feel as though the story was authentic enough they would use the
product (18). The similarly is what the program is intended to accomplish, the
middle school students should feel as though they are encapsulated by the story
of the older students, and if they ever found themselves in a similar story
they would make the same drug free decision.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The second key to advertising theory
in this program is normalization of the daily lives of the students. Each
student dressed in regular clothes and not the t shirt that the kids receive,
is to create an idea in the students mind that each of them to start is on the
same level as well to allow students to know this is part of every day life.
Studies show that students and models that dress in moderately attractive, to
average clothing are more effective to adolescents than those who stylize or
attempt to become more attractive (19). By advertising with average looking
students, the program is designed to make the kid visualize themselves sitting
among the panel when they are in high school and coming back. The key is for
them to do this they must remain drug free, which not only promotes the product
of remaining drug free, but also gives the kids a goal to aspire to. When using
advertising theory, the goal is to make the kids believe that, this will be
them in a few years provided they decide to not use drugs. Unlike D.A.R.E.,
advertising theory plays one of the largest roles in helping to determine the
success of the students remaining drug free, because it creates something for
the students to attain other than being healthy, which is the only main thing
D.A.R.E. can offer.<b><o:p></o:p></b></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Defense 3- Psychological
Reactants/FREEDOM!<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> D.A.R.E.’s ultimate fatal flaw,
resides in the fact that this program takes away some freedom from a group of
people that relish every bit of freedom they can receive. The “STUD” program
uses social expectation theory combined with understanding of psychological
reactants to make students feel as though the freedom to determine the outcome
is completely within their control. Social expectations theory states that
perceived social expectations dictate people’s actions. This is especially
important when talking about the relationship between adolescents and the
adults involved in their lives. A study by Brook et. al, which looked at the
relationship between Adolescent Illegal Drug Use and Family and Environment
Factors, found that children with any evidence of impulsivity, rebelliousness,
or delinquency range 2 times to 5 times the likelihood to use marijuana (20). This
is likely to be expected as a way to garner freedom from their parents and the
environment they are in. This only compounds social expectation further,
because D.A.R.E. is telling the students, drugs are things, you’ve signed that
you will not touch, so you cannot have them. This makes the drugs the exact
thing they want to attain, because it is the ultimate form of rebellion from
their environment, as it was similar to the childhood inaccessible toy
experiment (21)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The “STUD” program, takes the
opposite approach to this, because part of discussion is telling the kids if
they really want drugs, they are going to be available to them. Informing adolescents
drugs are not going to be something they can’t have, rather something they are
going to choose to not want to have. The first point is that it takes away the
lure behind drugs being this special thing that they have to try when they get
the chance. An estimation out of surveys conducted by Columbia University
suggests that 1 in 5 teens today smoke or use drugs at school (22) The program
also establishes that each student is going to have his or her own personal
freedom, to make the decision regarding his or her drug use. According to
Christopher Daddis, a researcher at the Ohio State University, “teenage needs
for autonomy stems from the desire to establish their own personal domain and
own personal worth” (23). The program focuses on helping individuals establish
for themselves what is best for them, while looking through a world of new
social expectations. In the new program under these new social expectations,
self-worth is going to be determined that the only way to really have
self-worth is if your reaction when presented with drugs would be to say no,
and that this will be your only way to continue to have the extra freedom that
was given to you by committing to the “STUD” program.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Conclusion<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The fundamentals of D.A.R.E. are
positive, because students not using drugs is better for all of society, but
realistically D.A.R.E. only created an environment where students had more
information about drugs, but had no real moral obligation or reasoning to not
use them other than a paper they signed in 5<sup>th</sup> or 6<sup>th</sup>
grade, when they probably didn’t have access to them. By creating a model for
kids to aspire to, and model themselves after, and providing not just health
incentives, but freedom and material incentives, there is a way to inspire kids
to not use drugs, while playing to all their deepest desires.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">REFERENCES<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">1. D.A.R.E..
About D.A.R.E.. Los Angeles, CA: D.A.R.E.. 2012; </span><a href="http://www.dare.com/home/about_dare.asp"><span style="font-family: "Georgia","serif";">www.dare.com/home/about_dare.asp</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">2. Rosenbaum D.
and Hanson G. Assessing the effects of school-based drug education a six year multi-level
analysis of project D.A.R.E. Center for Research in Law and Justice. Chicago,
IL, 1998.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">3. Wolchover N.
Was D.A.R.E. Effective?. Life’s Little Mysteries. 2012; </span><a href="http://www.lifeslittlemysteries.com/2278-effective.html"><span style="font-family: "Georgia","serif";">www.lifeslittlemysteries.com/2278-effective.html</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">4.Annoymous.
DARE Program Complely Ineffective Says US Gov. Detentionslip.org. 2011; </span><a href="http://www.detentionslip.org/2011/01/dare-program-completely-ineffective.html"><span style="font-family: "Georgia","serif";">www.detentionslip.org/2011/01/dare-program-completely-ineffective.html#</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">5. Donnermeyer
J. Educator perceptions of the D.A.R.E. officer. Journal of Alcohol and Drug
Education 1998; 44:1-17.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">6. Dukes RL,
Steing JA, and Ullman JB. Long-term impact of Drug Abuse Resistance Education
(D.A.R.E.). Results of a 6-year follow-up. Evaluation Review 1997; 12:483-500.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">7. The 84. Check
Us Out-Join the 84. MA: The84.org. </span><a href="http://www.the84.org/check-us-out/"><span style="font-family: "Georgia","serif";">http://www.the84.org/check-us-out/</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">8. Wu C. and
San-San H. Less is More: How Scarcity Influences Consumers’ Value Perceptions
and Purchase Intents through Mediating Variables. Journal of American Academy
of Business 2006; 9.2:125-132<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">9. Sussman S.,
Grana R., Pallav P., Rohrbach L., Sun P. Forbidden Fruit and the Prediction of
Cigarette Smoking. NIHPA Author Manuscripts 2010; 45:1683-1693.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">10. University
of South Alabama. Social Learning Theory. 2007. Online Learning Laboratory. </span><a href="http://www.southalabama.edu/oll/mobile/theory_workbook/social_learning_theory.htm"><span style="font-family: "Georgia","serif";">http://www.southalabama.edu/oll/mobile/theory_workbook/social_learning_theory.htm</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">11. Duan L.,
Chih-Ping C., Andreeva V., Pentz M. Trajectories of Peer Social Influences as
Long-term Predictors of Drug Use from Early Through Late Adolescence. Journal
of Youth Adolescence 2009: 454-465.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">12. Conrad KM,
Flay BR, Hill D. Why children start smoking cigarettes: predictors of onset.
British Journal of Addiction 1992; 87:1711-1724.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">13. Hawkins JD,
Catalano RF, Miller JY. Risk and protective factors for alcohol and other drug
problems in adolescence and early adulthood for substance abuse prevention.
Psychological Bulletin 1992; 112:64-105.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">14. Bandura A.
Social Learning Theory (Bandura). 1969-1997. Learning-Theories.com. </span><a href="http://www.learning-theories.com/social-learning-theory-bandura.html"><span style="font-family: "Georgia","serif";">www.learning-theories.com/social-learning-theory-bandura.html</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">15. D.A.R.E..
Why Does DARE America Need to Fund Raise Documents. Los Angeles, CA. 2011. </span><a href="http://www.dare.com/documents/WhydoesDAREAmericaneedtofundraise.pdf"><span style="font-family: "Georgia","serif";">http://www.dare.com/documents/WhydoesDAREAmericaneedtofundraise.pdf</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">16.
Zimmer-Gembeck M., Hunter T., Pronk R. A model of behaviors, peer relations and
depression: Perceived Social Acceptance as a mediator and the divergence of
perceptions. Journal of Social and Clinical Psychology 2007; 27:273-302.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">17. Song F.
Trust and reciprocity in inter-individual versus inter-group interactions: The
effects of social influence, group dynamics, and perspective biases. Journal of
Experiment Economics 2006; 9:179-180.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">18. Chiu HC,
Hsieh YC, Kuo YC, How to Align your Brand Stories with Your Products. Journal
of Retailing 2012; 88:262-275.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">19. Tsai CC,
Chang CH. The effect of physical attractiveness of models on advertising
effectiveness for male and female adolescents. Journal on Adolescence 2007;
42:827-836.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">20. Brook J.,
Brook D., De La Rosa M., Whiteman M., Johnson E., Montoya I. Adolescent Illegal
Drug Use: The Impact of Personality, Family, and Environmental Factors. Journal
of Behavioral Medicine 2001; 24:183-203.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">21. Fawcett CA,
Markson L. Children reason about shared preferences. Journal of Developmental
Psychology 2010; 46:299-309.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">22. Terry A.
Almost 1 in 5 teens smokes or uses drugs at school, US students report. New
York, NY. The Christian Science Monitor. </span><a href="http://www.csmonitor.com/USA/Education/2012/0822/Almost-1-in-5-teens-smokes-or-uses-drugs-at-school-US-students-report"><span style="font-family: "Georgia","serif";">http://www.csmonitor.com/USA/Education/2012/0822/Almost-1-in-5-teens-smokes-or-uses-drugs-at-school-US-students-report</span></a><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">23. Daddis C.
Desire for Increased Autonomy and Adolescents’ Perceptions of Peer Autonomy:
“Everyone Else Can; Why Can’t I?”. Journal on Child Development 2011;
82:1310-1326.<o:p></o:p></span></div>
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Eric A Strattonhttp://www.blogger.com/profile/02213610553752385746noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-2439099016698312782013-01-30T12:40:00.002-08:002013-01-30T12:40:18.992-08:00Strong4Life: A Dismal Approach to Childhood Obesity and How to Better Incorporate Mass Media to Deliver a More Effective Message – Jamie Klufts<br />
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<b><span style="font-family: "Georgia","serif";">Strong4Life: A Dismal
Approach to Childhood Obesity and How to Better Incorporate Mass Media to
Deliver a More Effective Message</span></b><span style="font-family: "Georgia","serif";">
– Jamie Klufts <o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Georgia","serif";">Introduction:<o:p></o:p></span></b></div>
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<br /></div>
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<span style="font-family: "Georgia","serif";"> Recently, the media have shed light
on the prevalence of obesity in the United States. The most recent data
indicates that over one-third of Americans are overweight or obese and
approximately 17% of children and adolescents are obese in the United States (4).
Thanks to the media, many are aware of the prevalence of obesity in America and
that it can have many serious implications on one’s health, but little has been
done to resolve this epidemic. The state of Georgia has an extremely high
frequency of obesity, but it is their rate of childhood obesity that is truly
astounding. Nearly 40% of children in Georgia are overweight or obese. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">The Children’s Healthcare of Atlanta is a
pediatric healthcare system in Georgia that recognizes the severity of this
problem. They recently implemented a campaign called Strong4Life that aims to
affect change in the weight of the state through small, incremental changes (6).
Most notably, they initiated a series of commercials and posters called
“Warning Ads” to bring attention to the obesity issue throughout the state (18).
These commercials and posters have become the topic of much discussion and have
caught the attention of the entire nation, but arguably for the wrong reasons. Three
major flaws of the media component of this campaign are that they focus too
heavily on the Health Belief Model, they poorly frame the obesity issue, and the
delivery of the message is in violation of communications and agenda-setting
theories. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Critique Argument 1: The
Health Belief Model<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";">Georgia’s Strong4Life media campaign
focuses heavily on the individual and his or her state of being overweight or
obese, thus victimizing the child without acknowledging behaviors that led to
his or her weight classification (13). A major problem with obesity campaigns,
especially Stong4Life, is that they pay little attention to behaviors causing
obesity. Instead, they focus on the individual’s outcome: his or her current
state of obesity. Acknowledgement of this state is intended to inspire the
individual to change his or her own behaviors. This focus on the individual
largely stems from the Health Belief Model. The Health Belief Model is an
individual-level health belief theory that assumes that health behavior is
motivated by perceived susceptibility, perceived severity, perceived benefits
of an action, perceived barriers to taking that action, an experienced cue to
action, and experienced self-efficacy with respect to that action (10). These
components are believed to lead an individual to seek health and behavior
change. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">The campaign aims to get parents to
recognize the problem depicted in the advertisements in their own children and
to lead them to the Strong4Life website to begin to make changes within their
own families. This reliance on perceived susceptibility is a major limitation
of Strong4Life. The “Warning Ads” show very overweight children who are
saddened by their condition, but do not acknowledge how they got to be that way
or offer them a way out of their predicament (13). It is assumed that parents
and children viewing these commercials will see themselves and their own emotions
reflected by the children depicted in the advertisements, inspiring them to
reach out to the Strong4Life website to access tools and resources necessary to
make behavior changes. This assumption is barred by the fact that many parents
deny that their child is overweight or obese. The viewer cannot see himself or
his child in the deliverer of the message, chiefly because the commercials do
not acknowledge the behavior that led the deliverer to their state of obesity. By
not demonstrating what behaviors cause obesity, solutions to treat or prevent
it cannot be formulated either. Without perceiving one’s susceptibility to
obesity, they ignore the severity of the issue and do not seek to make behavior
changes. The Strong4Life media campaign’s reliance on the Health Belief Model
distances the viewer from the problem instead of drawing them closer to it. The
commercials are intended to function as a cue to action, but instead cause the
viewer to dismiss the message entirely. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Critique Argument 2: Framing
and Tools for Attack <o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";"> <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">In addition to too little attention paid
to the behaviors of the individual, the campaign provides people with
information already widely known about obesity without offering solutions or
tools to attack the problem or prevent it (13, 15). Although the Strong4Life
website provides many tips and tools for both reversing the effects of obesity
and preventing it, the media aspect of the campaign does not reflect that. The
commercials and posters used in this campaign are visually stimulating and
offer strong statements such as “Stop sugarcoating it, Georgia” without telling
them how to do so (18). Instead, the media messages stigmatize overweight and
obese individuals, making them less likely to acknowledge the problem or to
“stop sugarcoating” the obesity issue (15). This stigmatization causes viewers
to reject the message, craving positive reinforcement instead (1). The campaign
developers call for “tough love” regarding the issue, but research has found
that making people feel bad about their weight is not an effective instrument
of change (12, 15). Harsh messages without offering solutions or encouragement
to make changes are not effective means to fight obesity. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> These harsh messages and overall
“tough love” approach do little to achieve the campaign’s goals of encouraging
people to identify the obesity problem in themselves and to begin to take steps
to make changes. Framing is a tool used to present values and images in a way
that leads individuals to believe the message being portrayed (5). In public
health the value of health is often used, but is frequently outweighed by
stronger values such as freedom, control, and family. Framing can be used as a
way to both promote a behavior and instill a message in the viewer. By focusing
on health and using images and messages that inhibit core vales stronger than
it, Strong4Life is seriously hindering its ability to resonate with viewers by
failing to demonstrate how obesity prevention and treatment can occur while
promoting freedom, control, and family. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">In one of the commercials used in the
Strong4Life media campaign, a young overweight boy is shown with his obese
mother and asks her “Mom, why am I fat?” (18). The mother responds with a heavy
sign and the commercial ends with the message “Stop Childhood Obesity”. Framing
the obesity issue in a way that focuses solely on health and using messages
like “why am I fat?” suppresses the strong core values aforementioned and
stigmatize overweight and obese individuals, leaving them more likely to
deliberately find ways to counteract the messages being delivered than to try
to find solutions to the problem. This is further reflected in the theory of
psychological reactants. Messages that take away control or threaten freedom
like the ones used in the Strong4Life campaign encourage people to act in a way
that opposes the advertisement’s intent (8). Reframing the message to promote,
rather than hinder, feelings of freedom, control, and family, while offering
solutions to the obesity problem, would allow the viewer to not only absorb the
message, but would encourage him or her to begin to make behavioral changes to
combat obesity. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Critique Argument 3: Communications
and Agenda-Setting Theories<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";"> Of great concern is the inability of
the advertisement messages to reach their target audience through use of a deliverer
who the audience cannot or will not relate to. In addition, the commercials and
posters emit a dark and dismal tone that is depressing and discouraging. The
aim of these tactics is to draw attention to the problem in order to invoke
action. Communications theory is based on the idea that peoples’ behaviors can
be predicted and automated through the use of familiarity, similarity, and
associations (8). Familiarity increases the persuasive effect of a message by
delivering it from an individual who is well known and well liked. This is most
often done through celebrity endorsement. The technique of familiarity as it
applies to communications theory was not incorporated into the Strong4Life campaign.
By not using a familiar source to endorse and deliver the anti-obesity message,
Strong4Life reduces the chance that individuals will attempt to stop childhood
obesity. Instead, the advertisements attempt to persuade the viewer to practice
anti-obesity behaviors by using a messenger that campaign developers believe to
be similar to the target audience, one that viewers can relate to. This is the
concept of similarity. Ordinarily similarity increases the reception of a
message and its persuasive effects. Research has shown that negative messages
that evoke more serious emotions as opposed to emotions such as happiness and
humor are more effective, but research also shows that making people feel bad
about their weight does not work as a vehicle of change (12, 15). The negative,
dark and depressing feel of the advertisements stigmatize obesity, distancing
the target audience from the problem, inhibiting the ability of the messenger
to call people to action. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> The agenda-setting theory serves to
fill a void in communications theory by taking the recognition of a topic one
step further by getting people to talk about the issue at hand (14). Agenda-setting
theory is believed to cause change by increasing the hype over a certain
subject through the use of mass media. This is a more social approach to
acquiring behavioral change. The idea is that by increasing discussion about
obesity and the thought that it should be “stopped” will influence a social
“nudge” (16). A small nudge should influence multiple individuals to perform
some intended action, influencing a massive social change. This is the concept
of peer pressure; humans are easily nudged by other humans and likely to
conform due to others’ influence. It is often said that obesity is
“contagious”. By this, it is meant that peoples’ eating habits are influenced
by the food choices of others. The failure to demonstrate this as a behavioral
limitation to obesity prevention is a major flaw of Strong4Life. Without
presenting the obesity issue as something largely influenced by the behaviors
of others, including food industry advertisers, Strong4Life limits its aims to
counteract obesity. The Strong4Life advertisements are designed to draw
attention, which they do, but fail to fulfill the other aim of agenda-setting
theory to effect change. Not demonstrating how or why change can or should be
made causes this failure. These advertisements lack a component that draws
attention to the root of the problem, nudging society away from its messages
instead of towards them. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">Behaviors are influenced by what a person
thinks, knows, and believes, but an inability to change an individual’s beliefs
renders both agenda-setting theory and communications theory ineffective (14). Research
has shown that many individuals are aware of the obesity epidemic but do not
believe themselves to be susceptible to it or impacted by it (13). These two
theories are severely limited by the campaign’s use of the Health Belief Model
and a poor framing strategy. By presenting the deliverers of the messages in a
way that victimizes them without offering a solution, Strong4Life enhances the
stigmatization surrounding childhood obesity and distances parents and children
from a desirable intervention. Failure to represent the obesity issue as one
people can relate to by neglecting to demonstrate the behaviors that cause it
and how to change them severely inhibits Strong4Life’s ability to bring about the
desired behavior changes. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Articulation of Proposed Intervention:<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";"> Georgia’s Strong4Life childhood
obesity campaign has been effective in bringing attention to the subject, but
its ability to affect change is questionable. In order to make the media
component of Strong4Life more persuasive in its aim to “make small changes for
positive progress” the following interventions are being proposed: reframe the
campaign, incorporate social expectations theory, and utilize advertising
theory. These strategies will be used to demonstrate how to use the existing
campaign and the goals it represents to most effectively reach its target
audience and obtain the desired result of obesity treatment and prevention. The
interventions proposed are designed to improve upon Georgia’s Strong4Life
campaign as advertisements can serve as an impactful medium to deliver messages
with the ability to reach many people. The American Heart Association reports
that young people are exposed to more than 40,000 advertisements on television
per year (2). With some alterations, the Strong4Life media campaign has the
potential to influence thousands of individuals to help them recognize an
obesity problem and to perceive themselves susceptible to it, leading to a desire
and enact a change in behavior. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Intervention 1: Reframing <o:p></o:p></span></b></div>
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<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">Reframing
is a tool to take the core values of a successful message and apply them to an
opposing view to elicit a better response (5). Earlier it was acknowledged that
core values of freedom, control, and family are stronger than the core value
the Stronge4Life campaign is currently using, health. Frames incorporate
components such as catch phrases, visual imagery, identification of the source
of the problem, predicted outcomes, and appeals to principle in order to
resonate with the viewer and support values he or she deems important (17).
With the obesity issue, the opposing view is that of the food industry.
Research shows that aggressive advertising and marketing of unhealthy foods to
children are contributing to the nation’s obesity epidemic (2). These messages
are successful at enticing people of all ages to purchase and consume unhealthy
products without regard to their health. Although specific research on the
framing of food advertisements was not conducted, the affect of reframing can
be assessed through another medium: tobacco. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> Florida’s “truth” campaign serves as
a model for effective reframing in the context of public health. The campaign
focuses on “empowering” youth to remain tobacco-free (3). The messages
delivered in this campaign were designed to “deglamorize tobacco use and
portray the tobacco industry as manipulating youth for profit”. By basing their
movement on persuasive cigarette advertisements, “truth” reframed the values of
autonomy, freedom, and control to support their own argument to suppress
smoking (11). These values became tools for youth to rebel against the industry
who were framed as suppressing these fundamental values. By turning the desire
to limit smoking among teens into a crusade for autonomy, freedom, and control,
the anti-tobacco movement became a success. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">An intervention that would promote
freedom, control, and family in relation to the anti-obesity movement would
serve as a means to increase the effectiveness of the Strong4Life campaign. By
learning from the truth campaign, a successful anti-obesity campaign could be
performed in a way that promotes freedom and control, rather than hinders it.
Reframing anti-obesity behaviors to be a solution to regain control in one’s
life by breaking free from the food industry’s hold over their desires would be
successful. Presenting the food industry as a manipulative force that inhibits
an individual’s personal freedoms and ability to exert control over one’s own
life would be an effective way to get the obesity issue to resonate with
individuals. This was a successful reframe in the truth campaign that depicted
the tobacco industry as a force trying to control and limit one’s freedom and
ability to make autonomous decisions in regards to cigarette smoking and
tobacco use. Reframing the obesity issue in this same way would inspire parents
and children to regain control over their own behaviors. This would also allow
for demonstration of solutions to the obesity epidemic without portraying the
Strong4Life campaign as trying to control actions, but promoting ones that
allow individuals to have control over their own lives in a way that supports
anti-obesity behaviors. <o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Georgia","serif";">Intervention 2: Social
Expectations Theory <o:p></o:p></span></b></div>
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<br /></div>
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<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">Social
expectations theory aims to influence behaviors on a group-level basis by
changing social norms (8). Social expectations theory is a more encompassing
approach to obesity prevention as it builds upon communications theory and
agenda-setting theory. It not only draws attention to the issue at hand, but
also can influence behavioral changes by altering the social norms of the
community or society at large and nudge people towards anti-obesity behaviors.
Successfully using agenda-setting theory demonstrates the importance of
interpersonal contacts (14). It is not enough to influence attitudes about
obesity; behavior itself must also be changed and this can be accomplished
through the influence of social movements. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> Social nudges can be used to change
social norms, thus achieving the aims of social expectations theory. An
intervention that acknowledges the power of peer pressure in relation to health
behaviors will be most effective. Presenting physical exercise and healthy
eating as both group activities and behaviors that other people are doing will
encourage individuals to perform them. Shifting behavior with a nudge can be as
simple as informing people that others are exercising or eating healthfully also
(16). This is how social norms can be changed. By stating that an activity is
the social norm, it may, in fact, become the social norm. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">The environment needs to be addressed in
order to change obesity-related behaviors (13).
This is most effectively done through the enactment of social policies. Policies
that build upon the reframing of the obesity problem as an issue of control
inhibited by the food industry would aid individuals in maintaining
anti-obesity actions. Policies that limit or restrict food industry
advertisements would be most effective to create environmental changes that
promote healthy activities. In addition, social expectations theory can change
the social norms about nutrition and physical activity by promoting
non-traditional ways of acquiring healthy foods and performing exercises (15).
These can further be promoted through the existence of social policies. The
Strong4Life messages can be used to influence new social norms by changing
behaviors on a group-level scale through nudging and can encourage social
policies that further support the anti-obesity movement and enforce these
changes in social norms. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Intervention 3: Advertising
Theory <o:p></o:p></span></b></div>
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<br /></div>
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<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">Advertising
theory is an extremely effective approach to portray messages in a way that
both stimulate the viewer and lead him or her to engage in a certain behavior
(9). Advertising theory encompasses many other tools to cause changes in beliefs
and behaviors, including reframing, communications theory, agenda-setting
theory, and social expectations theory. Advertising theory is a powerful tool
to effectively reach a target audience, but it must be well thought out and
executed efficiently. The idea is that advertising can jolt an individual to
action through the ubiquity and persuasiveness of advertisements. This jolt is
the result of an advertisement’s promise to fulfill some aspiration of the
individual and support for that promise of fulfillment through the use of
images, stories, and music. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> The best way to understand
advertising theory and its role in public health is through examination of
Florida’s anti-tobacco campaign, “truth”. Truth was a media campaign that
successfully incorporated the components of advertising theory to successfully
achieve the campaign’s aims of influencing anti-tobacco attitudes and
increasing youths’ perceived susceptibility (11). Not only was the campaign
able to properly employ advertising theory, through the use of a professional
advertiser to help develop the campaign, it also had considerable funding and
was able to obtain desirable television spots that increased its effectiveness.
These aspects are often neglected in public health campaigns, but are crucial
to success. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> The truth campaign was developed
with the target audience in mind. By looking to youth for inspiration, campaign
developers were able to package their desired outcome of smoking attitude
changes and perceived susceptibility in a way that youth found to be
“aspirational, relevant, and ‘cool’” (11). They modeled their campaign after
new products and brands that youth liked such as Nintendo, Mountain Dew, and
Sketchers. The campaign reiterated the conception in advertising that facts are
not a successful way to provide support to a campaign. The youth were unmoved
by the fact that 1,200 people die everyday from tobacco related illnesses in
the USA. Instead, tobacco use was discovered to be an act of rebellion, a form
of control. This demonstrates the ineffectiveness of health as a core value in
framing. The core value of control is much more potent than the value of
health. Reframing the issue by promoting refraining from using tobacco as a way
to ultimately gain control over one’s life and to rebel against the
manipulative tobacco industry was most effective. This promise of control was
well supported through striking visual images, music, and stories while offering
youth alternatives to smoking. This movement empowered youth to “lead community
action against tobacco” (3). Truth became a social movement that reframed the
tobacco industry’s core value of control and used young people viewers could
relate to in order to change the social norms about smoking. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> Truth’s approach to anti-tobacco can
effectively be used to approach anti-obesity in the Strong4Life campaign. By
incorporating advertising theory in the context of public health, behavioral
changes are attainable with repeated exposure to highly effective,
well-executed commercials and posters. Like in the truth campaign, knowledge is
not the problem. The issue of obesity is widely known, just as the dangers of
tobacco smoking are (11, 13). Creating commercials that portray overweight
prevention as a right to be free from obesity and an act of defiance to the
manipulative hold the food industry has over Americans would be an effective reframe
of the issue. In addition, selecting individuals who are not just morbidly
obese and depressed to deliver the anti-obesity messages can effectively
incorporate communications theory. Choosing individuals who practice behaviors
that put them at risk for obesity would shift the focus of the intervention not
just on the outcome, but on recognition of how the problem develops and how it
can be resolved. Demonstrating how these identifiable and relatable individuals
can combat obesity through non-traditional means and group efforts would also
be effective. One must be able to self-reference, or see himself or herself, in
the deliverer of the message.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> Anti-obesity advertisements must aim to turn
values such as freedom, control, and family into the only means for having
these feelings. These must become the aspirations that ground the Strong4Life
campaign. Promising freedom, control, and family through pursuit of health
behaviors should become the campaign’s main objective. Empowering people to
effect change through images, stories, and music that deepens their core value
aspirations will further increase the campaign’s effectiveness. Reframing the
campaign in a way that is conducive to advertising theory will not only
increase its effectiveness at influencing the behavior of the individual who
views it, but lead to changes in social norms that will influence policy to
help maintain these anti-obesity behaviors. The critical limitations to the
current Strong4Life movement will be reversed, allowing individuals to recognize
the problem in themselves, desire to change their behaviors, acquire the
knowledge how to do so, and ultimately influence social norms that can
permanently reverse the obesity epidemic. <b><o:p></o:p></b></span></div>
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<b><span style="font-family: "Georgia","serif";">References</span></b><span style="font-family: "Georgia","serif";">:<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">1. Abrams, L. Obesity campaigns: The
fine line between educating and shaming. <i>The Atlantic</i>. 2012. </span><a href="http://www.theatlantic.com/health/archive/2012/09/obesity-campaigns-the-fine-line-between-educating-and-shaming/262401"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">http://www.theatlantic.com/health/archive/2012/09/obesity-campaigns-the-fine-line-between-educating-and-shaming/262401</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;"><o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">2. American Heart Association. Facts:
Unhealthy and Unregulated Food Advertising and Marketing to Children.
Washington, DC: Advocacy Department, 2012. </span><a href="http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_301781.pdf"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_301781.pdf</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;"><o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">3. Bauer UE, Johnson TM, Hopkins RS,
Brooks RG. Changes in youth cigarette use and intentions following
implementation of a tobacco control program: Findings from the Florida Youth
Tobacco Survey, 1998-2000. <i>JAMA</i> 2000;
284:723-728. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">4. Centers for Disease Control and
Prevention. Childhood Overweight and Obesity Data. Atlanta, GA: Division of
Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease
Prevention and Health Promotion, 2011. </span><a href="http://www.cdc.gov/obesity/data/childhood.html"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">http://www.cdc.gov/obesity/data/childhood.html</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;"><o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">5. Certain Trumpet Program. <i>Framing Memo: The Affirmative Action Debate</i>.
Washington, DC: Advocacy Institute, September 1996. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">6. Children's Healthcare of Atlanta.
Strong4Life. Atlanta, GA: Children’s Healthcare of Atlanta. </span><a href="http://www.strong4life.com/"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">http://www.strong4life.com</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;"> <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">7. D'Arcy J. Strong4Life campaign:
shocking us into caring about childhood obesity. <i>Washington Post</i>. 2012. </span><a href="http://www.washingtonpost.com/blogs/on-parenting/post/strong4life-campaign-shocks-us-into-caring-about-childhood-obesity/2012/01/02/gIQAwCdYYP_blog.html"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">http://www.washingtonpost.com/blogs/on-parenting/post/strong4life-campaign-shocks-us-into-caring-about-childhood-obesity/2012/01/02/gIQAwCdYYP_blog.html</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;"><o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">8. DeFleur ML, Ball-Rokeach SJ.
Socialization and Theories of Indirect Influence (pp. 202-227). In: DeFleur ML,
Ball-Rokeach SJ, ed. <i>Theories of Mass
Communication</i>, 5<sup>th</sup> edition. White Plains, NY: Longman Inc.,
1989. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">9. Vakratsas D, Ambler T. How
advertising works: What do we really know? Journal of Marketing 1999; 63:
26-43. </span><a href="http://www.jstor.org/stable/10.2307/1251999"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">http://www.jstor.org/stable/10.2307/1251999</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;"><o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">10. Edberg M. Individual Health
Behavior Theories (pp. 191-195). In Edberg M, ed. <i>Essentials of Health
Behavior: Social and Behavioral Theory in Public Health</i>. Sudbury, MA: Jones
and Bartlett Publishers, 2007.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt; mso-bidi-font-style: italic;">11. Hicks
JJ. The strategy behind Florida’s “truth” campaign. <i>Tobacco Control</i>
2001; 10:3-5.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">12. Johnson T. Hard-hitting public
health ad campaigns sparking awareness: new tactics gaining results,
controversy. <i>The Nation's Health. </i>American
Public Health Association 2012; 42.5: 1-10. </span><a href="http://thenationshealth.aphapublications.org/content/42/5/1.3.full"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">http://thenationshealth.aphapublications.org/content/42/5/1.3.full</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;"><o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">13. Katz D. Exploring Effectiveness of
Messaging in Childhood Obesity Campaigns. <i>Childhood Obesity</i> 2012; 8.2:
97-105. </span><a href="http://online.liebertpub.com/doi/pdfplus/10.1089/chi.2012.0082.roun"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">http://online.liebertpub.com/doi/pdfplus/10.1089/chi.2012.0082.roun</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;"><o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">14. Shaw EF. Agenda-Setting and Mass
Communication Theory. International Communication Gazette 1979; 25: 96-105. </span><a href="http://xa.yimg.com/kq/groups/22925642/1944236267/name/Shaw-%20AgendaSetting%20and%20Mass%20Communication%20Theory.pdf"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">http://xa.yimg.com/kq/groups/22925642/1944236267/name/Shaw-%20AgendaSetting%20and%20Mass%20Communication%20Theory.pdf</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;"><o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">15. Teegardin C. Grim Childhood Obesity
Ads Stir Critics. <i>The Atlantic Journal-Constitution</i> 2012. </span><a href="http://www.ajc.com/news/news/local/grim-childhood-obesity-ads-stir-critics/nQPtQ"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">http://www.ajc.com/news/news/local/grim-childhood-obesity-ads-stir-critics/nQPtQ</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;"><o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">16. Thaler RH, Sunstein CR. Following
the herd (pp. 53-71). In: Thaler RH, Sunstein CR, ed. Nudge: Improving Decisions
About Health, Wealth, and Happiness. New Haven, CT: Yale University Press,
2008. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">17. Winett L. Advocates guide to
developing framing memos (pp. 420-432). In: Iyengar S, Reeves R, eds. <i>Do the Media Govern? Politicians, Voters,
and Reporters in America</i>. Thousand Oaks, CA: SAGE Publications, Inc., 1997.
<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">18. Youtube. Strong4Life: Warning Ads.
Atlanta, GA. Strong4Life. </span><a href="http://www.youtube.com/playlist?list=PL3B99758F38961860"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;">http://www.youtube.com/playlist?list=PL3B99758F38961860</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 16.0pt;"><o:p></o:p></span></div>
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Eric A Strattonhttp://www.blogger.com/profile/02213610553752385746noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-90413499453464485262013-01-30T12:39:00.000-08:002013-01-30T12:39:07.790-08:00Where Are the Apples in the Big Apple? A Critique of New York City’s Approach to the Obesity Epidemic - Nina Burke<br />
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<b><span style="font-family: "Georgia","serif";">Where Are the Apples in the
Big Apple?<o:p></o:p></span></b></div>
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<b><span style="font-family: "Georgia","serif";">A Critique of New York
City’s Approach to the Obesity Epidemic<o:p></o:p></span></b></div>
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<b><span style="font-family: "Georgia","serif";">- Nina Burke <o:p></o:p></span></b></div>
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<b><span style="font-family: "Georgia","serif";">Introduction: <o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";">With nearly 40% of the U.S. adult
population obese, the obesity epidemic is a high priority issue on the nation’s
health agenda (1). The consequences of obesity are seen in morbidities such as
coronary heart disease, stroke, hypertension, fertility problems, and many more
health problems (2). In 2008, obesity cost the United States an astronomical
147 billion dollars in health care expenditures (2). At the state and local
levels, obesity prevention programs are fast emerging. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">In New York City, 58% of the adult is
overweight/obese, and 40% of NYC public school students 8<sup>th</sup> grade
and below are overweight/obese (3). One in three New Yorkers has diabetes or
pre-diabetes (3). With these unfortunate statistics, New York City began
stepping up obesity prevention efforts in 2008.
Two laws have been passed and an advertising campaign was launched in
NYC in efforts to curb obesity in the city. The first law, passed in 2008,
modified the NYC Health Code and requires all restaurants with 15 or more
nationwide locations to post calorie counts on menu boards (4). The second and
more recent 2012 law bans restaurants, theatres, stadiums, food carts, and
other food service establishments (FSEs) from selling sugar-containing drinks
in containers larger than 16 ounces (5). The first advertising campaign was
launched in 2009 and involves a variety of grotesque posters in public places
around the city. New York City’s current three-pronged obesity prevention
approach does not take into account models and theories that are effective in
promoting behavior change. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Critique 1: Amendment of
Article 81 of the Health Code- Menu Labeling Law<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";"> In 2008, the Board of Health of New
York City amended Article 81 of the NYC Health Code to require all food service
establishments with 15 or more nationwide locations to include calorie counts
on their menu boards (4). The NYC
Department of Health is charged with the task of preventing and controlling
disease, including chronic disease (4). As obesity is a chronic disease, the
Department of Health has the power to enact and launch prevention efforts,
including laws. This menu-labeling law, as quoted directly from a public
hearing notice, is rooted in the idea that “</span><span style="font-family: Georgia, serif;">Calorie
information provided at the time of food selection in FSEs would enable New
Yorkers to make more informed, healthier choices and can reasonably be expected
to reduce obesity and the many related health problems which obesity causes”
(4). While the Department of Health was certainly acting with good intentions for
the health New Yorkers, the law relies on flawed health models. <o:p></o:p></span></div>
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<span style="font-family: Georgia, serif;"> Although menu labeling does provide consumers additional
freedoms and autonomy in making food decisions, the law assumes that people
will use this new information to make healthier eating choices. Unfortunately
for the NYC Department of Health, a study published in the British Medical
Journal in 2009 demonstrated that the law has not created substantial change in
consumer behavior (6). The average amount of calories purchased showed no
change among consumers, and only 1 in 7 consumers even utilized the caloric
information posted (6). The menu labeling law relies on individual behavior
models, such as the Health Belief Model and the Theory of Reasoned Action. Both of these models assume that people,
consumers of food outside of the home in this case, make decisions in a
rational manner (19). They also do not consider external environmental factors
that affect behaviors (19). The Health Belief Model states that people will
weigh the perceived benefits versus the perceived costs and then make a
decision (19). Applying the menu
labeling law, the Department of Health assumed that people would read the
calorie count and then weigh the costs and the benefits of consuming the foods
on the menu. The Theory of Reasoned Action relies on intention leading to
behavior (20). This theory would translate into calorie information shaping
consumers intent of purchasing healthier food and then the consumers actually
choose the healthier options. However, the flaw in this theory is that intent
does not always lead to behavior. Intending to choose healthier food based on
calorie counts does not always lead to the consumption of the healthier foods. It
has been demonstrated that NYC consumers’ behavior has not improved with
calorie information on menus (6), which is due to flaws in the city’s approach
to obesity prevention. <o:p></o:p></span></div>
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<b><span style="font-family: Georgia, serif;">Critique 2: New York City
Soda Ban <o:p></o:p></span></b></div>
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<span style="font-family: Georgia, serif;"> In September of 2012, the New York City Board of Health
voted to ban the sale of sugar-containing beverages larger than 16 ounces at </span><span style="font-family: "Georgia","serif";">restaurants, theatres, stadiums, food
carts, and other food service establishments. The impetus behind this law is
that sugar-containing beverage attribute on average to more than 300 calories
daily (per person), and that these calories are directly related New York
City’s obesity epidemic (12). Again, although the NYC Department of Health
voted on this ban for the benefit of New Yorkers’ health, the department did
not consider how this legal approach to the obesity epidemic would affect
health behaviors. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> Public health laws exist to protect
the health and the rights of the public. While some laws may restrict an
individual’s freedom, they restrict freedom in order to protect the health of
the public. New York City’s soda ban is not unconstitutional, as states have
the power to enact laws that protect the public, however, the foundation of
this law is unlikely to achieve its purpose of protecting the public. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">Americans arguably value their freedom
more than any other American core value.
This love of freedom tends to lend itself to strong opposition towards
restrictive laws. The NYC soda ban is
based on restricting freedom, albeit the freedom to buy unhealthy drinks, but
freedom nonetheless. The ban, which will
go into effect in March of 2013, has already received backlash from more than
half of NYC residents (7). Mayor
Bloomberg believes this law is “the single biggest step any city, I think, has
ever taken to curb obesity” (8). This
may be the biggest “step,” but how far will this step get New Yorkers? By attempting to curb obesity by restricting
freedom and autonomy, one can expect this law to invoke psychological reactance
come March 2013. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">Psychological reactance is the
motivational state directed toward reestablishing a threatened or eliminated
freedom (10). The premise of this theory is that when people have their control
taken away, they do what they can to regain control (10). In the case of this
soda ban, people can easily regain control by utilizing the loopholes of the
law. The law does not prevent people
from buying two 16-ounce sodas; therefore, the law may actually cause an increase
in soda consumption through consumers purchasing multiple sodas. Now, instead
of consuming 24 ounces of soda, because it is illegal to sell that quantity,
people will consume 32 ounces of soda at the Yankees game because they can
purchase two 16-ounce sodas. Another aspect of the theory of psychological
reactance states that the more explicit the message, the more reactance it
invokes (26). A soda ban is a rather explicit message, and therefore it is
expected to invoke psychological reactance. An article in the <i>Journal of Consumer Research</i> discussed
the effect of loss of freedom on consumer purchasing (9). Clee et al. discuss
that laws are often considered the highest threat to personal freedom, and
“these laws are often flouted.” (9). Based on the opposition from residents, it
is highly likely the soda ban too will be flouted. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">A study conducted at the University of
Arizona examined how psychological reactance can occur with the implementation
of a health program (11). Using University of Arizona students, Rains et al.
created a mock health program called the Healthy Campus Initiative, and told
the students it was mandatory to participate. The results of the study
indicated that even with the best intentions for the students, the health
program still invoked psychological reactance (11). <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">Regardless of good intentions with health
in mind, people do not like their freedom encroached upon. Public health
programs should enhance autonomy in decision-making, as opposed to restricting
it. Piloting health interventions to test for psychological reactance is
important. Although a law cannot exactly be piloted, the Department of Health
could have asked for residents’ opinions or ideas on the proposed ban and/or
requested their input on alternatives to a law. <o:p></o:p></span></div>
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<b><span style="font-family: Georgia, serif;">Critique 3:<u> </u> New York
City Obesity Prevention Advertising Campaign <o:p></o:p></span></b></div>
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<span style="font-family: Georgia, serif;"> The New York City Department of Health and Mental Hygiene
launched an obesity prevention advertising campaign in August 2009 (12). The
campaign highlighted the increases in sugary-beverage consumption and their consequences
on health. In January 2012, a second
advertising campaign was launched with nearly an identical platform as the 2009
campaign, focusing on an increase in portion sizes. In a press release
announcing the 2012 campaign, the Department of Health was hopeful that the
“hard-hitting” campaign would be a successful tool in obesity prevention (13). The success of the campaigns has not yet been
measured. However, social and behavioral
theories would suggest that the content and images of the advertisements have
not and will not have the effect on health behavior that the NYC Department of
Health is hoping for. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: Georgia, serif;"> Unfortunately for public health professionals, the public
values its negative health behaviors much more than one would expect. People use defense mechanisms as a way to
cope with and justify these unhealthy behaviors and have ways of
self-reinforcing their unhealthy behavior (21). A successful advertising
campaign would not invoke defense mechanisms in the audience. The creators of
this NYC obesity prevention campaign did not seem consider the campaign’s
potential to invoke defense mechanisms, which would in turn perpetuate the
residents’ unhealthy behaviors. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: Georgia, serif;"> The 2009 advertising campaign indeed had many flaws, and
it is shocking that the 2012 campaign would choose to use the same tactics. The
advertisements are grotesque and negative. The main slogan from the 2009
campaign asks New Yorkers if they are “pouring on the fat” (12). The posters
are focused on soda and sugary beverages making consumers fat. The images are
nauseating and repulsive. One advertisement has </span><a href="http://www.nytimes.com/2010/10/29/nyregion/29fat.html?pagewanted=all&_r=0"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman";">10
pounds of fat on a plate</span></a><span style="font-family: Georgia, serif;"> with another showing </span><a href="http://www.nyc.gov/html/doh/html/pr2009/pr057-09.shtml"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman";">fat
being poured</span></a><span style="font-family: Georgia, serif;"> into a glass from a soda bottle (14, 13). These
advertisements are not consistent with psychology of human behavior. Messages that form positive associations are
more likely to initiate behavior change (27). It has been shown that people who
have positive reactions to beer advertisements are more likely to consume
alcohol because the commercials create or add to positive beliefs about alcohol
(22). Based on this, it is appropriate to say that having positive associations
with healthy behaviors would make people more inclined to change their
lifestyles. The current disgusting obesity advertisements do not have any
positive associations attached to them, making them unlikely to spark healthy
behavior change. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: Georgia, serif;"> The 2012 campaign does not demonstrate any improvement in
advertising technique. The slogan of the recent campaign is “cut your portions,
cut your risk” (13). The advertisements attempt to demonstrate the various
health consequences of increased portion sizes. One poster includes a </span><a href="http://www.nyc.gov/html/doh/html/pr2012/pr001-12.shtml"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman";">man
with both legs amputated and three sizes of soda</span></a><span style="font-family: Georgia, serif;"> (13). The poster says:
“Portions have grown, so has Type II diabetes which can lead to amputations”
(13). Another poster includes an </span><a href="http://cityroom.blogs.nytimes.com/2012/01/31/model-in-anti-obesity-ad-criticizes-the-campaign/"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman";">obese
woman climbing the stairs of the subway</span></a><span style="font-family: Georgia, serif;"> in the
background of three different French fry containers (15). The content of this
poster says: “Portions have grown, so has obesity which can lead to many health
problems” (15). These campaigns ignore important and useful elements of
Marketing and Advertising Theory. The NYC Department of Health attempts to sell
health in all of its advertisement. Health does not sell, as it is not a core
value of Americans. All of the posters
rely on the weak core value of health and do not make any promises to consumers.
In addition, there is a lack of self-referencing in the ads. Not many people
identify with a man who has no legs (although his legs were actually just
cropped out for the advertisement), and people who identify with the obese
woman may feel shame in identifying with her. The obese model herself was
quoted in the New York Times criticizing her own poster. She said, “This [ad]
is so negative. If they think they are going to </span><span style="color: #262626; font-family: "Georgia","serif"; mso-bidi-font-family: Georgia;">reach overweight
people with these ads, they’re not going to do it. I don’t think they would
make someone go, ‘You’re right, I need to change” (15). The model also said that
the ads are “too negative to inspire” (15). The creators of this ad campaign
should have put more thought into how these graphic and negative advertisements
would affect the emotions and behaviors of their target audience. </span><span style="font-family: Georgia, serif;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: Georgia, serif;">Summary of Critique:<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: Georgia, serif;"> New York City’s three-pronged obesity prevention efforts
fail to take into account the social and behavioral models that predict
behavior change. Each of the three interventions, the two laws and the
advertising campaign, are unlikely to promote health eating habits among New
Yorkers due to assumptions about decision-making, the restriction of freedom,
and the lack of advertising theory. The boldness of prevention efforts shows
the City’s dedication to health; however, there are more effective ways to
promote healthy behaviors than the actions taken by the Department of Health. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: Georgia, serif;">Proposed intervention: <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: Georgia, serif;"> From experience spending time in the city and knowing a
fair share of New Yorkers, people from NYC have an immense pride for their
native New York status. This New York pride could provide an amazing basis for
a new advertising campaign. The current advertising should be scratched
completely. The negative and repulsive ads should be stripped from the subway
to make way for fresh campaign. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: Georgia, serif;"> The new obesity prevention advertising campaign for NYC
should utilize effective Marketing Theory.
Promoting weight loss and healthy eating is certainly not an easy
task. It is not as simple as persuading
people to buy a product or show up to a one-time event. Obesity prevention is
about changing people’s behaviors for a lifetime. In order to succeed, the new
campaign will have to make people want to change. The new advertising campaign will need
multiple components, not just posters hanging from the subway. The new campaign
will engage New Yorkers, not disgust them. The components of the campaign will
include a cohesive trio of posters across the city, television commercials, and
free public events. A brand will be created for this intervention. This new
approach to obesity prevention addresses the flaws of the current approach. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Defense of Intervention 1: <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The new obesity campaign will not
rely on assumptions of individual behavior models, such as the Health Belief
Model or the Theory of Reasoned Action.
It has already been shown that providing information about calories does
not change eating habits, therefore, this intervention will not focus on giving
New Yorkers the hard facts about food. Additionally, intent to change behavior
does not always lead to behavior change (19,20), therefore it is useful to
change people’s behavior first and their attitudes second (25). Changing
behavior can begin through public events. The possibilities of events include
promotions in the subway to encourage people to use the stairs, spin classes in
Central Park and various fitness events in popular public spaces (including in
the Burroughs). Modeling Theory will be used through plain-clothes ‘models’
hired by the Department of Health or the City to take the stairs in the
subways, shopping centers, and other places where stairs are ignored over
escalators. Lastly, although these public events are geared towards adults, it
has been shown that a familial approach to obesity, with behavior change
stemming from the parents, is an effective model for lowering BMI in children (16).
<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Defense of Intervention 2: <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The new approach to obesity prevention
in New York City will use Marketing Theory effectively. Marketing Theory is
rooted in the use of core values. The core values of the advertising campaign
hold the entire campaign together (23). In order to be a successful campaign,
the obesity advertisements cannot rely on health as a core value. Health is a
weak value in eyes of Americans.
Therefore, the campaign must utilize strong American core values in
order to initiate behavior change. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The core values used in the ad
campaign will be those that the soda ban restricted - freedom and autonomy.
Giving NYC residents the ability to make choices about their lifestyle can
employ freedom and autonomy. Both the posters and television commercials will
need to provide health behavior options that residents can choose from.
Examples include: Go for a short walk during your lunch break to perk yourself
up for the afternoon; Go for a bike ride with your son before the weather gets
too cold. The core value of family will also be employed by the advertisements.
Not only is family a strong American core value, but a family approach to the
obesity epidemic has been suggested by many researchers (17). By not
restricting freedom, the advertisements will hopefully not invoke psychological
reactance. However, the posters and commercials will piloted in a small group
of New Yorkers to ensure that psychological reactance is not a product of the
campaign. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Defense of Intervention 3:<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The proposed intervention will
effectively use Advertising Theory. Advertising Theory is based on the idea of
making a promise to consumers. The current posters sell ‘products’ that no one
wants. Through the amputation poster and
the poster of the obese woman on the stairs, the Department of Health is
selling disappointment, shame, and unhappiness. If obesity prevention efforts
are to be successful, the ads need to sell what people want and who they aspire
to be. No one wants to be shamed, embarrassed, or a disappointment. The new poster and television ads will sell
happiness, inspiration, determination, and love. The television ads will also be accompanied
by inspirational music. If New Yorkers
have positive experiences and associations with the advertisements, psychology
of persuasion suggests that behavior change is more likely to occur (23). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The new material will also consider
self-referencing when choosing spokespersons and models. It has been
demonstrated that if the campaign spokesperson is in congruence with the
product, the spokesperson is perceived as truthful and the product is viewed
more positively (24). This fact leads us deduce that people are more likely to
change their health behavior if they identify with the spokesperson giving the
message. Obesity is a difficult problem
to deal with, physically and emotionally, so it is important the advertisements
only encourage and do not discourage people from changing their behavior. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> Finally, the new advertising campaign
needs to capitalize on the idea of New York pride! New Yorkers are known for
their community and hometown pride. By incorporating New Yorker-isms into the
brand of the campaign, New Yorkers will feel a sense of unity in the fight
against obesity. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">The Future of Obesity in
NYC:<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> Mayor Bloomberg and the New York
City Department of Health are working to reverse obesity trends in NYC and have
many goals and indicators set for 2016 (18). However, if they continue the
current obesity prevention efforts, the obesity statistics of NYC are unlikely
to improve. With one law that has been proven fruitless, another that is
strongly opposed, and a disturbing advertising campaign, the residents of NYC
are in need of an inspiring impetus to change their lifestyles. A fresh, multi-faceted advertising campaign
that adds to the pride of New Yorkers is very much in need. Obesity is not a
health problem to joke about, and a campaign that considers factors that
influence behavior change is in order. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">References:<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">12.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif";">New York City Department of Health and
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">19.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif";">Edberg M. Individual health behavior
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Washington, DC: Jones and Bartlett, 2007. <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">21.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif";">Bandura A. Behavior theory and the models
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responses to televised beer advertisements associated with drinking and
problems reported by 18 to 29 year-olds. Addiction 1998; 93: 749-760. <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">23.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif";">Evans WD., Hastings G. Public Health
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">25.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif";">Bettingaus E. Health promotion and the
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Eric A Strattonhttp://www.blogger.com/profile/02213610553752385746noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-16249693920469783912013-01-30T12:38:00.000-08:002013-01-30T12:38:09.340-08:00Spring 2013: Will There be an Obesity Tipping Point in NYC – Aileen Ledingham<br />
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<b><span style="font-family: "Georgia","serif";">Spring 2013: Will There be an
Obesity Tipping Point in NYC<o:p></o:p></span></b></div>
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<b><span style="font-family: "Georgia","serif";">–Aileen Ledingham<o:p></o:p></span></b></div>
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<b><span style="font-family: "Georgia","serif";">Introduction:
<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";"> These
are very interesting times pertaining to the association of soda consumption
and obesity</span><span style="font-size: 11.0pt; line-height: 200%;">,</span><span style="font-family: "Georgia","serif";"> particularly in New York City. Without any doubt, it is of benefit to the
American people that the rate of obesity in the population begins to decline
because obesity contributes to the disease incidence of diabetes and
hypertension. However, there is a fair
amount of doubt regarding the best way to address this issue. Is this an issue for the government to
intervene? Just as the government has
intervened to protect drivers by mandating air bags verses teaching people to
drive safely at the speed limit and teaching them not to fall asleep at the
wheel. Or is this an issue for people to
make better decisions based on better knowledge of factors influencing
obesity. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> Mayor Bloomberg proposed a ban on
the sale of sugary drinks in containers greater than 16 ounces. The ban was approved by the Board of Health in
September 2012 and hence, beginning in March of 2013, food service facilities
will have to abide with the law. Restaurants, movie theaters, street carts,
delicatessens (delis) and sports arenas are all such food service facilities (1).
This paper will provide a critique on
how the Public Health Department in New York City managed their obesity
campaign, and it will provide suggestions on how to improve the campaign’s
effectiveness. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">First Critique Argument: <o:p></o:p></span></b></div>
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<b><span style="font-family: "Georgia","serif";">Too much dependence on individual
behavior change models<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";"> Educating the public via health
clinics and fairs, provision of food coupons for farmers markets, were all expected
to reach individuals and help them change their behaviors to decrease obesity (2).
The use of the Health Belief Model, the Theory
of Planned Behavior, the Transtheortical Model and the Precaution Adoption
Process Model, all limit intervention to the individual level, without
consideration for the environment or social influences that the world provides
(3). Secondly, these individual behavior
models assume that by providing knowledge, you will change a behavior. This could be valid, however there is
evidence that behavior can change without any knowledge or planning. In his book R.B Cialdini writes “In fact, automatic, stereotyped behavior is
prevalent in much of human action because in many cases it is the most
efficient form of behaving, and in other cases it is simply necessary” (4 pg.6). Lastly, the conceptual basis of these models
asserts that people are rational; we know that is not true. For example, Dan Ariely writes about “The Truth of Relativity” how the use of
decoy can create an <i>illusion</i> of a
better deal, the “deal” being exactly what the seller wants us to buy, because
our behaviors can be predictably irrational (5). <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Second critique argument: using health as a core value<o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman";"> “</span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">We are absolutely committed to doing
everything in our power to help you get on track and stay on track to maintain
a healthy lifestyle,” he said (Mayor Bloomburg) “Because this isn’t your crisis
alone — it is a crisis for our city and our entire country”(2). This is one of many examples where health is
used as a core value. As if having good
health is the secret to a lifetime of happiness. The opponents to the soda ban are using
Freedom as their core value. The
campaign by the soda industry emphasizes that individuals will lose their
“freedom to buy beverages as they see fit” (1).
</span><span style="font-family: "Georgia","serif";">The meaning of
Freedom instills much more emotion then the meaning of Health. </span> <span style="font-family: "Georgia","serif";">Resistance
to loss is a</span> strong<span style="font-family: "Georgia","serif";"> emotion
(5). Once we own the right to buy any size soda we
do not want to lose that right. Intuitively,
health should be a motivator, but irrational human reality speaks differently. The New York City department of public health
campaign would be more successful if the message delivered to the target
audience had meaning to people who are obese.
Instead, the message is about health and at the end of the day, it is too
weak a concept to combat freedom. <b><o:p></o:p></b></span></div>
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<b><span style="font-family: "Georgia","serif";">Third critique argument: Poor use of advertising theory.<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";"> One video advertisement I observed
illustrated a young white adult male of normal body weight, wearing cloths I
would describe as business casual, drinking a pint of liquid fat (6). The purpose was to impose a fear to getting
fat. The New York City Department of
Public Health were hoping that the “disgusting” illustration would promote a viral
advertising campaign that will move people toward healthy eating habits, combating
obesity (7). <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> What were they thinking when they
chose the actor? Maybe they were thinking
the demographics of obesity are more prevalent in young adult white males? Are young white professional males the
targeted audience? I think not, because
the area of New York City with the highest percentage of obesity is in the
Bronx, where Hispanic race is the majority and White race is the minority (2). A study conducted by Rehm et.al. reported 1.
people of black race and hispanic race consumed more soda then white race; 2.
households with lower income and 3. individuals with less education consumed
more soda (8). One lesson from the Communications theory to
consider: The person delivering the
message has to be likeable, and the more familiar the person is to the
audience, the more persuasive the message can be. I have doubts that a young professional white
adult was the right person for this message. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> This same message “Don’t Drink
Yourself Fat” was provided to print media. Were they thinking that capitalizing
on psychological reactance would help this campaign? Telling a person not to do something, only
makes it more desirable to do that same thing (9). “Don’t
Drink Yourself Fat” will create a desire to drink fat, in this case fat being
soda. The bold explicit language of the
message triggers reactance (10). This
campaign provides no compelling reason to abide by the message; there is
nothing to like about it. The use of a
positive message would have more of a change effect then a negative message (11).<o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Proposed intervention. <o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";"> Promote freedom from obesity. The New York City public health professionals
“need to steal the flag” of freedom.
They need to re-frame their campaign to foster the sense of freedom that
can be achieved by having “normal” body weight.
Promote the right for individuals to have access to healthier choices,
be free from that temptation of a “better deal” with a larger soda. Get people to rebel against the soda
companies that just want to sell more soda and make more profits. Fire up some emotion to protect their freedom
from the lure of the soda companies. Find
a better reason why people should want to drink less soda. They need to find a substitution for the fear
people have over loosing the control of purchasing larger drinks. This would be supported by Kevin Hogan who
writes “because we naturally resist what we don’t believe and we experience
reactance to all that we fear, there is a real need to help customers create
new pictures with new information to allow them to arrive at a new outcome in
their head”<i> </i>(12). The first step that needs to be taken is
research. What needs to be know is what aspires the
targeted audience; what do obese individuals dream of. Having this information will help formulate a
better advertising campaign. Having this
information provides an opportunity to fit the product of less soda
consumption, into a marketing campaign. Having sound research information, provides
opportunity to create a brand that can further help sell the idea of less soda
consumption. Having sound research can
foster early adapters to trigger a
“skinny” herd of people moving the campaign across the nation via
diffusion of innovation theory. A
campaign with the right frame, the right advertising principles and the right
marketing principles can turn this rebellion against the NYC soda ban into a successful
“let’s drink something other than soda” movement. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Why change the core value
to freedom<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";"> Freedom is a stronger when compared
to health as a core value. Freedom comes
with responsibility, but it has a distant association to loss. When people feel freedom, they feel strength. They feel confidence. They feel like they can concur the
world. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> Freedom from obesity will bring
freedom from ridicule of what you are eating or what you are wearing.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> Freedom from obesity will bring
freedom from isolation or loneliness because you will feel more desirable to
other people. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> Freedom from obesity will bring
freedom from embarrassment due to excessive body sweat. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> My basic research into how it feels
to be obese provided some insight to the idea that these individuals wish to
feel desirable, but no one desires them.
Obese individuals are subjected to critical inspection when they eat in
public, as to what they are eating. They
live in fear of embarrassing social situations, such as not being able to
maneuver into the back seat of a car; or being told they must buy two seats to
fly on a plane. And on a day-to-day
basis, they perspire more then most non- obese individuals, a situation that
can crush self-confidence (13).<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Why use more marketing
theory and less individual theory models </span></b><span style="font-family: "Georgia","serif";"> Marketing theory looks at what a group
of people want<b> </b>compared to
individual health theory which looks only at individuals. Individual health theories virtually ignore
the social aspects of people and the environment that surrounds them. As if people live in a vacuum. Marketing theory recognizing and maximizes
the idea that people have universal wants and desires. Knowing
those wants and desires can foster a campaign to reach masses of people. Behavior can be changed because an individual
wants to become part of a group movement (11).
This change in behavior can happen
automatically, without any planning (4).
<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> One of the key aspects of marketing
theory is creating a brand. This
strategy was successfully used in the Truth Campaign, which facilitated adolescents
to rebel against the tobacco industry (14,15).
Having a brand provides an identity of a promise. One promise that could be used in the NYC
campaign is “NoSweat”. It would be
implicit to obese people. It would
promise that decreasing soda intake will decrease bodyweight, which in turn
will decrease body sweat. The term “no
sweat” has an alternative meaning of “taking it easy”. I think this positive message is far more attractive
then “Don’t Drink Yourself Fat” and I am confident, because the positive message
is also more subtle, there would be less psychological reactance and the
message would be better received by the targeted audience. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Why change the advertising
campaign, and how to change it<o:p></o:p></span></b></div>
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<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">The
message of the current advertising campaign is not effective, it instills
psychological reactance and actually reinforces the act of drinking soda. What follows are my ideas on how to make
improvements to this New York City advertising obesity campaign.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> Create a promise of happiness due to
being free of obesity. By doing the
right research, within a community of obese individuals, the means of their
happiness can be discovered and used to sell the promise of being happy (16). <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> Incorporate the message with as many
images as possible of overweight, Hispanic & Black people drinking water
instead of soda. Sell the message that
water can be free, be happy not to spend money on soda. Support the message with a popular song by
someone like Enrique Iglesias. The use
of music can set a emotional tone that can reinforce the promise of happiness. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> Create a commercial using a
celebrity such as Viola Davis. I would
choose someone like her because of a number of reasons. First, she is a woman in her late forties. A woman in her late forties can implicitly
bring motherhood into the picture.
Mothers can influence a child’s choice and promote non-sugary
drinks. Second, she is black and
therefore looks similar to a majority of people in NYC who are obese. Third,
she is of average body size – not too skinny. Because of her successes, I think the
targeted audience can use her as a model of body weight to aspire to.<o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">Conclusion: Will there be a tipping point<o:p></o:p></span></b></div>
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<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">There are two points that Malcolm
Gladwell writes about in his book referring to epidemics: 1. it needs to be contagious and 2. there is
a need for geometric progression where the action is repeated to an explosive
level and it is surprising how a little action is out of proportion to the
cause. (17).<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> I believe, given the right
advertising campaign, early adapters of switching from drinking costly soda to
drinking free water is a possibility. “Free” is contagious and it could spark a
tipping point. This could be achievable
given the right, multifaceted approach using Advertising Theory, Marketing
Theory, Communication Theory and Diffusion of Innovation Theory to change
behavior.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">REFERENCES<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> 1. Grynbaum, M. Health Panel Approves Restriction on Sale of
Large Sugary Drinks, <i>The New York Times</i> 2012; May 30, 2012<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";"> 2. WINNIE H. Obesity ills that won’t
budge fuel soda battle by Bloomberg, <i>The</i>
<i>New York Times</i> 2012; June 11, 2012<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> 3. Edberg M. Individual health
behavior theories (pp. 35-49). <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">
In: Edberg . <i>Essentials
of Health Behavior: Social and Behavioral Theory in Public Health</i>. Sudbury, MA:
Jones and Bartlett Publishers, 2007.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> 4. Cialdini RB, Introduction and Weapons
of Influence (pp. xi-xiv and <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">
1-16). In: Cialdini RB. <i>Influence</i>: <i>The Psychology of Persuasion</i> <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">
New York: Harper Collins Publishers, 2007.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> 5. Ariely, D. <i>Predictably Irrational: The Hidden Forces that Shape Our Decisions </i>New York, NY: Harper Collins,
2008.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> 6. New York City Department of
Health and Mental Hygiene. <i>Are you putting on the pounds?</i>
http://www.nyc.gov/health/obesity.</span> <a href="http://www.youtube.com/watch?v=-F4t8zL6F0c"><span style="font-family: "Georgia","serif";">www.youtube.com/watch?v=-F4t8zL6F0c</span></a><span style="font-family: "Georgia","serif";"> <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> 7. Hartocollis, A. E-mail reveal dispute over city’s ad against
sodas, <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">
<i>New York Times </i>2012;<i> </i>October 28, 2010<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";"> 8. Rehm, C.D., Matte, T.D., VanWye,
G., Young, C., Frieden, T.R. Demographic and behavioral factors
associated with daily sugar- sweetened soda consumption in New York
City adults. <i>Journal of Urban
Health: Bulletin of the New York Academy of Medicine</i> 2008; 85(3):375-385<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> 9.
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freedom. <i>Journal of Personality and Social Psychology </i>1977,
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<span style="font-family: "Georgia","serif";"> 10.Yan,C., Dillard, J.P., Shen, F.
The effects of mood, message framing and behavioral advocacy on persuasion. <i>Journal of Communication</i> 2010, 60:344-363<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> 11. Thaler, R.H., Sunstein, C.R.
Following the Herd (pp. 53-71). In: Thaler R.H., Sunstein, C.R. <i>Nudge: Improving Decisions About Health, Wealth, and
Happiness</i>. New Haven, CT: Yale University Press</span>, 2008.<o:p></o:p></div>
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12.<span style="font-family: "Georgia","serif";">Hogan, K. <i>The Psychology of Persuasion: How to Persuade Others to Your Way of Thinking. </i>Gretna,
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Eric A Strattonhttp://www.blogger.com/profile/02213610553752385746noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-58991174433160146662013-01-30T12:36:00.000-08:002013-01-30T12:36:10.974-08:00Critique of the United States Federal Government’s Anti-Bullying Campaign – Currie Touloumtzis<br />
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Critique of the United States Federal
Government’s Anti-Bullying Campaign – Currie Touloumtzis<o:p></o:p></span></b></div>
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt;"> <o:p></o:p></span></b></div>
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Introduction<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Center for Disease Control defines bullying as a
physically or verbally aggressive act, causing the victim emotional harm and
sometimes physical harm [1]. The federal government defines bullying as<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">U</span><span style="font-family: "Georgia","serif";">nwanted, aggressive behavior among school
aged children that involves a real or perceived power imbalance. The behavior
is repeated, or has the potential to be repeated, over time. Both kids who are
bullied and who bully others may have serious, lasting problems [2]. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Bullying is most prevalent among adolescent youth,
and thus the campaigns and interventions try to target this group. Private
schools are not exempt from bullying; both public and private schools are
steadily putting interventions in place that attempt to combat this serious
public health issue. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> The
U.S. Federal Government’s current campaign is “Stop Bullying,” designed to help
alleviate bullying. There are three players in a bullying incident: the bully,
the victim, and the bystander [22]. The campaign, outlined on its website </span><a href="http://www.stopbullying.gov/"><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">http://www.stopbullying.gov/</span></a><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">, is trying
to address this immense problem among youth. Their site is broken into five different
tabs, with headers: Parents, Educators, Community, Teens, and Kids. Each tab
provides information for its corresponding group. Essentially, it is a
source-based campaign that enables those visiting the site to gather
suggestions to address their bullying problems and concerns. President Obama
and First Lady Michelle Obama note this growing campaign in a public service
announcement [21]; however, government funding of this intervention does not equate
to effectiveness. The federal government’s campaign fails to reach its target
audience - the design does not incorporate all three players of bullying, and
it does not utilize similarity to relate to its audience. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt;"> <b>Failure
to Address the Target Audience<o:p></o:p></b></span></div>
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<br /></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">The government’s StopBullying.gov campaign does
not employ Communications Theory. This theory incorporates the concept of using
likability, familiarity, similarity and visual associations to convey a message
to its target audience, usually through a media-based outlet [19].
StopBullying.gov does not have a defined target audience. The campaign should
be focused on getting its message to impact the most influential audience when
it comes to bullying: youth. Rather, Stop Bullying provides prevention
strategies to teens <i>and </i>teachers <i>and </i>parents <i>and </i>the community <i>and </i>kids
[2]. The target audience must be a singular group, and the campaign should be
direct in reaching it [32]. In this case, the campaign should be focused on
speaking to teenagers.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Stop Bullying has essentially sided
itself exclusively toward the parents, community and administration in the
school systems. It has inadvertently done so through its “Kids” and “Teens”
sections on the site. This campaign loosely tries to reach out to kids through
a series of videos, called “Webisodes,” found on the Stop Bullying website [3].
These 2 to 3 minute episodes are intended to dissuade elementary-aged children
from bullying one another. However, these video clips are cartoons, with very
dorky characters that are supposed to represent students as different types of
animals, and the teachers and adult figures are also animals and equally silly.
These messages may transpire to kindergarten and first graders, but their
parents will be the ones needing to go on to the computer and show them these
episodes. For those in the age where bullying becomes a real threat (ages 8-18)
[23], they will most likely not find these Webisodes meaningful. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> A
key component to Communications Theory is the ability to relate to its target
audience. This campaign does not relate to the majority of the “Kids” since the
Webisodes fall out of the scope of the age group needing the effective
anti-bullying campaign. If teenagers were browsing this site and saw these
clips, it is unlikely they would find any likability with the characters [24].
Additionally, how could 8-18 year olds watching these Webisodes possibly find
any similarity with not only cartoons, but animals that are portraying the students?
The outcome would be that they would not take the message seriously, and
possibly dismiss the entire site because of the Webisodes [24]. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> Within
the section for “Teens” even less information is provided, and the site does not
even attempt to provide any videos to dissuade bullying. The site does offer the
subcategory, Cyberbullying, where StopBullying.gov gives some examples of places
cyberbullying can be found. Cyberbullying entails all media-based bullying -
including but not limited to Facebook, Instant Messenger, Text messaging – that
the bully or bullies will use to target their victim(s) [25, 9]. Stop Bullying
has a short video called, “Stand Up to Cyberbullying” which is another example
of this campaign’s inability to get on the level of the teenagers. It is a
cartoon as well, this time with indistinguishable cut-out faces discussing the
message of being nice when texting [9]. This newer version of bullying is of
strong concern because it can easily be hidden from adults, and even more
pressing is the idea that cyberbullying can be happening beyond the schoolyard;
that cyberbullying follows you home [25]. Parental supervision on the internet
can only extend so far, and if this bullying is taking place on “acceptable”
sites such as Facebook and Twitter, adults may not recognize what is going on.
Cell phone use may have minimal monitoring as well, unless parents are willing
to invade their child’s privacy by going through their child’s phone and
reading past messages. Unlike the perception Stop Bullying and its predecessor
Ad Council assumes, teens are probably not going to discuss cyberbullying with
an adult. The advice for the parents may well be moot. In fact, teens are two
times more likely to talk to a friend about a cyberbullying incident than to
talk to their parents or a trusted adult [10]. Unfortunately, the government’s
campaign does not extend into the deeper rooted issue of cyberbullying, but
instead coasts over it with a few tips on where to find it [25, 9]. Consequently,
even if the site attempted to focus on teens to provide them information on
bullying such as cyberbullying, the stodgy atmosphere of the site still
dismisses communications theory and the message would get lost [25]. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Failure
to Reach All Three Players in Bullying<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">An additional flaw in the design of this
campaign is the attempt to minimize teen violence through the Theory of Planned
Behavior (TPB). The overall strategy Stop Bullying uses at the youth-level is
to encourage student bystanders witnessing bullying to speak up (as well as
tell parents/teachers about these incidents). Although this is a legitimate
goal, the campaign should not use the TPB to execute this objective. Ideally, if
TPB was implemented by the teen, when they witness bullying they will assess
the situation, use the decision-making process to either intervene themselves,
or find a teacher, and then in a rational manner make that assessment be their
behavior [11]. However, as with most all human beings, including and maybe even
more so with teens, it cannot be expected that even if that process of assessment
occurs, the individual will follow through with that planned intention. The
portion of this campaign designed for teenagers assumes that straightforward
steps will proceed as follows: Bystander teen will see bullying occur, s/he will
assess situation and decide if they are comfortable confronting bully and victim
or go to teacher/faculty, s/he makes
that behavior happen, bullying stops. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> Using
TPB as a foundation for the campaign does not support the bullies to stop, and
it does not help the victims of bullying either. The campaign is almost exclusively
targeted toward the bystanders. By using this theory, the campaign assumes that
bystanders will see this site, feel encouraged to step up and make the strategic
decision to intervene next time they see bullying, and then actually follow
through with changing their behavior. However, it is neither realistic to
presume that a bystander will take the time to go on to this website, nor sensible
that the campaign rely on the players of bullying to actively seek their
information. This required site visitation is another barrier to the
intervention.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Similarly, the meager section
for the victims, entitled “I might be being bullied” [6] is not an assertive or
comforting message. By using TPB the campaign again assumes that the victim is
seeking out the site, sees the title that draws the victim in, helps the victim
formulate a plan to either tell someone or tell the bully to stop, and then do
so. But what if the victim gets cold feet at the very last minute? Or the
weekend goes by and they no longer have the gumption? This model does not extend
to meet the campaign’s intention [11], and this campaign’s intention does not
extend to the needs of the bullying players.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Although TPB does incorporate
the role of social norms on influencing one’s overall behavioral intention [11],
the degree to which peers determine decisions amongst peers is not recognized
in this campaign. Behavioral prediction will not be the most effective method
of predicting actual behavior, especially if the campaign is disregarding how
much of an impact teens can have on other teens (at a group level). This theory
immersed in the Stop Bullying campaign does not cover the irrational behavior
of individuals [28]. Other anti-bullying campaigns are similar in that they do
not truly identify the immense impact peer pressure has on teens and the teen bystander
[33]. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Aside from using an
individual-based model that does not account for the complexity of its at-risk
population, another critique of this campaign is that it disregards the source.
This site does not provide any information for a bully. What if the bullies decided
they wanted to stop, but do not want to jeopardize losing their friends or in
turn become a victim? Or, how do bullies that never want to consider being nice
because they do not find it important fit into this campaign model? [11] TPB
does not have the capacity to address the multitude of scenarios involved with
the issue of bullying. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">“Teach your kid not to be a
bystander” is an integral part of the Stop Bullying campaign, promulgated by Ad
Council to be a strategic route. However, this is assuming that your kids are
not getting bullied themselves. Yes, it is important to have these difficult
discussions with your kids, but parents cannot presume their child is exempt
from bullying. Rather than just teaching them the benefits of not being a
bystander, parents need to talk to their child(ren) about whether they <i>themselves </i>are being bullied, or whether
<i>they </i>are the bully. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">The Stop Bullying campaign
presupposes the prevalence of bullying is known. On average, about 1 in 4 teens
in the U.S. will experience bullying, and upwards of 80% of high school
students report witnessing bully-behavior at least once a week [4]. However,
these figures do not incorporate or provide speculation on the number of kids
being bullied without ever reporting it. This, then, requires the involvement
of teachers and faculty within the school systems to assume the essential role of
reporting on what is really going on in the hallways. But, anti-bullying
campaigns should not in any way rely on adult involvement, especially if most
of the bullying is not being seen by or reported to them [33]. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Parent’s involvement has an
uneven impact on the decrease in youth violence [5]. Unfortunately, not all
parents are attentive to their children and their children’s struggles in
school. Kids may find it difficult or impossible to discuss an issue, such as
being bullied, with their family for fear of being questioned, accused, or
feeling embarrassed [33]. Parental involvement can work, but it is not a
consistent method in decreasing acts of bullying [5]. This becomes yet another
reason for the target audience to be teenagers, and that the scope of this
audience includes all three players of bullying. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 115%;">Promotion of Psychological Reactance<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">The federal government’s current anti-bullying
campaign is unable to deflect psychological reactance. Psychological Reactance
is when our method or mode of persuasion to steer a group in one direction completely
backfires, and consequently has the opposite desired effect [7]. An example of
this in public health was with the “Just Say No” campaign. In its attempt to
discourage kids from doing drugs, the $1 billion dollar campaign ended up
failing overall, with the explicit message not reaching its teenage audience
[26]. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> Since the message threatens
teenagers’ freedom and autonomy, such campaigns are counterproductive and
elicit undesired reactions, also known as the “boomerang effect” [26]. In order
to maintain or re-gain that freedom, the individual(s) will react by taking the
opposite approach [8]. In Stop Bullying’s case, more bullying can occur. In
fact, this is the type of campaign where psychological reactance that happens from
viewing these ads could lead to the creation of parodies about the ads, as seen
from other government campaigns such as “Above the Influence” [20]. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">By sending out a message
conveying “Bullying is bad” with their spokespeople being cartoon animals, the
meaning is not taken seriously. Aside from the Webisodes and Cyberbullying
videos, the campaign presents bland, informational text. The text reads in a
declarative manner, making it very susceptible to psychological reactance [8].
On the “Teens” page, the advice is given from their peers (other teenagers
“like them”). However this page, with its incredibly smiley group of teens, all
looking positively smitten, is not the form of similarity that is necessary to
prevent psychological reactance from occurring [8]. Even if the group
photograph of these teenagers was a relatable depiction, it is still found on a
dull, explicit website that teens truly looking for a resource to deal with
their bullying issue would not find comfort or relation. The ‘Teens’ section on
StopBullying.gov has quotes like, “If you are bullied, say something!” and, “If
you are bullying, it’s not cool.” [6] Even if these unimaginative statements
evoked positive feelings in the bullied/bullies, the site still has little
merit from its overall design. Thus, the “boomerang effect” is highly possible
[26, 8].<o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Final
Thoughts on Critique <o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Pointing fingers at students
and declaring that they be nice to one another gets completely overlooked by
teens. Threatening kids to be nice to one another or else punishment will ensue
is an equally empty threat [7, 8]. The creators of this campaign did not
consider tackling anti-bullying at the group level. Stop Bullying is not a
visually appealing site. It does not reach its audience but instead provides a
CDC-like, informational site that most would glance over quickly. In an age
where 8-18 year olds spend an average of 7.38 hours using some form of media
[12], this site is not with the times. Although this is an alarming number of
hours, it also supports the idea that a campaign must be designed to appeal to
this media-hungry audience. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Articulation
of Proposed Intervention<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">A new anti-bullying campaign, with teenagers as
its singular target audience, should be designed to incorporate three key
elements which would ideally persuade teenagers to stop bullying and stop
letting it happen. These elements include: using real, relatable people; using
a message that appeals to the masses; and using a campaign that addresses not
only bystanders and victims, but the bully (or the “source”) as well.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 115%;">Use of Communications Theory<o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">For an anti-bullying intervention to be
effective, it is imperative that the intervention’s target audience is
reachable through the campaign. An example of a campaign that is trying to
speak directly to its target audience is </span><a href="https://meanstinks.com/"><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">https://meanstinks.com/</span></a><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">. This
web-based campaign is set up in a similar format to the popular website called </span><a href="http://www.pinterest.com/"><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">www.Pinterest.com</span></a><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">. The
website was created by Rachel Simmons, author of the book “Odd Girl Out” and is
a particularly effective strategy because the Mean Stinks: Gang Up For Good!
campaign is geared toward teenage girls [13]. Pinterest is a very popular
website among this demographic and maintaining a familiar format makes the
message initially appealing and keeps the audience engaged. Many anti-bullying
campaigns are not designed to address the deeper layers of bullying. The area
that many are set up to address (including Stop Bullying) is the superficial
level of bullying – the bullying that is <i>seen.
</i>Unfortunately, much of the bullying that does occur involves hidden
cruelty. Planned exclusion, rumors and gossip are often overlooked or unnoticed
by adults and parents, and even potential “bystander” students, and therefore,
they cannot intervene. Bullying disguised as friendship and using friendship as
a bully’s weapon can leave kids uncertain how to cope [34]. This type of
bullying must be considered in an effective campaign, because it is the entire
spectrum of bullying that keeps the cycle going. <span style="color: red;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Since one of the main principles
in Communications Theory is that the person delivering the message has to be
likable, an anti-bullying campaign must include this if it wants the audience
to be persuaded by the message. Creating this new anti-bullying campaign would
ideally have involvement with younger big-name celebrities. Justin Beiber may
be one of several spokespeople to use for the new campaign. An intervention
could be more meaningful if there were likable and familiar role models to not
only dissuade bullying, but also relate by telling their own experiences with
bullies. These influential individuals could have messages discussing the three
categories of bullying. One could be a well-known, likable sports player
discussing how he was<i> </i>a bully.
Another ad could be a popular singer (like Justin Beiber) who was a victim of
bullying. And finally there could be a third ad where a role model discusses
their experience as a bystander. There could be multiple ads, several
addressing each bullying category. It is important that these ads include an
example of every aspect of bullying, not just the superficial portion. Cyberbulling
and “hidden” friendship bullying would all be covered. Additionally, the famous
spokespeople could discuss bullying on specific groups such as the LGBTQ
Community, and bullying in teenagers with special needs. Having relatable
spokespeople that can speak to the level of their audience could increase the
chance of the message getting across. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Although it is challenging to
form a campaign that can be relatable through the communications theory in
every aspect, especially with the diversity in our society, just having one
similar attribute that can connect the student with the message is powerful.
Additionally, this similarity can help stave off psychological reactance [13]. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Use of Group-Level Theories<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Aside from effectively
utilizing Communications Theory, this new anti-bullying intervention would
benefit by relating to teenagers at the group level. Rather than tackling
bullying with individual-based theories, it would be more effective to use
theories that factor in our <i>entire</i>
target audience. We want, preferably, an intervention that affects the teenage
population as a whole. This, in theory, should be even easier than the
individual-based approaches, since teens are a particularly impressionable
group to begin with. Use of Herding Theory would set us in motion. Herding
Theory describes how a group of people can act together without a plan or a
direction [27]. People conform without really knowing why. A well-known example
of such conformity is when a group of people traveling, inadvertently all
decide to go to the uneventful town of Abilene, Texas. Each thought the other
wanted to go when, in reality, no one did. This has been called the ‘Abilene
Paradox’ [15]. A more topical example is seen in the movie “Mean Girls”,
directed by Mark Waters with screenplay by Tina Fey. The movie has a scene
where the “popular girl” who is also the main bully in the movie, comes back
from gym class to find her shirt has two holes cut out. Rather than letting it
bother her, she wears the shirt anyway. Immediately after, all of the other
girls at school follow what this popular girl is wearing, and cut holes in
their own shirts [16]. They look ridiculous, but all follow along to conform
with one another, using the popular girl as their herding leader. Although this
example is entirely fictional, humans often follow along without having any
rational basis [28]. Because of this tendency to “follow the herd” and react at
a group level, it is imperative that a new anti-bullying campaign implement
this theory. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"> Herding
Theory could be put into practice by way of an anti-bully symbol. The UK’s
primary anti-bullying campaign called “Beatbullying” is a charity-driven
campaign that has blue wrist bands for individuals to wear to symbolize they’re
against bullying. Beatbullying says, “Wearing a Beatbullying wristband is a
great way to make your pupils feel part of your anti-bullying strategy and help
them feel safe in school.” [17] The anti-bullying campaign, “I Choose”, uses
the same method where bracelets and phrases are used to promote the choice of
not bullying [36]. Having a visual image that is appealing to teens and viewed
as “cool,” if applied to the masses, could have an immense impact. The tee-shirt
‘Three Wolf Moon’ became an overnight sensation, and that was just a t-shirt
without a cause behind it [35]. The aforementioned campaign “Mean Stinks”
symbolizes its anti-bully message with a blue-painted pinky nail. Doing this is
a method that provides uniformity and connection between girls, to feel they’re
not alone in the fight against bullying. The website encourages girls (who can
“Join the Cause” and post through popular websites such as Facebook and
Twitter) to take photos of their blue-painted pinkies interlocked with a friend
[13]. This simple encouragement can be effective. Hopefully we will start
seeing more girls with blue pinkies.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Unlike Stop Bullying, an anti-bullying
campaign needs to address the issue on a group-level. MTV and Facebook have
recently joined forces to create a campaign that is catchy, visually appealing,
and attempting to appeal to the masses. MTV and Facebook recruited Justin
Beiber to be a face to their new anti-cyberbullying campaign. Since the media
is certainly a threat with the bullying issue, making not bullying appealing
and having the chance to get “Justin Beiber on your voicemail!” makes being
nice all the more appealing [14]. This is the right idea. The intervention
needs to make NOT bullying the norm, and create a movement. Ideally, not being
a bully would be seen as the cool and rebellious thing to do, and the victims
would no longer feel isolated from their peers.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Use of Advertising
Theory to Address the Source of Bullying</span></b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">To tackle bullying full-on, an anti-bullying
intervention must incorporate all <i>three</i>
players of bullying. Bullies need to know how to stop bullying just as much as
victims need to know how to cope with bullying. An intervening bystander is not
the only method to deal with this issue. There is very little being done to try
and determine <i>why </i>the bully is
bullying, and how we can change this. To again use a campaign that tries to
affect the teenage population at a group level, the new intervention should
utilize Advertising Theory, and the idea of “The Tipping Point.” The Tipping
Point is when a new trend becomes popular and then suddenly, becomes
tremendously popular, whereby ideas and products, messages or behaviors spread
like viruses do [29]. An example of the tipping point, where something can fall
into the “gone viral” phenomenon is the music video “Gangnam Style.” This video
has received over 889 million views [30]. Why could we not have an ad out there
with at least half that success, depicting friendship as being the “in thing”? In
order to create a popular ad, it would be imperative to conduct research about
what teenagers think about bullying – and target all three players in bullying.
<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">Advertising Theory works on the
group level. For example the “Truth” campaign used in Florida to deter teen
smoking, used Advertising Theory to implement their campaign. They used their
audience, teenagers, as their inspiration and guidance [31]. “Truth” did its
research before it set anything in motion. This would be an appropriate tactic
to mimic when creating an anti-bullying ad. These ads, which could be viewed
online and on television (aired to the masses), would break the barrier of
needing to actively seek out the messages. The ubiquitous ads would have
effective visuals, celebrities and idealized role models carrying the message,
and would be speaking directly to the audience: the teenagers. These messages
would not include the finger-pointing, “Bullying is bad” and “Speak up if
you’re a bystander.” Rather, they would reinforce the message of community, and
friendship, and that excitement of being that age. Rebellion is an intriguing
idea among youth. “Truth” campaign used this knowledge in their ads [31]. The
message for the new anti-bullying campaign could be rebellion against the
segregation bullying causes, and in turn promote unity through friendship.
Instead of “speak up”: Step Up!! <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 115%;">Conclusion <o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 200%;">We should not be reading about teenagers who
took their life after relentless bullying. News stories such as, “Two high
school girls distribute cupcakes laced with urine to their peers” [18] is a
frightening headline. These stories, sometimes outlandish but oftentimes, real,
demonstrate the urgency of implementing an anti-bullying intervention that will
speak to the<i> teens</i>. They are the ones
that need to really <i>hear </i>the message
in order for any change to occur. Not bullying needs to be cool and accepted. Bullying
segregates people – teens need to rebel against that isolation. We are in a
world where internet videos can “Go viral” and get millions of hits; where
television can be found at every corner. Smart phones are ubiquitous in
America. A message can get across to the masses. We need that message to stick.
Step Up!!<o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif"; font-size: 12.0pt; line-height: 115%;">References<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0in 0in 0.0001pt -22.5pt;">
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Retrieved December 10, 2012, from </span><a href="http://www.youtube.com/watch?v=Gk1EeylYsWc"><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">http://www.youtube.com/watch?v=Gk1EeylYsWc</span></a><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">21.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">White House conference tackles bullying - USATODAY.com.
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I., Pepler, D., & Wiener, J. (2005). Teachers’ Understanding of Bullying. <i>Canadian
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(2001), At what age are children most likely to be bullied at school? <i>Aggressive
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-language: HE; mso-fareast-font-family: "Times New Roman";"> Pechmann, C. & Reibling, E.T. (2000).
Anti-Smoking Advertising Campaigns Targeting
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-language: HE; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Fishbein, M.; Hall-Jamieson, K.; Zimmer, E.; Haeften, Ina von.; Nabi,
Robin. (2002). Avoiding the Boomerang: Testing the Relative Effectiveness of
Antidrug Public Service Announcements Before a National Campaign. <i>American
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-language: HE; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Thaler, R.H. & Sunstein, C.R. (2008). Nudge <i>Improving Decisions About Health, Wealth, and Happiness</i>. Chapter 3,
Pp 257-273.<o:p></o:p></span></div>
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NY. Pp 316-318.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-language: HE; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Gladwell, M. (2000). The Tipping Point. Little, Brown and Company. Boston,
London, New York. Pp. 279-285.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-language: HE; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Lee, Y. & Nakashima, R. (2012). </span><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">“Gangnam
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">32.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-language: HE; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Williams, R.J.
(2012). </span><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">How
to Reach Your Target Audience. Narrow your focus to get your message out to
potential clients. </span><a href="http://www.entrepreneur.com/article/65242"><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">http://www.entrepreneur.com/article/65242#</span></a><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> Accessed Dec. 11,
2012.</span><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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Politics of 'Telling'. <i>Oxford Review of Education</i>, Vol. 33, No. 1. Pp
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-bidi-language: HE; mso-fareast-font-family: Georgia; mso-font-kerning: 18.0pt;">34.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-language: HE; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Simmons, R. (2009). Is Your Best Friend Your Bully?<i> Rachel Simmons Leadership for Life.</i></span> <a href="http://www.rachelsimmons.com/2011/05/is-your-best-friend-your-bully/"><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-language: HE; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">http://www.rachelsimmons.com/2011/05/is-your-best-friend-your-bully/</span></a><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-language: HE; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;"> Accessed Dec.
11, 2012.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">35.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">Wright, D.; Fahy, U.
& Bass, S. (2009). Three Wolf Moon: T-Shirt Becomes Overnight Internet
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">36.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">I Choose. (2012). </span><a href="http://whatdoyouchoose.org/"><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">http://whatdoyouchoose.org/</span></a><span style="font-family: "Georgia","serif"; font-size: 12.0pt;"> Accessed Dec. 10, 2012.<o:p></o:p></span></div>
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Eric A Strattonhttp://www.blogger.com/profile/02213610553752385746noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-77729454432433548512013-01-30T12:29:00.003-08:002013-01-30T12:29:38.412-08:00“Recycle More” Initiative: Ineffective at Changing Boston Residents’ Recycling Habits - Samantha Feld<br />
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<span style="font-family: "Georgia","serif";">“Recycle More” Initiative: <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">Ineffective at Changing Boston Residents’
Recycling Habits<o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">INTRODUCTION</span></b><span style="font-family: "Georgia","serif";"> <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">Waste
generated by individuals and communities has substantial consequences to the
public health, though residential recycling is a system that can mitigate these
consequences and reduce health effects at the population level. According to
the United States Environmental Protection Agency, in 2010, Americans generated
250 million tons of trash—more than any other nation -- and recycled 34.1% of
this material (1). Individually, the typical American generates 4.43 pounds of
trash per person per day, and recycles or composts just 1.51 pounds of this
trash (2). Recycling alone will not solve our climate change and environmental
health problems. However, recycling saves energy and reduces pollution and
greenhouse gas emissions contributing to global climate change by reducing the
need to collect new raw materials to produce and distribute additional goods
(3). Diverting trash for recycling also reduces that amount of hazardous
emissions produced from the waste incineration process, as well as the methane
gas produced and emitted from modern landfills (4). <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> Boston’s residential curbside
recycling rate stands at 13%, lagging behind most other Massachusetts municipalities,
and many large urban cities across the country (5). Changing individuals’
behaviors to encourage recycling has proved to be a significant challenge. In
2009, following the success of a two-year pilot program, Mayor Thomas Menino
and the city of Boston rolled out a single-stream recycling program, where
residents can discard all recyclable materials in one 64 gallon city-provided blue
bin without having to separate the items out first. The goal of the
single-stream recycling program is to increase the number of households who
recycle, and in turn reduce costs for the city (6). As part of the distribution
of the blue receptacles, mayor Menino launched the “Recycle More” campaign in
order to encourage residents to do just that. The “Recycle More” campaign,
launched in 2009 and still in effect today, is comprised of PSAs, informational
pamphlets, press releases, and advertisements intended to change Bostonians’
waste habits and promote recycling. <o:p></o:p></span></div>
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<b><span style="font-family: "Georgia","serif";">FAILURE OF THE HEALTH BELIEF MODEL<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";"> Boston’s “Recycle More” program and
approach to residential recycling is inherently flawed as it fails to take into
account relevant social and behavioral theories. The “Recycle More” program is
intended to change behavior on a very individual level. Under the program, each
apartment building or home receives a blue bin in which they may discard all of
their recyclable items, in conjunction with pamphlets and written information
about how, when, when and where to recycle. The program relies on the classic
Health Belief Model (HBM), under which people take action after weighing the
benefits of a perceived action with the perceived costs. According to this
model, an individual will recycle if he or she thinks the negative impacts of
failing to recycle (ie global climate change and environmental degradation)
will affect him or her and the potential consequences will be severe should
they manifest, relative to the barriers or costs that would limit him or her
from recycling. In the context of the Health Belief Model, the purpose of the
“Recycle More” campaign is to limit the cost or barriers to an individual’s
ability to recycle by providing the single-stream bins free of cost, while also
providing educational materials to residents discussing the importance of recycling
to increase the perceived benefit. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> The Health Belief Model is not an
effective method by which to base a city-wide recycling campaign. While implementing
a single-stream system may make it physically easier for Boston residents to recycle,
this intervention has failed in changing behavior on a mass scale. While
recycling rates having increased among residents in Boston over the past five
years, three years after the “Recycle More” campaign was launched, still less
than one in five discarded items is recycled (7). The Health Belief Model
assumes that once an individual intends to act, he or she will. It does not
take into account any of the cultural, sociopolitical or economic conditions
that might impact an individual’s decision to take action (8). If the Health
Belief Model could account for why people do or do not recycle, once barriers
are reduced (ie through the distribution of bins), then we should see a
drastically greater rate of compliance. There is clearly more at play that
impacts an individuals’ decision to recycle that the Health Belief Model has
not accounted for.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<b><span style="font-family: "Georgia","serif";">VIOLATES THE MARKETING PARADIGM <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> Boston’s “Recycle More” program relies
primarily on the distribution of the 64 gallon bins to collect recyclable
materials, in the hopes that by providing a simplified system and additional
knowledge on the process, behavior will change. What the campaign lacks
altogether is a strong marketing plan that will appeal to the needs and wants
of Boston residents. The traditional method used by the Boston Waste Reduction
Division, which implements the city’s recycling program, has been to appeal to
city residents to recycle more in order to “make our streets cleaners and city
greener,” in the words of mayor Menino. When the mayor unveiled the “Recycle
More” initiative in 2009, Jim Hunt, the chief of the mayor’s Environmental and
Energy stated: “one of the simplest things we can do in our daily lives to
advance our goal to create a greener city is to recycle” (9). Hunt and Menino
are appealing to residents to change their behavior for the greater goal of
“improving the environment.” The central issue with this approach is that the
city is attempting to “sell” Bostonians on the idea of working towards a
“greener”, healthier, more sustainable city for the sake of environmental
sustainability. With this approach, city officials and public health
practitioners are making the assumption that the desire for a greener,
healthier city is strong desire among residents, and that it is a need that is
strong enough to compel people to change their daily actions in order to
achieve it. However, are we certain that a widespread desire among Bostonians
for a green, healthy city really is that strong? <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> The “Recycle More” initiative
violates the basic marketing principles, contributing to the failure of the
program to change behavior on a large scale. Rather than starting out by
examining what it is that Boston residents really want and desire, and then
developing a campaign that can seemingly fulfill those needs and wants,
“Recycle More” is based on an intuition that everyone will naturally hold
environmental sustainability as a strong core value. If sustainability and
environmental health is not such a strong value as the city assumes, action on
a large scale will not follow. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> In addition to failing to capitalize
off of marketing techniques to understand the audiences’ desires, and then
creating a campaign utilizing this market research, the “Recycle More”
initiative has failed to create a brand for itself that resonates with Boston
residents. The city’s campaign relies on the fact that providing residents with
the single-stream carts, and information about how to partake in the program
would change people’s behaviors, and it fails to harness the technique of branding
that would compel residents to engage with the initiative. As Evans and Hastings
describe in <i>Public Health Branding:
Applying Marketing for Social Change</i>, a brand is an identity label that
conveys a message – an ideal -- to society (10). According to Evans and
Hasting, those who associate themselves with the brand aspire to take on and be
part of the ideal, and in turn the brand fulfills the consumer’s aspiration. In
this way, the brand is very much a social contract. Imagery is central to
perpetuating the brand, including the use of a distinct logo, symbol, image and
slogan that is easily recognized and associated with the brand’s ideal (11). From
a distinct brand comes action – in this case actively recycling– enabling the
consumer to fulfill the “contract” and achieve his or her aspirations. Boston’s
“Recycle More” campaign has failed to deliver a clear brand image that would
convey residents’ values and aspirations. The slogan “Recycle More” and the accompanying
image and logo branded on the side of recycling trucks represents the public
health and local government’s ideal, rather than that of the general
population. Relying on informational pamphlets and the distribution of the
single-stream receptacles, rather than employing a strong marketing strategy
has proven to be unsuccessful in creating large scale behavior changes. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<b><span style="font-family: "Georgia","serif";">INVOKES PSYCHOLOGICAL REACTANCE<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> A critical flaw of the “Recycle
More” campaign is its repeated invoking of psychological reactance. According
to Jack Brehm, the psychologist who developed the theory, psychological
reactance “is conceived as a motivational state directed toward the
reestablishment of the free behaviors that have been eliminated or threated
with elimination. Generally, then, a person who experiences reactance will be
motivated to attempt to regain the loss of threatened freedoms of whatever
methods are available and appropriate” (12). Essentially, when someone is told
what to do, that person’s freedoms are being restricted, and according to Brehm,
the natural response is <i>not</i> comply so
that the individual can maintain a sense of control. Sharon Brehm and Marsha
Weintraub demonstrated this innate human response in a study with young
children. In the study, two-year-old children were brought into a room full of
toys. Some of the toys were made inaccessible by a barrier, and some toys were
easily accessible. Even though the children could freely access some of the
toys, they were drawn to the toys behind the barrier, demonstrating an attempt
to assert their control (13). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> Applying Brehm’s work to Boston’s
recycling program, psychological reactance is very much at play in the “Recycle
More” campaign. The very name of the campaign itself – “Recycle More” – gives
an order to residents. In materials provided to residents, including pamphlets,
PSA videos and information listed on the city’s website, the information is
presented in the form of commands, with strong direction words such as
“required”, “must”, “prohibited.” While some of this information, such as what
can go into the recycling system and what cannot, is indeed helpful and even necessary
to convey, all of the information provided is in a very instructional,
authoritative manner that induces psychological reactance. Applying Brehm’s
work on psychological reactance, the city of Boston’s approach to recycling is
concerning because rather than persuading individuals to recycle, the messaging
is doing just the opposite. Instructing individuals to discard their wastes in
a certain manner restricts individuals’ freedoms and achieves the opposite
effect. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<b><span style="font-family: "Georgia","serif";">PROPOSED INTERVENTION <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> In order to effectively increase
recycling rates among Boston residents, I propose a revised intervention and
campaign that would counter the three major limitations stated above. This
campaign consists of three main components: first, I would mandate city-wide
recycling and levy a fine for residents who do not comply in order to catapult
a change in social norms. Second, I would conduct market research to determine the
overarching desires and needs of Boston residents in order to create a
marketing and advertising campaign that meets those desires and compels
residents to engage with the program. In my research, I would investigate the
different demographics and sub-populations within Boston – such as college
students, for example – in order to determine if and how these populations
might differ. This would enable me to create a campaign tailored to different
demographics, if in fact the core values differ. From this market research, I
would launch a marketing and advertising campaign across different mediums to
bolster the recycling initiative. Finally, I would use framing techniques so
that all messaging – whether from a press release, online content, or ad
campaign is conveyed in a manner that will satisfy Bostonian’s core values. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<b><span style="font-family: "Georgia","serif";">INTERVENTION COMPONENT 1: UTILIZATION OF SOCIAL
NORMS THEORY <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> A core component of my improved
recycling initiative for the city of Boston would be to mandate city-wide
recycling and levy a fine on any residents or business who are out of
compliance with the regulation. The fines would be applied to those who either
fail to separate out their recyclables from their trash wastes, or who place
trash wastes in the recycling receptacles. Prior to being fined, residents and
businesses would receive a warning from the city. Recycling and trash
collectors would be able to report particular residents and business who
repeatedly and in excess violate the recycling ordinance. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";">One
reason to institute a recycling mandate with fines for non-compliance is purely
practice. Failing to comply with the recycling protocols is very for the city
as additional resources are needed for sorting (14). However, instituting a
fine has another effect in how it changes behavior: it changes social norms.
According to the Social Norms Theory, also known as the Social Expectations
Theory, change can be created on a massive scale by simply changing social
norms. Rather than focusing on individual attitudes, this model changes
behavior on a very large scale at the group level. According to Melvin DeFleur
and Sandra Ball-Rokeach in <i>Theories of
Mass Communication</i>, behavior is shaped directly by the rules of social
conduct – often conveyed by the media – recalled by an individual (15). Social
expectations theory, then “provides an accounting of social action that is not
depended upon cognitive forces and factors that shape and control human
behavior,” DeFleur and Ball-Rokeach write (15). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";">This
approach stands in contrast to the Health Belief Model, which cannot account
for group-level behavior. According to the Health Belief Model, Boston
residents should be regularly recycling once barriers are reduced (ie
single-stream bins are provided) and perceived benefits are increased (ie
information distributed on the benefits of recycling). Based on Boston’s dismal
recycling rates, the Health Belief Model has not been a successful model to base
a recycling intervention. Whereas the Health Belief model aims to change
attitude in order to change behavior, the Social Norms Theory posits that changing
behavior can then change attitude. If recycling becomes a “social norm,” according
to the Social Norms Theory, Boston residents will recycle. Mandating recycling
and fining people for not complying does just that – it signals to the
population that recycling <i>is</i> the
norm. As this norm is established, the group’s actions will follow in
compliance with the norm. Prior attitudes are irrelevant. San Francisco is a
good demonstration of the Social Norms Theory at play. Recycling and composting
became compulsory in 2009, the same year that “Recycle More” came into effect. In
October of 2012, the mayor of San Francisco announced that 80 of the city’s
wastes are now diverted to recycling and composting programs (16). A similar
policy change in Boston that leverages the Social Norms Theory also has the
potential to dramatically change group-level behavior. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<b><span style="font-family: "Georgia","serif";">INTERVENTION COMPONENT 2: UTILIZATION OF
MARKETING AND ADVERTISING THEORY <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> In order to increase recycling
compliance in Boston, I would determine (perhaps through survey or
collaboration with the Boston Waste Reduction Division) which specific
sub-populations or geographic regions in Boston were recycling and to what extent,
so that I could more effectively establish which populations need to be
targeted for increased compliance. Then I would launch a thorough market
research effort to create detailed profiles on who my “customers” were. Through
this marketing research, which might take the form of focus groups or surveys
and questionnaires, I would determine: What does this group of Bostonians value
most? What do they need, want and aspire to? How do they view Boston? What are
their opinions on the environment and environmental conservation? What do they prize
most about Boston or being a Boston resident? Being a diverse city I would create
profiles of different demographics of typical Boston residents. I would also
give strong attention to the student population in Boston. Though there are so
many students in Boston who are not permanent residents, they are an integral
group that would contribute to the success—or failure– of a recycling program.
Despite their impermanent status, they should not be overlooked. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> After conducting thorough market
research, I would design and implement a recycling campaign that speaks to the core
values articulated by the audience. I would visually demonstrate the core
values articulated through branding. I would not create the brand for the
campaign—the logo, campaign title, image, symbols – until this market research
had been conducted so I was sure to reach the target demographic and hit their
core values. Once I create the campaign’s brand, I would employ advertising
theory—providing a promise and supporting it visually along with other mediums—in
disseminating the brand and the brand’s message on a massive scale. By understanding
and capturing the values of the target population, I will be able to create a
product (ie a recycling campaign) that will meet that population’s desires.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> Other public health campaigns have
successfully used marketing and advertising to change behavior, and the learnings
from these campaigns have influenced my initiative. When Texan public health
officials who were attempting to address highway littering experienced
resistance from men between 18 and 24 who resented government interference,
officials successfully launched a campaign by specifically targeting this
demographic and speaking to their particular interests and values (17). Using
popular Texan celebrities as spokespeople, officials marketed the “Don’t Mess
With Texas” campaign with a “tough-talking slogan that would also address the
unique spirit of Texas pride” (18). The slogan, the logo and the accompanying
imagery was created in a manner that those most resistant to behavior-change
could embrace and integrate as part of their own image. This strategy was
effective in reducing visible roadside litter by 72 percent because officials conducted
research to know who they needed to target and how they could reach that
population (18). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";">In
“The strategy behind Florida’s ‘truth’ campaign,” Hicks describes how a
statewide campaign based on youth-marketing and branding significantly reduced
youth smoking rates, from 18.5% to 11.1% among middle school students and from
27.4% to 22.6% among high school students in a two-year period (19). Central to
the success of the campaign was the use of modern marketing tools, media buys on
the open market, youth involvement in the feedback and creative process, and effective
branding (20). “Knowledge was not the problem… We learned that a youth’s reason
for using tobacco had everything to do with emotion and nothing to do with
rational decision making. Tobacco was a significant, visible, and readily
available way for youth to signal that they were in control… [So] Attacking the
duplicity and manipulation of the tobacco industry became ‘truth’s’ rebellion,”
Hicks writes. The Truth and “Don’t Mess With Texas” campaigns exemplify that knowledge
is not enough to change behavior – in the same way that providing Boston
residents with single-stream recycling bins and information on recycling is not
enough to change behavior. A thoroughly researched marketing strategy that will
target the aspirations of the audience is key component to achieve the desired
behavior change. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<b><span style="font-family: "Georgia","serif";">INTERVENTION COMPONENT 3: LIMITING
PSYCHOLOGICAL REACTANCE BY FRAMING <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> In launching an improved recycling
campaign in Boston, I would pay critical attention to the way in which the
campaign is described and discussed by city officials, public health
practitioners, and in the media in order to prevent psychological reactance
from the target population. As discussed above, psychological reactance occurs
when a person’s freedoms or control is some way limited, and the individual
responds by doing the opposite of what was commanded of them, rather than
heeding, in order to maintain personal control. The current “Recycle More”
campaign is rife with psychological reactants, as it is premised on the local
government instructing residents on how they should act. There are, however,
methods to deflect and limit psychological reactance. Paul Silvia, for example,
describes his two experimental studies in “Deflecting Reactance: The Role of
Similarity in Increasing Compliance and Reducing Resistance” which show that when
the recipient of a message recognizes similarity from the person giving the
message, the message is more persuasive (21). Kevin Hogan, in his book <i>Covert Persuasion: Psychological Tactics and
Tricks to Win the Game</i>, further points out that individuals will quickly
agree with their current point of view, so in order to get an individual to act
the way you would like him or her to, “always discover current beliefs and
attitudes so you can affirm them in some way” (22). While this may seem
counter-intuitive, to reduce psychological reactance, the target audience’s core
beliefs should be reinforced, rather than conflicted. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"> Hogan’s and Silvia’s insights will
inform Boston’s improved recycling campaign. In order to reduce psychological
reactance, I will utilize the findings from the above discussed market research
to determine the core values of the target population, and our campaign’s
marketing and communications will reinforce those values by re-framing the act
of recycling. For example, if “family” is found to be a major core value among
the target population, I will employ visuals in the marketing and specific
language in the recycling campaign that will highlight how recycling will
promote and enhance the value of family. If among college students, a key value
is determined to be “fun/pleasure,” I would showcase how by recycling, streets
and apartments are kept clean, enabling students to have more fun and enjoy the
city of Boston. Based on Silvia’s findings on the role of similarity in
reducing reactance, I would rely on visuals invoking familiarity, such as
quintessential Boston images. In an advertising campaign, I would use “spokespeople”
to convey the message who are similar to the target audience (for example students
giving the message to other students), and I would use different spokespeople
to target different demographics. Using these techniques will effectively limit
reactance and thus limit a barrier to getting people to change their actions. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<b><span style="font-family: "Georgia","serif";">CONCLUSION<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";">The
current “Recycle More” campaign that was launched in 2009 to increase recycling
compliance rests on the premise that if the residential recycling process is
simplified into a single-stream system, then residents will comply. Current residential
rates of recycling show that this premise, rooted in the Health Belief Model,
is ineffective. An effective intervention is one that will utilize policy tools
to change social norms, in conjunction with effective marketing, advertising,
and reactance-reducing techniques that are rooted in an understanding of the
target audience’s values. With these tools, there is substantial opportunity to
affect the population’s behavior on disposal of recyclable goods. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: .5in; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal">
<b>REFERENCES <o:p></o:p></b></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(1) The
United States Environmental Protection Agency. Municipal Solid Waste.
Washington, DC: Environmental Protection Agency.
http://www.epa.gov/epawaste/nonhaz/municipal/index.htm. <o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(2) The
United States Environmental Protection Agency. Municipal Solid Waste.
Washington, DC: Environmental Protection Agency.
http://www.epa.gov/epawaste/nonhaz/municipal/index.htm.<o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(3) The
United States Environmental Protection Agency. Recycling Basics. Washington,
DC: Environmental Protection Agency. http://epa.gov/recycle/recycle.html.<o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(4) Maxwell
N. <i>Understanding the World We Live In</i>.
Sudbury, MA: Jones and Bartlett Publishers, 2009. <o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(5) Massachusetts
Department of Environmental Protection. Massachusetts Municipal Residential
Recycling Rates Fiscal Years 1997-2001 and Calendar Years 2002-2008. Boston,
MA: MassDEP. http://www.mass.gov/dep/recycle/priorities/munirate.pdf.<o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(6) City of
Boston. Mayor Menino Announces Citywide Single-Stream Recycling. Boston, MA:
City of Boston. http://www.cityofboston.gov/news/default.aspx?id=4250.<o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(7) Abel D.
Despite Gains, City Lags in Recycling<i>. </i>Boston,
MA: Boston.com.
http://www.boston.com/news/local/massachusetts/articles/2012/06/19/boston_lags_behind_other_cities_as_it_promotes_recycling/<o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(8) Marks
D. Health Psychology in Context. <i>Journal
of Health Psychology </i>1996 1:7-21.<o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(9) City of
Boston. Citywide Single Stream Recycling Announcement. Boston, MA: City of
Boston. http://www.cityofboston.gov/cable/video_library.asp?id=1310.<o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(10) Evans
W ed., Hastings G ed. <i>Public Health
Branding: Applying Marketing for Social Change.</i> New York, NY: Oxford
University Press, 2008. <o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(11)Evans
W, Hastings G. <i>Public Health Branding:
Applying Marketing for Social Change.</i> New York, NY: Oxford University
Press, 2008.<o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(12)Brehm
J. A Theory of Psychological Reactance. In: Burke W ed., Lake D ed., and Paine
J ed. <i>Organization Change: A
comprehensive Reader</i>. San Francisco, CA: John Wiley & Sons, Inc., 2009.<o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(13) Brehm
S, Weintraub M. Physical barriers and psychological reactance: 2-yr-olds'
responses to threats to freedom. <i>Journal
of Personality and Social Psychology</i> 1977; 35: 830-836.<o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(14) The
United States Environmental Protection Agency. Collection Costs. Washington,
DC: Environmental Protection Agency.
http://www.epa.gov/osw/conserve/tools/localgov/economics/collection.htm <o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(15) DeFleur
ML, Ball-Rokeach SJ. Socialization and Theories of Indirect Influence (pp.
202-227). In: DeFleur ML, Ball-Rokeach SJ.<i>
Theories of Mass Communication</i>. White Plains, NY: Longman Inc., 1989.<o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(16) SFEnvironment.org.
Mayor Lee Announces San Francisco Reaches 80 Percent Landfill Waste Diversion,
Leads All Cities in North America. San Francisco, CA: Mayor’s Office of
Communication, 2012. <o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";"> http://sfenvironment.org/news/press-release/mayor-lee-announces-san-francisco-reaches-80-percent-landfill-waste-diversion-leads-all-cities-in-north-america.
<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Georgia","serif";">(17)
Thaler RH, Sunstein CR. Following the herd (pp. 52-71). In: Thaler RH, Sunstein
CR.<i> Nudge: Improving Decisions About
Health, Wealth, and Happiness</i>. New Haven, CT: Yale University Press, 2008.<o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(18) Thaler
RH, Sunstein CR. Following the herd (pp. 52-71). In: Thaler RH, Sunstein CR.<i> Nudge: Improving Decisions About Health,
Wealth, and Happiness</i>. New Haven, CT: Yale University Press, 2008. <o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(19) Hicks
JJ. The strategy behind Florida’s “truth campaign. Tobacco Control 2001;
10:3-5. <br />
(20) Hicks JJ. The strategy behind Florida’s “truth campaign. Tobacco Control
2001; 10:3-5. <o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(21) Silvia
PJ. Deflecting Reactance: The role of similarity in increasing compliance and reducing
resistance. <i>Basic and Applied Social
Psychology </i>2005; 27:277-284. <o:p></o:p></span></div>
<div class="MsoEndnoteText">
<span style="font-family: "Georgia","serif";">(22) Hogan
K. <i>Covert Persuasion: Psychological
Tactics and Tricks to Win the Game</i>. Hoboken, NJ: John Wiley & Sons,
Inc., 2006.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-indent: .5in;">
<br /></div>
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Eric A Strattonhttp://www.blogger.com/profile/02213610553752385746noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-50820569320120533432013-01-28T16:21:00.000-08:002013-01-28T16:21:21.292-08:00Safe Drinking Water: Changing lives and fulfilling dreams one hand pump at a time- Cristina Los
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<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: Georgia; font-size: 14.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Safe
Drinking Water: Changing lives and
fulfilling dreams one hand pump at a time- Cristina Los<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Introduction<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">What is a basic
human right, lack of it can cause 6,000 deaths in children a day, and is
unavailable to 884 million people in the world? (1) The answer
is interestingly one of the things that many of us in the developed world take
for granted; access to clean and safe drinking water. The lack of access to this basic necessity in life has been brought
to the attention of world leaders almost 40 years ago. In the 1970’s access to safe drinking
water became a “cornerstone of the public health agenda” and formally became
known as a basic human right. When
it was realized that almost a quarter of the world’s population did not have,
what was now considered a basic human right, it started a world-wide movement (2). The decade starting in 1981 became
known as the International Drinking Water Supply and Sanitation Decade (3). This spurred world leaders to being to discuss this topic and
devise strategies and goals to tackle the problem. In 1990 it was estimated that 23% of the population did not
have access to clean drinking water, and while some progress was being made, it
was slow and not enough governments around the world were taking the problem
seriously (4). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">In September of
2000, the United Nations created the Millennium Development Goals. In these goals, Target 7.C was to
halve, the proportion of the population without sustainable access to safe drinking
water and basic sanitation, by 2015 (3). To meet this goal meant that the
percentage of people without improved access to safe drinking water in 2015
would be 12% (4). While we are
currently on target to meet this goal if the development of clean water access
continues, there are some roadblocks to consider. First, the constant increase in the world’s population means
that while we may hit our target percentage, the number of people who need to
be served in order to reach that goal also increases (4). While this is positive, because more people
will have access to clean drinking water, it also means that the programs and
solutions which are implemented need to be sustainable, so they can accommodate
the growing population. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Current
Interventions<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> Because
this is a worldwide problem, there have been thousands of groups which are all
working to create interventions to increase safe water access. Across the board, there have been some
commonalities that most groups follow.
First, outside groups give a financial contribution to help communities
gain access to clean water. These
financial investments are usually funded through international assistance
programs or private investors (5; 6).
The bulk of the money goes to buying the technology to create a way to
harvest the clean water from the ground.
Across the years, the most popular method to bring safe drinking water
to a community is to create boreholes.
The boreholes are created with drilling machines which drill down
through the ground until they reach a water table. A hand-pump can then be attached to the hole to bring water
to the surface (7). In the early
90’s, the drilling of these holes were much more expensive as the equipment was
much more cumbersome and hard to use.
In more recent years, this process has been reduced in cost as the
technology for drilling has been advanced and the process became more
user-friendly for those not skilled in drilling (8). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">An additional
component to most programs is the addition of some type of education
system. These education campaigns
usually cover topics such as hygiene, sanitation, and the importance of
drinking safe, uncontaminated water, and are usually based on current research
and data from surrounding areas (9).
They also may include information on how disease, sanitation, hunger and
poverty are all connected through the importance of drinking safe water (10). While these are all important concepts
to learn, these programs are also all very short in duration, and do not spend
a great amount of detail discussing the maintenance of the new water system (11). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> In
trying to educate the communities, a common campaign seen across the board is
the Global WASH campaign. This
campaign was started in 2001 in response to making a move on the MDGs that were
established in 2000. WASH
represents a renewed emphasis on global water, sanitation and hygiene. Branded in several ways over the years,
from “The Big Issue” and “Hurry Up”, the campaign focused on spreading
awareness of water, sanitation and hygiene, and trying to change policy makers
(14). While components of this
program have been used in isolation or as a whole, many of the groups
implementing clean water solutions have some components of the WASH campaign in
their education system. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> Two
examples of groups that have used the described method of intervention include the
country of Kenya and UNICEF. In Kenya
the government has partnered with many international groups, rotary clubs and relief
agencies to build boreholes and hand pumps in their communities. They then use components of the WASH
program to teach the importance of hygiene and sanitation (5). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">The Water,
Environment and Sanitation (WES) sector of UNICEF has also been using a similar
method of bring safe drinking water to communities around the world. Their projects include the same basic
premise as the Kenyan intervention program, and also incorporate field research
based practices into their programs.
In their plan to help minimize the water crisis, they focus on bringing
in the technology to build bore holes, the tools to install hand pumps, and
education lectures and trainings to help people become knowledgeable of the
importance of clean water, sanitation and hygiene. In their planning, UNICEF is focused on “promoting
behavioral change” so their efforts are focused on bringing the “best available
information and new research on the issue” to the communities they are
serving. UNICEF also understands
the importance of connecting with the community members in order for their
campaign to be a success. To this
end, they use a model of assessment, analysis and action and focus their
evaluation on knowledge, attitudes and practices. In this way UNICEF feels they have the best chance of making
a lasting impact on these communities (9).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">While some of these
interventions have helped to reduce the numbers of people in the world without
access to clean water (2), they have not provided a sustainable solution and
there are still over 700 million people without access to clean and safe water
(15). Unfortunately, the impact of
these programs has been minimized due to some of the following reasons. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Critique
1<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">The first major
critique of the existing intervention is that the program does not inspire or
develop a sense of community interest.
This can be seen in both the technology and education parts of the
existing interventions. For example, external companies and funders come in with
a funding source, and neither the source nor the money is linked to the
community (11). In this way,
community members do not have interest in the project monetarily. This also means that when the company
and the money leave, the communities are left with no supplies or money to
maintain the technology. Maybe in
a few more months when the hand pump breaks, they don’t have any spare parts,
and there is no one to fix it, because the community members were not trained
in pump maintenance (8). The
people who put it in in the first place cannot come back, no one has interest
about the project, and then again, people regress back to their old state of
gathering water and no forward progress is made. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Additionally, the
education program that is included does not promote community interest and
sustainability. When the new water
sources are created, the communities are flooded with new tools and education,
where they were taught how important it is that they maintain the new sources
of water and how practicing safe sanitation and hygiene will reduce the risk of
disease and increase their quality of life. However, they have no means to sustain these new practices. For example, in the education program,
they learned the importance of washing your hands with soap after using the
bathroom, and how it can minimize diarrheal cases of disease by up to 45% (12). However, if they do not have any soap
to wash their hands with, because they have no money to buy soap (13), this can
create cognitive dissonance. They
would buy more soap if they had the money, or make soap if they knew how, but
because they do not have access to these resources (11), they stop practicing
the behavior. Additionally, the
education of hand washing was given based on data to show how it is a more
healthy practice (5), but because their education about hand washing was
relatively new, and was not shown to them in a way that it would be embedded in
their core values, the hand washing routine will be easily dropped and
forgotten. In these ways, the
program as it currently stands does not inspire community interest and
therefore is not sustainable by the communities it seeks to help. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Critique
2</span></b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">The second reason these
implementation methods are not successful is because the education component does
not create lasting change. This is
because the educational lessons are framed around the core value of health. Core values are the critical values
that are fundamental to a culture and help them define who they are as a
community. Also, because these
values are so important to the members of the community, people choose to make
decisions and conduct behaviors that are congruent with these values (</span><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">16). In close conjunction with core
values is the technique of framing.
Framing is a technique used to provide an overarching theme to a set of
arguments and to capture all the information under one larger umbrella (17). Framing can be thought of in terms
viewing different issues through a camera. If you look through a camera you will see a scene. If you change the lens on the camera it
changes the way you see the scene, it can become black and white, or inverted
or all green. Using this analogy,
framing using core values is an important part of sending a message to the
public that people will listen to, remember, and adopt into daily practice. When
giving a message to a community or in this case, delivering health education,
it is useful to use framing to deliver your idea. Within current interventions, in delivering these trainings,
the emphasis is currently on health, safe water and sanitation. The lessons are based on data and facts
from studies done in the area (9), and promote behaviors such as hand washing
because it will improve one’s health (10). The trainings are delivered using the frame of health. However, this may not me the most effective way to promote
safe water practices and sanitation.
If health is not a core value of the community, people will be less
likely to adopt those behaviors. </span><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Conversely, the more they can relate to the core value being
presented the more likely they are to agree with that frame, and they will be
more likely to adopt that behavior.
This is related to Schon and Rein (1994)’s definition of a frame in
which they describe a frame as a culture’s beliefs, values and perspectives,
which the members of that community then use to bring meaning to their thoughts
and actions (18). The
education programs that are being used such as WASH (14) emphasize the
importance of hygiene because it is good for your health and to fight hunger
and poverty (10). This may not be
the best approach as health is generally not a strong core value, and
specifically in the water scare populations. </span><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Critique
3</span></b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> The third and most important critique is
that there is no sustainability of the intervention, and this is due to the
fact that there is no community buy in into the project. The lack of community buy in can be
attributed to the lack of ownership in the project. In the social sciences it has been shown that ownership of
an item or program can have a substantial impact on how much people value that
thing, and how much they are invested in protecting it (19). In the case of the water crisis, in the
current interventions communities who are getting access to clean water are not
valuing the project enough to have ownership of it. This is due to lack of monetary contributions,
lack of maintenance education and not targeting the write persons for
education. Firstly, in the design
of the projects, the preferences of the community members were not considered (8).
This could be detrimental to the
project, as sometimes some of these practices may interfere with community
values or religious beliefs, and therefore are not internalized by the
community, and the interventions are quickly forgotten or not used (11). Additionally, community members were
not required to contribute monetarily to the project (4). While this was considered
a benefit of the programs, because people should not have to pay for water,
this also minimized their possible feeling of ownership.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Another missed
opportunity to create sustainability through ownership was in the education
part of the projects. Members of
the community were not taught how to maintain the hand pumps, nor did they have
equipment to fix them if they broke, which happened often as the technology was
not made for the mass community use (11).
While this has become less of a problem as the technology becomes
simpler, the lack of education and showing them how to maintain the tools is a
lost opportunity to create a sense of ownership. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">An additional
critique of the education system is that it did not target women and
children. In order to be most
effective with the message of drinking safe water and sanitation, in order to
see the biggest impact, the intervention should target those people who are
most involved in gathering the water, because these are the people who will be
most affected by this intervention.
In most cases, the women and children, especially young girls are
responsible for this task (4; 8). For
these reasons, the lack of ownership in the project has put a significant
damper on the possible impact these interventions could have on minimizing the
water crisis. <o:p></o:p></span></div>
<b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><br clear="ALL" style="mso-special-character: line-break; page-break-before: always;" />
</span></b>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Proposed
Intervention<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> In
the past few years, renewed emphasis has been placed on continuing to improve
the interventions that are put in place to continue to reduce the number of
people in the world who are without access to safe drinking water. Researchers now realize the importance
of working with the community (2) when building a program that can be
implemented successfully and which can be sustained. A model program in this new movement is the work of
Water.org. This organization
understands the importance of getting the community members involved in all
steps of the process in order to make their efforts worthwhile and sustainable,
and this is at the forefront of their minds in planning new interventions. Water.org specifically targets projects
in communities where there is an interest with strong buy in from community
leaders. They
first get communities involved by working with local partners to set up a loan
for that community. These local
partners who provide the money are thought to better know the needs, values and
political issues within that specific community, and can build a closer
relationship from the start. It
gives all parties involved a feeling of togetherness and ownership rather than
one person helping another. With this
small microloan, community members are able to work to drill a bore hole and
put in a water pump, but they need to work together as a community, to make enough
money to pay back the loan (20). The community is then actively involved in digging the hole
and putting in the water pump. In
order to make sure that the project can be sustained, Water.org specifically
makes sure that the women and children (whose main job is to bring water to the
site) are involved in learning about how the new system works and how it can be
sustained (2). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> For
my proposed intervention, I am going to suggest a plan that further develops
the model that Water.org is currently implementing. Many of their improvements are key elements of a successful
campaign, and I would like to suggest even more ways to strengthen the impact
of this campaign.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Intervention
1<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">The first
suggestion for improvement is to help gain community interest and buy-in which
will create ownership and sustainability.
I propose to achieve this using social norms and agenda setting theory (21</span><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt; line-height: 200%;">).</span><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> Water.org has done a great job of
recognizing the need to work with communities who are truly interested, and who
have the members and the teams who are interested and ready to work. By working with these teams, the
company is already at an advantage because they have something that these
communities want, and therefore when they get it, they will show more ownership
of their program (19) and try harder to sustain it. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> In
trying to create a greater sense of community interest I suggest that we use
agenda setting theory and social norms theory. Both these theories are based on group decision making and
suggest that more impact can be made in groups. For this reason they try to move important ideas onto the
public agenda and help them to become social norms so they are easily adapted
by the community. <o:p></o:p></span></div>
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<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> The
goal of agenda setting theory is to bring the issue you care about to the
public’s attention (</span><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt; line-height: 200%;">21).</span><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> In this case,
we want to have people in the community care about having safe drinking
water. Because children are such
an integral component in the water gathering process, I suggest that we start
integrating this new agenda in schools with the children. In conjunction with Water.org on this
particular project, I propose that students in school be assigned a project to
help make a movie. The goal of the
movie will be to help all members of the community think about their
aspirations and dreams, and then help show the connection between drinking safe
water and achieving your dreams. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">This movie will
consist of two parts. The first
part will be about the family. The
children will film their family in their daily lives and then interview their
family about how they gets water,
what they use the water for, and their thoughts about what they could do if
they had access to safe water. The
second part will be short personal interviews of all the children of what they
want to be when they grow up. In
filming this video, the hope is that families would start talking about the
water crisis. Perhaps, children
who are not able to attend school because they need to harvest clean water
every day, will start to think about their aspirations and what they could do
if it was easier and less time consuming to gather water for their family. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">With this video, we
can then make the connection to family and what they know and are familiar
with, and how drinking safe water can make these dreams come true. By having everyone interview their
families, hopefully the families will start talking about what they wish they
had, and possibly think about how water can help. If we can make this connection between their dreams and
drinking clean water, this will help bring the issue of drinking clean water to
the forefront of discussions. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">We will then compile
all of the videos and start projecting the product into the community. We will show it on TV, have screenings
of it at the local library, and write about it in the newspapers. Using agenda setting theory, we will
push this issue into the consciousness of the whole community. Hopefully when enough people see the
video, they will begin to see social norms theory (</span><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">22</span><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">) take hold as more community members know that many of
their other community members care about this issue, and they will start to
care as well. The hope is
that this topic will spread throughout their community, especially to the
government officials and this will eventually increase community interest in
being proactive in bringing safe drinking water to their families and
children. <o:p></o:p></span></div>
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<b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Intervention
2</span></b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">The second
improvement we can make to previous interventions is to start using a different
frame. Instead of educating the
community about how important it is to wash your hands, and to drink clean
water and to practice good hygiene because it is healthy for you, I propose
that the lessons focus on selling autonomy. The focus on autonomy rather than health goes back to our
earlier discussion about the power of a frame. In terms of focusing on core values, autonomy and choice are
much stronger core values than health because they are more strongly valued
across a wider range of people</span><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"> (16)</span><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">. Also, since almost everyone would say
that choice and autonomy are already important to them in other areas of their
lives, by connecting clean water and sanitation with autonomy, you are not
introducing new concepts or asking them to change their opinions. It makes your information a much easier
sell, and greatly increases the number of people who will accept your new
information. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> As
an actual mechanism to bring autonomy into the education conversation I propose
to start a campaign using advertising and marketing theory. In advertising theory a promise is made
to an audience in which they believe that if they use the product or in this case, continue
to gain access to safe drinking water , they will be able to reach the promise
or goal described (23). This promise is then backed up by support, which can
range from images, movies, sound clips, or songs, all of which can be tied to
emotions and core values. A
similar concept using marketing theory posits that you know what the deepest
desires of the population are and create a message that links directly to those
desires. <o:p></o:p></span></div>
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<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> In
the case of the water crisis, this would be very easy to fit in. Because with Water.org the communities
are already working with local partners, the local partners will know what
values are important and what political or religious views the community
holds. With this information we
will be able to know what are the goals and aspirations of the group. We will also know more about the
aspirations of the group, from the interviews we conducted for the videos. We will then create a tailored lesson so drinking safe water
is linked to achieving their aspirations.
In this case, as an example, I will focus on school girls. I propose that we use flyers and
commercials and even local plays and skits to show girls that if they drink
safe water and practice good hygiene than they will be able to choose what they
can do with their lives. Instead
of being delegated to get water every day and be denied the opportunity to
become educated, if you stick with these practices you can choose who you want
to be and you can become anything you want. Also the education lessons should include a component about
pump maintenance. If we can teach
them how to fix it independently, we can further build on the autonomy frame,
as we literally give them the tools to be autonomous in maintaining this new
lifestyle. <o:p></o:p></span></div>
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<b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Intervention
3</span></b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">My final suggestion
for improving the current intervention would be to create sustainability and
ownership in the project.
These fixes are mostly already components of the Water.org project, so
they should be easier to implement on a wider scale. I would
suggest that the program put a large emphasis of making sure that the program
will be able to run once the main teachers and implementers have left the
site. In order for this to happen,
the community needs to have a sense of ownership. The community needs to feel that they own a piece of the
project, and in order to do this, they need to be actively involved in the
planning, creating and maintenance of the project (19). To reach this goal, I propose first that
we continue the practices of Water.org and partner with local banks and loan
agencies to finance small microloans for the communities to that they can have
monetary buy in into the project (20).
This will be an easy first step into the process, because if the
community is very interested in bringing safe drinking water to their sites via
the other two intervention suggestions, then once they are able to purchase the
equipment to set up a pump, they will value their fresh water even more (19),
and they will be invested in keeping it working which will allow them to pay
back the loan eventually. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Second, I propose
specific hands-on learning tools for the women and children of each
community. Because the women and
children are the ones who spend the most time going on long journeys to get
safe water, their time is the one most affected by this new improvement of safe
and clean water. As shown at the
website (10), having clean water in a village can greatly improve the life and
aspirations of women and children.
If safe drinking water is more readily available, the women and children
of the village will have more time to tend to their families, and then
children, especially the girls will have an opportunity to stay in school
longer. In order to help strengthen
their feeling of ownership, they will be working hands on with each step of the
water process. All the people who
usually gather water will be trained in how to use the pump, they will be given
some tools to fix it and they will be shown what to do if something goes
wrong. By doing this training, the
impact long term will be exponential.
By giving them practice and lessons in how to gather water and fix any
problems, they will begin to gain self-efficacy and empowerment that they can
sustain this project (4). The time
and money spent on teaching them is a minimal but worthwhile investment, as
their ownership in the project will grow exponentially, because they know how
to maintain the technology and contribute to bettering the future of their
community. <o:p></o:p></span></div>
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<b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Conclusion<o:p></o:p></span></b></div>
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<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> Clearly,
there is much progress being made toward completing the MDG of halving the
number of people in the world who are without access to clean water by
2015. However, as we continue to
drill down and bring safe drinking water to communities we will face new
challenges. The constantly
increasing world population will encourage us to make our efforts more
sustainable, and as we continue to work with willing and able sites, the number
of sites who have fewer resources and who are more remote will increase. These dilemmas call in the need for
more widespread and sustainable interventions. By creating an intervention that can be adopted into a
communities’ core values, and if we can work side by side with each site to
empower them to take on ownership of this project and also their future, we can
hope to go beyond the scope of the MDGs and bring clean and safe drinking water
to everyone on the planet.<o:p></o:p></span></div>
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><br clear="ALL" style="mso-special-character: line-break; page-break-before: always;" />
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<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<b><span style="font-family: Georgia; font-size: 12.0pt;">References<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">1.
</span><span style="font-family: Georgia; font-size: 12.0pt;">World
Vision: Building a better world
for Children. Safe drinking water,
sanitation and hygiene initiatives.
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<span style="font-family: Georgia; font-size: 12.0pt;">2.</span><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;"> Graham, J. Sanitation and hygiene: Taking stock after three decades (pp.
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">3. </span><span style="font-family: Georgia; font-size: 12.0pt;">United Nations Millennium Development Goals. Goal 7: Ensure environmental sustainability. Retrieved from </span><a href="http://www.un.org/millenniumgoals/environ.shtml"><span style="font-family: Georgia; font-size: 12.0pt;">http://www.un.org/millenniumgoals/environ.shtml</span></a><span style="font-family: Georgia; font-size: 12.0pt;"><o:p></o:p></span></div>
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">4.
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Water and Sanitation-related Diseases and the Environment: Challenges, Interventions and
Preventive Measures, Singapore: Wiley-Blackwell, 2011a.<o:p></o:p></span></div>
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">5. </span><span style="font-family: Georgia; font-size: 12.0pt;">World Vision Kenya.
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">7. Elson, B. Low technology drilling (pp.
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">9.
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">10. </span><span style="font-family: Georgia; font-size: 12.0pt;">The Water Project.
Why water? The Water
Project Inc., Retrieved from </span><a href="http://thewaterproject.org/how-to-give-clean-water.php"><span style="font-family: Georgia; font-size: 12.0pt;">http://thewaterproject.org/how-to-give-clean-water.php</span></a><span style="font-family: Georgia; font-size: 12.0pt;"><o:p></o:p></span></div>
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">11. Black, M. & Talbot, R. Water: A Matter of Life and
Health. Oxford, NY: Oxford
University Press, 2005.<o:p></o:p></span></div>
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">12. Selendy, J.M. H.,& Aagaard-Hansen,
J. Introduction (pp. xv-xvii). In:
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">13.
</span><span style="font-family: Georgia; font-size: 12.0pt;">Hayes, J. Facts and Details: Toilets and
sanitation in the developing world (Third World). 2008 updated January
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">14.
</span><span style="font-family: Georgia; font-size: 12.0pt;">Water Supply
& Sanitation Collaborative Council (WSSCC). Global wash campaign.
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">15. </span><span style="font-family: Georgia; font-size: 12.0pt;">Water.org. Facts.
Retrieved from http://water.org/facts/<o:p></o:p></span></div>
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">16.
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Core values and cultural identity.
Ethnic & Racial Studies,1981, 4(1), 75-91.<o:p></o:p></span></div>
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<span style="font-family: Georgia; font-size: 12.0pt;">17. </span><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Certain Trumpet Program. Framing memo: The affirmative action debate.
Washington, DC: Advocacy Institute, September 1996.<o:p></o:p></span></div>
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Schon, D. A., & Rein, M., Frame reflection: Toward the resolution of intractable
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<span style="font-family: Georgia; font-size: 12.0pt;">19. </span><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">Ariely,
D. Predictably Irrational: The
Hidden Forces that Shape our Decisions. New York, NY: HarperCollins, 2008.<o:p></o:p></span></div>
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<span style="font-family: Georgia; font-size: 12.0pt;">20. Water.org. Solutions.
Retrieved from http://water.org/solutions/<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Georgia; font-size: 12.0pt;">21.</span><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">DeFleur, M. L., Ball-Rokeach, S. J. Theories of
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">22. </span><span style="font-family: Georgia; font-size: 12.0pt;">Wisconsin Clearinghouse for Prevention Resources. Best practices: Social norms. Retrieved from </span><a href="http://wch.uhs.wisc.edu/13-Eval/Tools/Resources/Social%20Norms.pdf"><span style="font-family: Georgia; font-size: 12.0pt;">http://wch.uhs.wisc.edu/13-Eval/Tools/Resources/Social%20Norms.pdf</span></a><span style="font-family: Georgia; font-size: 12.0pt;"> <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: Georgia; font-size: 12pt;">23. While, G. E. Creativity: The x factor in advertising theory.
Journal of Advertising 1972, 1(1), 28-32.
<o:p></o:p></span></div>
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<br /></div>
<!--EndFragment-->Eric A Strattonhttp://www.blogger.com/profile/02213610553752385746noreply@blogger.com1tag:blogger.com,1999:blog-1572776051032236617.post-90970344143767805282013-01-01T11:50:00.000-08:002013-01-01T11:50:45.864-08:00 Drug Abuse Resistance Education (D.A.R.E.): An evaluation of program efficacy based on social science theory and available alternatives--Ashley Thomas
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<div class="MsoNormal" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;">Introduction: The Drug Abuse Resistance Education (D.A.R.E.) Program</b></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
I remember when
he first came into our classroom. He was very tall, neatly dressed, and very
austere (I didn’t know that word at the time, but it perfectly encapsulates his
demeanor). Then again, as a fifth-grader, everyone is very tall, anyone in
uniform always appears neatly dressed, and all adults are austere. He quietly
sat in the back of the room until our teacher, Mrs. English, introduced him.
Despite how vivid all of his physical characteristics and mannerisms still are,
I cannot remember his name, so for our purposes, we’ll refer to him as Officer
Joe. Officer Joe was a trained officer of the Drug Abuse Resistance Education
(D.A.R.E.) in-school program, and our classroom was his “beat” for the next few
weeks.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
Developed in
1983, D.A.R.E. is an in-school curriculum that addresses pressures placed on
youth regarding drug use and violence <span style="mso-no-proof: yes;">(1)</span>. It has since expanded from
its original home of Los Angeles to around 80% of United States school
districts and 43 countries worldwide <span style="mso-no-proof: yes;">(1)</span>. Intrinsic to the program,
making it unique among other in-school drug resistance education programs, is
the incorporation of local law-enforcement personnel <span style="mso-no-proof: yes;">(2)</span>. Over a series of 16 weekly
lessons, the officer charged with educating the students introduces facts about
drug use (both underage and otherwise) and violence, while giving the students
tools and strategies to employ later on should they be confronted with a,
“…high-risk, low-gain choice…” <span style="mso-no-proof: yes;">(3)</span><span style="mso-no-proof: yes;">(4)</span>. At the program’s
culmination, lesson 17, participating students will reflect upon what they have
learned and what they hope to carry with them going forward.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
The D.A.R.E.
program was borne out of Nancy Reagan’s directive to children to, “Just say
no!” to drugs and alcohol <span style="mso-no-proof: yes;">(5)</span>. Despite its current
ubiquity, the D.A.R.E. program has been the target of many analyses and
criticisms decrying its efficacy. In some cases, it achieves no measurable
effect, certainly not enough to warrant the resources necessary for its
implementation. While the program has, admirably, evolved significantly in
response to these evidence based evaluations, understanding past failed
strategies will be integral to creating new, more effective curricula.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
In context, as of
2010 (most recently available data), drug and alcohol usage rates among teens
and young adults climbed compared to past years. Among youth aged 12-17, the
rate of illicit drug use was about 10% and about 7% reported currently using
marijuana. The data is much starker when looking at alcohol: 29% of those
surveyed reported being current users. Within this category, 25% of those aged
12-17 reported current use, and nearly 50% of those aged 18-20 reported current
use in the past month <span style="mso-no-proof: yes;">(6)</span>. As was demonstrated not only
by multiple meta-analyses, but also by the persistence of drug and alcohol use
among minors, D.A.R.E. fails to resonate with the students for whom the program
is tailored. This failure comes at high cost to the school, the state, and the
federal government <span style="mso-no-proof: yes;">(7)</span><span style="mso-no-proof: yes;">(8)</span>.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
This analysis
will take a hard look at three specific aspects of the program model and
question the social sciences theories from which those elements were derived.
The model of the program is predicated on the assumption that, regardless of
the situation or background of the student, he or she will be able to reason
through a decision relating to drugs, alcohol, or violence. Many of the
weaknesses of the earliest iterations of the program were a result of this
intense focus on individual linear reasoned behavior. New curricula and lessons
still fail to consider the environment in which the student is raised and the
modeling that impacts their ultimate choice. Compounding this issue is the
fundamental flaw of the program in addressing the normalizing of risky behavior
in youth. While “peer pressure” is a focus of the program model, its
interpretation within the model is dated and often not applicable to real-world
circumstances. Finally, the program assumes that by injecting the students with
a bolstered sense of self-esteem, environmental and situational influences will
no longer be relevant. Unfortunately, youth and their social situations are
much more complex than that.</div>
<div class="MsoNormal" style="line-height: 200%; margin-left: .75in; mso-list: l0 level1 lfo1; tab-stops: list .75in; text-indent: -.5in;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">I.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Criticism of
the D.A.R.E. model</b></div>
<div class="MsoNormal" style="line-height: 200%; margin-left: 1.0in; mso-list: l0 level3 lfo1; tab-stops: list 1.0in; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Critique 1: What works for one should work
for all</b></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
In its earliest
versions, D.A.R.E. targeted fifth- and sixth-grade students. The goal was to
intervene as early as possible to equip students as quickly as possible for any
challenges they may face regarding drug or alcohol use, or violence. Even
though the program was created for an extremely racially and socioeconomically
diverse student population <span style="mso-no-proof: yes;">(9)</span>, the program takes a homogenous
approach to all students, regardless of background.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
Simply due to the
sheer volume of students exposed to this program regularly, it is unrealistic
to assume that all students receive the program in the same way. Based on the
social learning theory, some behaviors have likely already been modeled and
normalized in the home. While these are not the behaviors targeted by the
program, the efficacy of the program is questionable if the students already
have a mental construct of the impact of drugs and violence in the home. This
mental construct can be healthy or dangerous, but the structure of the D.A.R.E.
program does not account for either. The implicit conclusion that follows from
the D.A.R.E. model is that any drug or alcohol use should be absolutely
avoided. These rigid social norms will conflict with the modeling to which the
student has already been exposed, and the desired effect of imparting a
zero-tolerance mentality on the student is not just diluted, but also
eventually lost (given the brief nature of the program).</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
In 2001, the
National Highway Traffic Safety Administration (NHTSA) released a comprehensive
set of “How To” guides around the topic of underage drinking prevention. In it,
they mentioned that there are a number of risk factors that are reliable
indicators of a student’s likelihood to abuse alcohol underage. These include
the following: parental drug use, family structure and function problems, lack
of commitment to school, anti-social behavior, and biological predisposition <span style="mso-no-proof: yes;">(10)</span>. With these in mind, the
student who can most benefit from the message given by D.A.R.E. is least likely
to engage with the program because she is not in school, nor would it be her
first (or most formative) encounter with drug and alcohol use. Because of the
program’s structure, however, these differential risks within the student
population are masked and unattended. Even if family or friends have not
exposed students to any sort of drug culture, they certainly encounter print,
media, or Internet advertisements, and each student to varying degrees. Admittedly,
singling out students who are at greater risk is not a favorable alternative,
but the D.A.R.E. model presumes a homogeneity among students that does not, in
fact, exist. If it did, the model would be singularly effective in any setting
with any permutation of student representation, including those who’d already
tried drugs or alcohol prior to participating in the program.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
D.A.R.E.’s
disregard for social and environmental pressures is indicative of its baseline
belief in the capacity of the individual student to reasonably make a decision
regardless of the situational constraints or past experiences. This stringent
adherence to the individual level social science model (particularly the Theory
of Planned Behavior) is effective in perpetuating the mission of the program
but does not successfully equip students and youth with the tools necessary to
confront complex situations involving friends and social pressures to conform.</div>
<div class="MsoNormal" style="line-height: 200%; margin-left: 1.0in; mso-list: l0 level3 lfo1; tab-stops: 1.0in; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Critique 2: Fitting in is of no concern</b></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
In focusing so
heavily on the individual agency of the student, the D.A.R.E. model does not
effectively confront the realities of tenuous social situations, especially
those encountered in groups. D.A.R.E. struggles to address peer pressure, but
it does so in ways that neglect the very basic principles of herd behavior and
social organization theory. Students are taught strategies and methods to,
“Just say no!” but those strategies do not take into account the pressure of
group behavior and perceived social roles.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
The D.A.R.E
curriculum prescribes very vague and general steps towards confronting peer
pressure. In their model, they help students to identify characteristics of
positive and healthy friendships and encourage them to build social and support
networks buttressed by these relationships <span style="mso-no-proof: yes;">(3)</span>. The difficulty, however, is
translating these skills to new environments with new and different potential
friends and navigating potentially risky situations while in these novel
surroundings.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
The herd
mentality theory asserts that individual choice is heavily, often
imperceptibly, impacted by perceptions of behavior within the same peer group.
In this scenario, a young underage student, most likely in high school or early
college, attends a party where alcohol is being consumed. She leaves for the
party armed with her fifth-grade D.A.R.E. training, but upon encountering a
group of like individuals who are drinking, she is more likely to forget
Officer Joe and instead join her peers. Thaler and Sunstein document behavioral
changes like this not only in underage drinking, but in eating habits, voting
patterns, and tax compliance <span style="mso-no-proof: yes;">(11)</span>. They point out that the
notion of “acceptable” or “normal” behavior may, in fact, be based on false
information, but the reality is that the group will behave in accordance with
the prevailing assumptions. In this case, the prevailing assumption is, when
you attend a party, you drink alcohol. What is at play here is an intense
desire to conform. If the long-term consequences, however grave or benign, are
not frighteningly obvious, conformity to immediate group behavior is inevitable
and well documented. This is an insidious form of peer pressure for which the
D.A.R.E. model does not account. Its earlier models were actually chastised for
hyperbolizing the ever-present threat of drugs and alcohol, counter-intuitively
normalizing a behavior that they were trying to stop.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
Behaving in
accordance with the peer group is not to say that all agency has been stripped
from the individual. On the contrary, according to social organization theory,
there is an implicit understanding within a group that each individual has a
role to play and rules to play by to maintain the order of the social structure
<span style="mso-no-proof: yes;">(12)</span>. As our student example from
above is likely the newest member to the social hierarchy, her desire to conform
is driven by deeply held socialization that differentiation is the enemy of
assimilation. Coupled with her understanding of the rules, as they are manifest
by the other, more senior, members of the group, she adheres to the norms
established prior to her introduction. If she doesn’t, she runs the risk of
being ostracized simply because other members of the group will no longer be
able to play by the same set of rules in approaching her as they would if
approaching anyone else.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
D.A.R.E.
scratches the surface of the pressure encountered by young adults on daily
basis when confronted with risky decisions. It does not, however, incorporate
the pressures of making decisions, as a new actor, within the confines of a
group with either limited knowledge or well-earned knowledge. In that scenario,
the actor is faced with the seemingly more important decision to either fit in
or get out, despite her level self-confidence prior to entering the party.</div>
<div class="MsoNormal" style="line-height: 200%; margin-left: 1.0in; mso-list: l0 level3 lfo1; tab-stops: 1.0in; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Critique 3: Self-efficacy will save us all,
or at least the children</b></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
D.A.R.E.
proponents vehemently believe in the Theory of Planned Behavior. The current
model is built around the notion that improving a student’s sense of
self-efficacy will ultimately empower the student to make the best decision in
a high-risk situation, regardless of surroundings. If this is true, then all of
the weaknesses noted above are immaterial because the more confident the
student is, the less external social and environmental constructs and group
behavior will matter. The fatal flaw of this model, however, is the assumption
that an agent will always behave rationally.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
A hallmark and
critical success of the D.A.R.E. model is the focus on the self-esteem of the
students. Noted in the same NHTSA guidelines, two additional warning signs for
early drug and alcohol abuse are: low self-esteem and shy temperament at a
young age <span style="mso-no-proof: yes;">(10)</span>. This programmatic strength
is, unfortunately, only a proximal result of the model: the students reported
feeling a bolstered sense of self only immediately after the program’s
conclusion <span style="mso-no-proof: yes;">(2)</span>. If this is a method to
counter the impact of the externalities of environment and group behavior, it
is ineffective.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
This focus
appears to be the model’s participation in the transition from the Theory of
Reasoned Action (TRA) to the Theory of Planned Behavior (TRB). Past studies
have tried to show that the TRB is a somewhat reliable predictor in the
underage use of alcohol, as long as the most compelling factors (e.g. attitude
toward alcohol, subjective norms, and prerequisite intention to use) align
correctly <span style="mso-no-proof: yes;">(13)</span>. The researchers firmly
asserted that as long as a young adult <i style="mso-bidi-font-style: normal;">intended</i>
to use alcohol, and all of the other social and personal factors were met, he
or she would, indeed use alcohol. Perhaps, then, if the students were taught to
no longer <i style="mso-bidi-font-style: normal;">intend</i> to use alcohol, the
risk would be eliminated.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
Unfortunately,
what the TRB does not take into account are changes to those critical factors
that influence intention, while assuming a strictly linear movement from
assessment to intent to action <span style="mso-no-proof: yes;">(14)</span>. Does this theory hold in the
context of our party example from earlier? Does the new student have the time
and opportunity to weigh her parents’ opinions, her siblings’ opinions, and her
friends’ opinions in a moment after she is asked whether or not she would like
a drink? Likely not. D.A.R.E.’s vision to empower the participating students to
take greater stock in themselves and have faith in their own self-worth is
absolutely essential for healthy development. However, as a means of addressing
the rather amorphous concept of “self-efficacy” in an effort to impact a nice,
but unrealistic, decision-making model, it is idealistic and poses no real
lasting beneficial effect for the students.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-left: .75in; mso-list: l0 level1 lfo1; tab-stops: list .75in; text-indent: -.5in;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">II.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Proposed
Improvement: Every 15 Minutes and Mariah’s Challenge</b></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
As vividly as I
remember Officer Joe, I remember a day in May when I was in eighth grade. I had
just come home from school and I noticed a newspaper article with my older
brother’s photo. The headline read, “High School Junior Dies in Tragic Drunk Driving
Accident.” The article talked about all of his achievements, how bereaved our
family was, and what a shame it was to have lost him that way. I was confused.
While I was reading the article, my brother came bounding in to the kitchen and
grabbed a snack from the refrigerator. It was safe to say I had no idea what
was going on. I came to find out that my brother was part of the Every 15
Minutes program at his high school.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
Every 15 Minutes
was developed around the statistic that every fifteen minutes, someone was
killed in a drunk driving accident. While this statistic is now dated, and
drunken driving fatalities have decreased by more than 50%, underage drinking
and driving is still a reality. The CDC reported that in 2011, nearly one
million high school aged youth drank and decided to drive <span style="mso-no-proof: yes;">(15)</span>. Clearly there is still a
disconnect in the message being communicated by anti-drug programs and the
actual behavior of teens and young adults. </div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
The D.A.R.E.
program, in an effort to be comprehensive, attempts to educate students on the
dangers of multiple drugs and violent acts. Because the program is limited to
16 lessons, the practitioners cannot delve deeply into specifics about a given
drug. These recommendations will focus on adolescent drinking and risky
behavior associated with the decision to drink. Here we will critically look at
two interventions that successfully use social science models to strengthen and
brand community of non-alcohol users: Every 15 Minutes and the Mariah
Challenge. An effective intervention targeting underage drinking and risky
behavior will combine the key elements of both of these programs and will reach
more students and resonate more deeply.</div>
<div class="MsoNormal" style="line-height: 200%; margin-left: 1.0in; mso-list: l0 level3 lfo1; tab-stops: 1.0in; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Response to Critique 1: Creation of a new
community through shared experience</b></div>
<div class="MsoNormal" style="line-height: 200%; tab-stops: 1.0in; text-indent: .25in;">
The
Every 15 Minutes campaign is a multi-faceted program incorporating various
media to bring the reality of drunk driving directly to a student population
through simulation. Students from the school will be selected to participate in
a mock car collision, where some will play the victims (both injured and dead)
and others will play the perpetrators. The simulated accident will take place
on the school grounds, and the car (often a car that was actually involved in a
drunk driving accident) will remain on the campus for a specified period of
time. Those who have “died” will have obituaries written for them, and the
school will hold a memorial assembly in those students’ honors. Parents will be
notified of the students’ “deaths” and both students and parents will
participate in a letter-writing exercise expressing their feelings surrounding
the incident. After the “accident” and prior to the memorial assembly, students
involved in the “accident” will be taken off campus to participate in a one
evening retreat led by local law enforcement officers and counselors, while
their classmates are instructed to reflect on the accident witnessed.
Individual schools can choose to incorporate or subtract specific elements from
the experience, but overall, the program is the same across schools <span style="mso-no-proof: yes;">(16)</span>.</div>
<div class="MsoNormal" style="line-height: 200%; tab-stops: 1.0in; text-indent: .25in;">
The
brilliance of this intervention lies in its novelty. No matter what the
background or former experiences are of the students participating, the entire
community together witnesses and works through a tragic accident. This
group-level intervention incorporates multiple members of the community, and
serves as a unifying event within the school populations’ collective history.
If the school chooses to adopt this same intervention annually, the tragedy is
not lost on those who have previously experienced it as different students are
selected to participate each year. In contrast to the D.A.R.E.
one-size-fits-all model, Every 15 Minutes simulates a difficult and tragic
event around which an entire community rallies, effectively and lastingly
reaching more students than the D.A.R.E. model structurally could.</div>
<div class="MsoNormal" style="line-height: 200%; tab-stops: 1.0in; text-indent: .25in;">
Emotional
and resonant in nature, Every 15 minutes also capitalizes on one recognized
strength for addressing underage drinking through school programming:
interaction <span style="mso-no-proof: yes;">(17)</span>. In this intervention, the
students are the very center of the appeal and those who are targeted are the
students as well. This dramatization exemplifies the central piece of the
communications theory, as the victims of this simulation are those with whom
fellow students can identify the most. While the simulation initially is not
positive in nature, the reintroduction of the students back into the school
population brings a sense of relief. After forcing the students to confront the
realities of losing a classmate either to arrest, injury, or death by reckless
decision making, that relief is much more profound and persistent over time.</div>
<div class="MsoNormal" style="line-height: 200%; margin-left: 1.0in; mso-list: l0 level3 lfo1; tab-stops: 1.0in; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Response to Critique 2: Branding a
community of non-users</b></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
A sense of relief
is a feeling that Leo McCarthy has been trying to regain for the last five
years. In 2007, his 14-year-old daughter was struck and killed by an underage
drunk driver. While giving his daughter’s eulogy, McCarthy made a commitment to
provide scholarships to high school students who pledged not to drink until
they are 21, not to get into a car with someone who’d been drinking, and to
give back to their communities. The pledge can be taken and signed online and
as long as a student has not been convicted of any underage possession related
offenses, the student is eligible to receive at $1,000 scholarship upon
graduation <span style="mso-no-proof: yes;">(18)</span>.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
Mariah’s Challenge
is a grass-roots organization that is built on the fifth premise of alternative
social science models, and creates a sense of premature ownership in the
students who decide to take the pledge. By incentivizing students with the a
potential scholarship, McCarthy is forcing the students to commit to a behavior
based on an anticipated, but not guaranteed, pay-off without having to buy into
the principles or dogmas that would otherwise lead to the desired behavior
change. As the students get closer to graduation, the likelihood of winning the
$1,000 scholarship is greater and greater and, based on the theories of
ownership, the students are more likely to adhere to the pledge regardless of
external pressures.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
The intriguing
facet about this intervention is that it also builds a branded community. In
the way that the popular Livestrong campaign has merchandise and identifiable
imagery, Mariah’s Challenge has a very recognizable logo and associated pink
merchandise that is quickly and easily linked to the cause. In creating this
brand, McCarthy has also created a community of inclusion for the students who
choose to pledge. Regardless of where those students go, or with whom they
interact, they will always be a part of Mariah’s Challenge. With that brand comes
the promise of responsibility. Being armed with that is much more potent in the
face of making difficult choices than being taught strategies to deal with
one-on-one peer pressure, as the D.A.R.E. model would advocate. A member of
this Challenge community will always be a member as long as he or she follows
through on his or her pledge. Because it is reinforced in a comfortable setting
at first, it is something that can transcend the pressure introduced by novel
surroundings, new individuals, or a changed culture of acceptance.</div>
<div class="MsoNormal" style="line-height: 200%; margin-left: 1.0in; mso-list: l0 level3 lfo1; tab-stops: 1.0in; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;">Response to Critique 3: Changing social
norms</b></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
Both the Every 15
Minutes intervention and the Mariah Challenge are working to change the social
norms surrounding underage drinking and driving by approaching the community
most affected. It was not until recently that the D.A.R.E. program expanded to
include high schools. By the time the graduates of the early D.A.R.E.
elementary programs reached high school, the value of the program, if any
gained at all, diminished. One could thus surmise that any lessons learned were
either forgotten or drowned out by other social pressures, personal
experiences, or environmental stressors.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
By the time early
graduates of the D.A.R.E. program reach high school, they are no longer in
control of the social norms surrounding drinking culture. They are subject to
them. Interventions like Every 15 Minutes and Mariah’s Challenge are forcing
high school students to question two assumptions: that it is permissible to
drink underage and that driving after drinking is not a serious offense. Every
15 Minutes combines the gruesome reality of drunk driving accidents with the
profound emotional impact of losing a loved one to such a horrific incident. It
makes tangible the otherwise easily written off threat that drinking and
driving poses. Mariah’s Challenge, borne out of such a tragedy, mobilizes a
community of committed students to take ownership of their futures. In doing
so, they will first change their behaviors, later change their attitudes, and
even further down the line, impact others to do the same. These collective
changes serve to impact the culture of drinking in the high school environment
by changing the subjective norms on the group level.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
Changing the
subjective norms, particularly those of immediate peers, surrounding the
decision or intention to drink while underage would render the Theory of
Planned Behavior moot. At the point where norms are changed, the issue of
self-efficacy is no longer relevant. Three independent studies evaluating
effective strategies for mitigating underage alcohol consumption have all
recommended that a concerted effort be placed on changing the societal and
community norms surrounding drinking <span style="mso-no-proof: yes;">(19)</span><span style="mso-no-proof: yes;">(17)</span><span style="mso-no-proof: yes;">(10)</span>. D.A.R.E.’s insistence on the
use of individually focused social science models, particularly the TPB, just
speaks to its own inability to adapt and evolve in time with the populations
they are most trying to impact.</div>
<div class="MsoNormal" style="line-height: 200%; margin-left: .75in; mso-list: l0 level1 lfo1; tab-stops: list .75in; text-indent: -.5in;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">III.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">Conclusion</b></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
The United States
Surgeon General has issued a comprehensive, multi-tiered plan to address the
persistent problem of underage drinking <span style="mso-no-proof: yes;">(20)</span>. She, a newly appointed
official, taking such a bold step towards combating this issue is indication
enough that current programming has not been working. One of the most
ineffective of all of these currently existing is the Drug Abuse Resistance
Education program. It is built using individually focused social science
theories and fails to take into consideration the pressures of group behaviors
and environmental pressures into its model, and the only group suffering are
those for whom it was initially intended.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
In its wake,
other interventions have arisen to address D.A.R.E.’s shortcomings. Programs
like Every 15 Minutes and Mariah’s Challenge have built communities around
shared experiences and have branded young students as ambassadors of
responsibility, imbuing them with a sense of purpose that transcends peer and
social pressures. A program with the brand power and sense of ownership of
Mariah’s Challenge coupled with the powerful community building effect of Every
15 Minutes could elicit significant change among high school students and young
adults. These programs are specialized to target very specific drug related
behaviors, compared to D.A.R.E.’s comprehensive, all-encompassing approach, and
create a profound and lasting impression on those who participate, adults and
students alike.</div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .25in;">
CNN recently
reported on a young woman who lost her father and older brother to a drunk
driver in one evening. She has since become an advocate against the behavior
and has told her story to multiple audiences. What she’s realized is that her
story is much more powerful than any numbers or fact sheets, and she has committed
to continue telling her story as long as it proves beneficial to anyone
somewhere <span style="mso-no-proof: yes;">(21)</span>. I don’t remember Officer
Joe’s real name, but I do remember my brother’s “obituary” and I won’t forget
Mariah’s story</div>
<div class="MsoNormal" style="line-height: 200%; margin-left: .75in; mso-list: l0 level1 lfo1; tab-stops: list .75in; text-indent: -.5in;">
<b style="mso-bidi-font-weight: normal;"><span style="mso-list: Ignore;">IV.<span style="font: 7.0pt "Times New Roman";">
</span></span></b><b style="mso-bidi-font-weight: normal;">References</b></div>
<div class="MsoBibliography">
1.
<span style="mso-tab-count: 1;"> </span>D.A.R.E.
[Internet]. The Official D.A.R.E. Web Site: Drug Abuse Resistance Education.
Available from: http://www.dare.com/home/default.asp</div>
<div class="MsoBibliography">
2. <span style="mso-tab-count: 1;"> </span>Ennett,
Susan T., Rosenbaum, Dennis P., Flewelling, Robert L., Bieler, Gayle S.,
Ringwalt, Christopher L., Bailey, Susan L. Long-Term Evaluation of Drug Abuse
Resistance Education. Addictive Behaviors. 1994;19(2):113–25. </div>
<div class="MsoBibliography">
3. <span style="mso-tab-count: 1;"> </span>Objectives
for D.A.R.E. School Curriculum [Internet]. 2012. Available from:
http://www.dare.org/officers/Curriculum/Storyf98c.asp?N=Curriculum&M=10&S=12</div>
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4. <span style="mso-tab-count: 1;"> </span>Rosenbaum,
Dennis. Program Profile: Drug Abuse Resistance Education (DARE) [Internet].
University of Illinois at Chicago; Available from:
http://crimesolutions.gov/ProgramDetails.aspx?ID=99</div>
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5. <span style="mso-tab-count: 1;"> </span>Drug
Abuse Resistance Education: The Effectiveness of DARE [Internet]. Alcohol Abuse
Prevention: Some Serious Problems. Available from:
http://www.alcoholfacts.org/DARE.html</div>
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6. <span style="mso-tab-count: 1;"> </span>Substance
Abuse and Mental Health Services Administration. Results from the 2010 National
Survey on Drug Use and Health: Summary of National Findings [Internet]. U.S.
Department of Health and Human Services Substance. Available from:
http://www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm#3.2</div>
<div class="MsoBibliography">
7. <span style="mso-tab-count: 1;"> </span>Ringwalt,
Christopher, Greene, Jody M., Ennett, Susan T., Iachan, Ronaldo, Clayton,
Richard R., Leukefeld, Carl G. Past and Future Directions of the D.A.R.E.
Program: An Evaluation Review [Internet]. Research Triangle Institute; 1994
Sep. Available from: https://www.ncjrs.gov/txtfiles/darerev.txt</div>
<div class="MsoBibliography">
8. <span style="mso-tab-count: 1;"> </span>Shephard
III, Edward M. The Economic Costs of D.A.R.E. Institute of Industrial
Relations; 2001 Nov. </div>
<div class="MsoBibliography">
9. <span style="mso-tab-count: 1;"> </span>Ethnic
Distribution of Pupils by District, Los Angeles County [Internet]. Los Angeles,
CA; 1997 2011. Available from: http://www.laalmanac.com/education/ed05_97.htm</div>
<div class="MsoBibliography">
10. <span style="mso-tab-count: 1;"> </span>Prevention
& Education [Internet]. U.S. Department of Transportation; National Highway
Traffic Safety Administration; 2001 Mar. Report No.: 4. Available from:
http://www.nhtsa.gov/people/injury/alcohol/Community%20Guides%20HTML/Book4_Prevention.html#Current
theories</div>
<div class="MsoBibliography">
11. <span style="mso-tab-count: 1;"> </span>Thaler,
Richard H., Sunstein, Cass R. Chapter 3: Following the Herd. Nudge: Improving
Decisions About Health, Wealth, and Happiness. New Haven, CT: Yale University
Press; 2008. page 53–71. </div>
<div class="MsoBibliography">
12. <span style="mso-tab-count: 1;"> </span>DeFleur,
Melvin L., Ball-Rokeach, Sandra J. Chapter 8: Socialization and Theories of
Indirect Influence. Theories of Mass Communication (5th edition). White Plains,
NY: Longman, Inc.; 1989. page 202–27. </div>
<div class="MsoBibliography">
13. <span style="mso-tab-count: 1;"> </span>Marcoux,
B.C., Shope, J.T. Application of the Theory of Planned Behavior to adolescent
use and misuse of alcohol. Health Education Research: Theory and Practice.
1997;12(3):323–31. </div>
<div class="MsoBibliography">
14. <span style="mso-tab-count: 1;"> </span>Edberg,
Mark. Chapter 4: Individual Health Behavior Theories. Essentials of Health
Behavior: Social and Behavioral Theory in Public Health. Washington, D.C.:
Jones and Bartlett Publishers; 2007. page 191–205. </div>
<div class="MsoBibliography">
15. <span style="mso-tab-count: 1;"> </span>CDC
Vital Signs - Teen Drinking and Driving [Internet]. [cited 2012 Dec 13].
Available from: http://www.cdc.gov/vitalsigns/TeenDrinkingAndDriving/index.html</div>
<div class="MsoBibliography">
16. <span style="mso-tab-count: 1;"> </span>Every
15 Minutes - Someone dies from an Alcohol Related Collision [Internet]. [cited
2012 Dec 14]. Available from: http://www.every15minutes.com/aboutus/</div>
<div class="MsoBibliography">
17. <span style="mso-tab-count: 1;"> </span>Komro,
Kelli A., Toomey, Traci L. Strategies to Prevent Underage Drinking. NIAAA
Spectrum [Internet]. Available from: http://pubs.niaaa.nih.gov/publications/arh26-1/5-14.htm</div>
<div class="MsoBibliography">
18. <span style="mso-tab-count: 1;"> </span>Grieving
father offers teens money not to drink [Internet]. CNN. [cited 2012 Dec 14].
Available from:
http://www.cnn.com/2012/06/14/us/cnnheroes-mccarthy-alcohol-challenge/index.html</div>
<div class="MsoBibliography">
19. <span style="mso-tab-count: 1;"> </span>Holder,
Harold D. Community Prevention of Young Adult Drinking and Associated Problems.
NIAAA Spectrum. </div>
<div class="MsoBibliography">
20. <span style="mso-tab-count: 1;"> </span>General
S. Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking
[Internet]. [cited 2012 Dec 14]. Available from:
http://www.surgeongeneral.gov/library/calls/underagedrinking/programs.html</div>
<div class="MsoBibliography">
21. <span style="mso-tab-count: 1;"> </span>What
sways teens not to drink, drive? Stories, not stats [Internet]. CNN. [cited
2012 Dec 13]. Available from:
http://www.cnn.com/2012/10/10/us/cnnheroes-underage-drunken-driving/index.html</div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
Mollyhttp://www.blogger.com/profile/18395792142837014194noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-61486039025230684472013-01-01T11:48:00.000-08:002013-01-01T11:48:09.419-08:00African American Gender Politics and the AIDS Epidemic: A Critique of Current HIV Intervention Strategy – Tali Schiller
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<span style="font-family: Georgia;">The AIDS epidemic has been an unprecedented medical
and public health issue for the last 30 years. Never before has a disease been
so difficult to fight medically, socially, and in the public health
sphere.<span style="mso-spacerun: yes;"> </span>Our national policy has
been more than up to the challenge to extend the required effort and financial
backing – in fiscal year 2012 alone, the United States earmarked $21 billion for
domestic research, prevention, and care and treatment of HIV (1).<span style="mso-spacerun: yes;"> </span>Early awareness campaigns, such as
SILENCE = DEATH and the Australian Grim Reaper commercial, were instrumental in
teaching the public about HIV in the early days of the epidemic; efforts to
maintain HIV in the public’s mind, and to educate them about how to prevent
transmission, is still very much a priority.<span style="mso-spacerun: yes;"> </span>This tremendous effort to prevent the transmission of AIDS
through information and awareness is almost unmatched in the field of public
health.<span style="mso-spacerun: yes;"> </span>Why, then, has the HIV
infection rate failed to drop?</span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The Center
for Disease Control and Prevention reports that the domestic new infection rate
has remained steady for the last 10 years, with about 50,000 new infections per
year.<span style="mso-spacerun: yes;"> </span>The African American
population makes up a disproportionate percent of these new infections – though
only 16% of the total population, African Americans accounted for 44% of new
infections in 2009 (2).<span style="mso-spacerun: yes;"> </span>Of this
population, women of color are the most affected: in 2010, African American
women made up two-thirds (64%) of new AIDS diagnoses and 57% of new HIV
infections among the entire female population of the United States (2).<span style="mso-spacerun: yes;"> </span>These rates show no sign of decreasing,
despite millions of dollars spent on education and prevention messages
broadcast on every medium.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>African American
women are at an especially high risk for contracting HIV.<span style="mso-spacerun: yes;"> </span>In 2010, black women were nearly 15
times more likely to be infected with HIV than white women, and nearly 1 in 30
black women will be diagnosed with HIV/AIDS in her lifetime (3).<span style="mso-spacerun: yes;"> </span>AIDS is the primary cause of death
among African American women aged 25 to 34 (4).<span style="mso-spacerun: yes;"> </span>Studies have shown that black women do not engage in riskier
behavior than other women, but social dynamics place them at a higher
risk.<span style="mso-spacerun: yes;"> </span>Factors that increase black
women’s risk of contracting HIV include differential access to health
information, unequal access to healthcare and prevention materials, low
self-esteem and a lack of empowerment, alcohol and drug use, poverty, sex-ratio
imbalance, and a number of others (5).<span style="mso-spacerun: yes;">
</span>These causes work synergistically to increase HIV transmission in the
African American community.<span style="mso-spacerun: yes;"> </span>The
most important factor to consider is <i style="mso-bidi-font-style: normal;">low
perceived susceptibility</i> to risk of infection – black women have a
significantly lower perceived risk than women of other races, even those who
participate in known high-risk behaviors (6).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The CDC is
fighting back against new HIV infections.<span style="mso-spacerun: yes;">
</span>They have made a serious commitment to the African American community
through a multi-pronged approach targeting different sections of the
population.<span style="mso-spacerun: yes;"> </span>The Act Against AIDS
Leadership Initiative (AAALI) is a $16 million partnership between the CDC and
leading organizations that represent the communities hit hardest by HIV.<span style="mso-spacerun: yes;"> </span>The Expanded Testing Initiative is a
$50 million per year, three-year expanded testing program to increase HIV
testing in the African American community.<span style="mso-spacerun: yes;"> </span>The CDC provides financial and technical support to
community-based testing and prevention organizations, such as the WILLOW
program, Sister to Sister, Nia, and Many Men, Many Voices.<span style="mso-spacerun: yes;"> </span>The CDC has also created the current
Act Against AIDS campaign, which delivers HIV testing information through the
“Testing Makes Us Stronger” campaign for black men who have sex with men (MSM)
and “Take Charge. Take the Test.” for the black heterosexual female population
(7).<span style="mso-spacerun: yes;"> </span>These financial commitments,
and many more, are inspired by President Obama’s July 2010 National HIV/AIDS
Strategy, new policy to address the problem of domestic HIV (8).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The CDC’s
response to steady HIV infection rates among the heterosexual African American
female population was to develop the national campaign “Take Charge. Take the
Test.” (TCTT), focused on timely testing as a vehicle to increase awareness of
HIV status and therefore increase treatment. It combines aspects of several
intervention models – Health Belief Model, Theory of Planned Behavior, and the
Ecological Model – to create the theoretical framework.<span style="mso-spacerun: yes;"> </span>The audience was also segmented; the
CDC selected “</span><span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;">single,
African-American women aged 18–34 years, with some college education or less,
who earned US$30,000 or less per year, resigned in certain zip codes of high
prevalence for HIV/AIDS, and who were having unprotected sex with men”(9). </span><span style="font-family: Georgia;">TCTT is currently the largest and most
comprehensive national response to the high incidence of HIV infections in the
black female population, launched in ten major US cities where a significant
percent of black women are affected.<span style="mso-spacerun: yes;">
</span>This comprehensive effort to reach the black female community is larger
than any that precedes it.<span style="mso-spacerun: yes;"> </span>So why
isn’t it working?<span style="mso-spacerun: yes;"> </span></span><span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;"></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;">I. Structural Barriers to Care </span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in;">
<span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;">Considering the creation
of an intervention for any disease requires contextualizing it within a
socio-cultural framework: no disease exists in a vacuum, but HIV is more
susceptible to societal factors than most. <span style="mso-spacerun: yes;"> </span>Its stigmatized routes of transmission create a complicated
environment in which to create effective public health messages.<span style="mso-spacerun: yes;"> </span>Any such message must contend with a
30-year long association with homophobia, drug use, and sexual
promiscuity.<span style="mso-spacerun: yes;"> </span>In the African
American community, these stigmatized activities are additional to the barriers
of being black in America – poverty, segregation, and the historical fallout of
a 300-year history with slavery.</span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;"><span style="mso-tab-count: 1;"> </span>Research has shown that black women and black gay men, the two
populations of color with the highest incidence of HIV, have a similar number
of sexual partners and use condoms as often as their white counterparts (10). Individual-level
behaviors do not fully explain the racial disparity; in fact, a focus on
behavior increases stigma by suggesting that individuals’ bad decisions are
solely to blame for their poor health outcomes.<span style="mso-spacerun: yes;"> </span>Instead, we must regard health inequalities within the
socio-cultural context of race when considering HIV disparity, as with any
other health problem that disproportionately affects communities of color.<span style="mso-spacerun: yes;"> </span>Some factors that foster health
inequalities include segregation in housing, education, employment, and health
care, and racially skewed mass incarceration (10).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in;">
<span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;">Racial segregation by
neighborhood increases HIV risk and prevalence. Residents of low-income,
minority neighborhoods are also significantly less likely to have access to
medical care or prevention methods (11).<span style="mso-spacerun: yes;">
</span>Studies show that within a medical practice, black patients are treated
differently than their white counterparts and that African Americans are
likelier to live or seek care in areas where the healthcare quality is low for
all patients (12).<span class="MsoFootnoteReference"> </span>Even if they have
access to healthcare, African Americans are less likely to have a regular
source of primary care and therefore a trusted source of medical care (12). </span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in;">
<span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;">Geographical segregation
also makes communities of color less likely to have access to medical education
– important for both seronegative individuals, to maintain their negative
status, and seropositive individuals, to maintain their health and make sure transmission
stops with them.<span style="mso-spacerun: yes;"> </span>Timely diagnosis
is an important factor when considering both HIV prognosis and spread in the
population.<span style="mso-spacerun: yes;"> </span>It is estimated that 1
out of 5 HIV+ individuals don’t know their status (2), affecting both their
health and the health of any potential sexual partners; left untreated, HIV is
more likely to develop into AIDS more quickly, and is more likely to be
transmitted through unprotected sexual contact or intravenous drug use.<span style="mso-spacerun: yes;"> </span>Lower rates of medical access,
information, and quality have real and quantifiable consequences for the viral
load in African American communities.<span style="mso-spacerun: yes;">
</span>It is absolutely vital to place any intervention aimed at the African
American community in general, and black women in particular, within a context
of social determinants and social justice by moving beyond individual-level
behavioral risk factors.<span style="mso-spacerun: yes;"> </span>The
downstream consequence of poor health outcomes should be recognized as the
result of upstream factors such as the distribution of wealth.<span style="mso-spacerun: yes;"> </span>It may also be worth noting that many
health behavior change models depend on the use and spread of health
information, in addition to raising self-efficacy, to inspire health
change.<span style="mso-spacerun: yes;"> </span>Due to the structural
problems the African American community faces, behavior-changing information
does not spread as widely in their community and therefore does not have the
desired effect.</span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;">II. Gender Power Imbalance</span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;"><span style="mso-tab-count: 1;"> </span>In the United States, there are approximately 9 African American men
for every 10 African American women (13); this creates a sex-ratio imbalance
that is frequently cited as a leading cause of relationship insecurity and a
fundamental reason for a gender power imbalance.<span style="mso-spacerun: yes;"> </span>Since 83% of HIV transmission is through heterosexual
contact (14), a dearth of acceptable sexual partners may lead women to choose partners
with higher HIV risk.<span style="mso-spacerun: yes;"> </span>Therefore,
the factors that contribute to a woman’s position within a sexual network may
place her at a higher risk of contracting HIV.</span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in;">
<span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;">The ratio imbalance
stems from a number of factors that remove African American males from the
community, including higher mortality rates from disease, high violence rates,
and high rates of incarceration (15).<span style="mso-spacerun: yes;">
</span>Black men are overrepresented in prison systems. <span style="mso-spacerun: yes;"> </span>More than 12% of men ages 20-29 are in
jail or prison, and black men are more likely to be incarcerated than white men
for the same crime (16).<span style="mso-spacerun: yes;"> </span>This
“sexual network” concept – that a group of individuals are connected directly
or indirectly through their sexual contact – has deep ramifications for the
African American community.<span style="mso-spacerun: yes;"> </span>Many
individuals choose sexual partners from within their neighborhoods, so even if
they do not engage in high-risk behavior, the systematic segregation will also
increase the risk of a high-risk partner (17).<span style="mso-spacerun: yes;"> </span>This relatively small network of potential partners allows
transmittable sexual diseases to spread more rapidly. In fact, the high viral
load of certain inner city segregated communities has been compared to that of
third-world countries (18).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in;">
<span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;">The theory of concurrent
relationships may offer some important insights about the spread of HIV in the African
American community. <span style="mso-spacerun: yes;"> </span>Previously
mentioned factors such as high incarceration and low sex-ratio lead to an
especially high number of concurrent relationships, which are “multiple
simultaneous sexual relationships or sexual relationships that overlap in time”
(19). </span><span style="color: #302b2a; font-family: Georgia; line-height: 200%; mso-bidi-font-family: Arial; mso-bidi-font-size: 13.0pt;">A study conducted
by </span><span style="font-family: Georgia; line-height: 200%; mso-bidi-font-family: Arial; mso-bidi-font-size: 13.0pt;">Morris et al.<span style="color: #27446e;"> </span><span style="color: #302b2a;">found that the rates of concurrency in African American
male participants between the ages of 20 and 38 were 3.5 times higher than
their White counterparts and 1.9 times higher than men of other racial
backgrounds. In the same study, African American females had rates of
concurrency at 2.1 times higher than their White counterparts and 4.1 times
higher than women from other racial backgrounds<i style="mso-bidi-font-style: normal;"> </i>(19).<i style="mso-bidi-font-style: normal;"><span style="mso-spacerun: yes;"> </span></i></span></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in;">
<span style="color: #302b2a; font-family: Georgia; line-height: 200%; mso-bidi-font-family: Arial; mso-bidi-font-size: 13.0pt;">The consequences of these gender
inequalities for HIV are clear. Expressed by Newsome et al: “African American
women contending with the gender ratio imbalance that exists may relinquish
negotiating power in their relationships, be more likely to settle for less
desirable partners, accept infidelity, and agree to engage in unprotected sex”
(15). </span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in;">
<span style="color: #302b2a; font-family: Georgia; line-height: 200%; mso-bidi-font-family: Arial; mso-bidi-font-size: 13.0pt;">A black woman’s sexual relationships
can be informed by concurrency, instability, and an imbalance of power.<span style="mso-spacerun: yes;"> </span>These limiting factors often result in
disassortative mixing by HIV risk, in which low-risk individuals partner with
high-risk individuals due to lack of choice and therefore become high risk
themselves.<span style="mso-spacerun: yes;"> </span>This system of
arrangements puts black women in high-risk situations not of their own making;
individual-level risk behavior is meaningless when confronted with a system
that puts women at higher risk through no fault of their own.<span style="mso-spacerun: yes;"> </span>These gender-based configurations of
power stymie traditional behavioral theories’ suggestion that knowledge of risk
should result in an increase in self-protective behaviors.<span style="mso-spacerun: yes;"> </span>The inherent imbalance of power in
sexual relationships naturally leads to an inability to engage in
self-protective behaviors – when your sexual options are limited, bargaining
for monogamy and condom use is not an option.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;">III. Spiritual Worldview and Self-Efficacy</span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;"><span style="mso-tab-count: 1;"> </span>A review of the current literature reveals that by far the most
important thing to consider when discussing HIV transmission in black
heterosexual females is that they have a much lower perceived risk of infection
than comparable populations.<span style="mso-spacerun: yes;"> </span>This
belief holds the key to understanding their high HIV transmission rates.<span style="mso-spacerun: yes;"> </span>Several factors to consider concerning
its genesis are the high levels of spirituality and religiosity historically
found in the African American community, the optimism and fatalism associated
with spirituality, and the power of an entrenched worldview coping mechanism
(20).</span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;"><span style="mso-tab-count: 1;"> </span>Spirituality and religiosity have been associated with the African
American community as a coping mechanism for systematic oppression (21).<span style="mso-spacerun: yes;"> </span>The community depends on religion in
times of adversity, and prayer is an important tool in times of need.<span style="mso-spacerun: yes;"> </span>African American women in particular
report a high level of spirituality and religiosity and “heavily rely on a
sense that everything is in the hands of a higher power” (20).<span style="mso-spacerun: yes;"> </span>In times of special need or stress, all
individuals are known to depend on extant coping mechanisms; this has been shown
to be true in cases of extreme illness or disease, such as HIV (20). <span style="mso-spacerun: yes;"> </span>However, certain aspects of this
religious coping mechanism clash with medically approved prevention or
maintenance behaviors recommended for the avoidance of HIV (22). Also, belief
in a higher power is associated with higher levels of optimism. This suggests
the concurrence of optimism bias, the theory that individuals have an
optimistic underestimation of their vulnerability to negative
consequences.<span style="mso-spacerun: yes;"> </span>Optimism bias has
been shown to be a contributing factor to the spread of HIV in the African
American community (23).<span style="mso-spacerun: yes;"> </span>This is
perhaps related to African Americans viewing AIDS as only a gay white male
disease (17) and therefore not viewing their risky behavior as risky enough to
place them in danger of contracting HIV.<span style="mso-spacerun: yes;">
</span></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in;">
<span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;">Belief in a higher power
also correlates with the principle of fatalism, or the amount of control people
feel they have over their lives and future. </span><span style="color: black; font-family: Georgia; line-height: 200%; mso-bidi-font-family: Times; mso-bidi-font-size: 10.0pt;">Powe (1996) stated, “In addition to poverty, oppressive forces
such as the long history of slavery, segregation, discrimination, substandard
health care, and the subsequent perceptions of meaninglessness, hopelessness,
and social despair provide the environment for the emergence of fatalism [among
African Americans]” (24).<i style="mso-bidi-font-style: normal;"><span style="mso-spacerun: yes;"> </span></i>People with fatalistic attitudes
have been shown to participate less frequently in preventive health behavior (20).<span style="mso-spacerun: yes;"> </span>In a study on cancer risk, African
Americans and women reported higher levels of fatalism than European Americans
and men (25).<span style="mso-spacerun: yes;"> </span>This study can
easily be extrapolated to HIV; African American women feel as though they have
little control over whether or not they contract HIV, and so do not feel as
though they need to take precautionary measures, such as condom use or regular
HIV testing.<span style="mso-spacerun: yes;"> </span>Studies show that
although black women are, in fact, in possession of a great deal of knowledge
about HIV transmission and prevention (due to years of targeted education), the
combined optimistic bias and fatalism inherent in their religion-based coping worldview
leads to a lower personal perceived risk of HIV contraction.<span style="mso-spacerun: yes;"> </span>This difference in known versus perceived
risk may also avoid the cognitive dissonance inherent when pursuing behaviors
one knows are risky but does not feel one has the power to avoid.</span><span style="color: #232323; font-family: Georgia; line-height: 200%; mso-bidi-font-family: "Arial Unicode MS"; mso-bidi-font-size: 13.0pt;"></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">IV.
Proposed Intervention</span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>What lessons
can be learned from this social and psychological profile?<span style="mso-spacerun: yes;"> </span>First of all, the real source of many
issues of public health can be found upstream.<span style="mso-spacerun: yes;"> </span>The health problems of the African America community extend
far beyond the prevalence of HIV, and the underlying cause is the systematic
racism, poverty, and segregation endemic in the community. Interventions geared
toward changing individual behaviors are useless without considering the socio-cultural
framework that the individual is part of.<span style="mso-spacerun: yes;">
</span>It’s impossible to understand a black woman without also understanding
how her gender, history, value system, and sexual network affect her behavior,
and how they interact to create seemingly irrational behavior patterns. </span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in;">
<span style="font-family: Georgia;">Second, accurate knowledge is the vital center of
many health interventions, yet knowledge alone is not enough to warrant
substantive change.<span style="mso-spacerun: yes;"> </span>Many models
address this disparity between knowledge and behavior through the addition of
self-efficacy; raising an individual’s efficacy is the theoretical answer.<span style="mso-spacerun: yes;"> </span>The problem with behavioral models is
that black women already <i style="mso-bidi-font-style: normal;">know</i> they
are at a higher risk of HIV and they <i style="mso-bidi-font-style: normal;">know</i>
safe sex will protect them.<span style="mso-spacerun: yes;">
</span>Educational interventions have taught them all about HIV.<span style="mso-spacerun: yes;"> </span>The problem is, all of the other
factors that create the worldview of a black American woman combine to decrease
her perceived risk. <span style="mso-spacerun: yes;"> </span>This
occurs in order to avoid the cognitive dissonance inherent in participating in
the risky behaviors known to be associated with HIV transmission while not
feeling like she has the power to avoid these risky behaviors.<span style="mso-spacerun: yes;"> </span>Behavioral interventions may teach safe
sex and regular HIV testing, but women will continue to ignore them as long as
that is the sacrifice they must make for the comfort of feeling protected by
their heterosexual relationship.<span style="mso-spacerun: yes;">
</span>But if the HIV incidence rates in the black female population are to be
reversed and eventually stopped, the first goal must be prevention through
engaging people’s existing worldviews on a societal scale.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<span style="font-family: Georgia;">The components of the proposed intervention are as
follows:</span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span><b style="mso-bidi-font-weight: normal;">a.)</b> There is no simple solution for the
root cause of health inequality. The best way to address the important HIV
implications of skewed incarceration statistics, wealth inequality, racism, and
segregation is to eliminate these systematic inequalities.<span style="mso-spacerun: yes;"> </span>This is easier said than done.<span style="mso-spacerun: yes;"> </span>The Obama administration’s National
HIV/AIDS Strategy and Implementation Plan makes great strides in this area by
focusing not only on HIV testing and education, but by also addressing disparities
as the root cause of high HIV transmission rates. <span style="mso-spacerun: yes;"> </span>Some action items suggested by this plan include making HIV
tests available to low-income populations, promoting a holistic approach to
health, and adopting community-level approaches to reduce HIV infection rates
(8).<span style="mso-spacerun: yes;"> </span>Still, it’s clear that
tackling the root causes of poor health outcomes will take generations, and may
only be addressed on a national level by increasing social funding.</span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">b.)</span></b><span style="font-family: Georgia;"> Increasing HIV testing in the African American
community, the primary goal of the CDC’s “Take Charge. Take the Test.”
campaign, is an important way to improve health outcomes for HIV+ individuals,
but the main message of any HIV intervention should be to avoid infection in
the first place.<span style="mso-spacerun: yes;"> </span>Decreasing HIV
infection must be the primary message if HIV rates are ever to decrease, in any
population.<span style="mso-spacerun: yes;"> </span>If you test positive,
it’s already too late.</span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">c.)</span></b><span style="font-family: Georgia;"> Black women are doubly disenfranchised by their
race and their gender.<span style="mso-spacerun: yes;"> </span>These
factors combine to increase their powerlessness in many situations, including
HIV prevention, because most prevention techniques depending on changing male
behavior.<span style="mso-spacerun: yes;"> </span>Women may not feel empowered
to ask their partners to use a condom or ensure monogamy, two of the most
important HIV prevention behaviors. <span style="mso-spacerun: yes;"> </span>Any intervention aimed at the black female population would
acknowledge that telling women to always use a male condom is problematic and
instead turn to other options. An answer may be to create new or popularize
existing prevention techniques in which the woman is empowered to practice safe
sex on her own terms.<span style="mso-spacerun: yes;"> </span>One such
existing technique is the female condom, a tool that allows women to dictate
their own safety.<span style="mso-spacerun: yes;"> </span>Leaving women’s
safety from sexually transmitted infections in men’s hands just because
affordable, comfortable female-controlled safe sex tools are unavailable is
ridiculous and untenable. </span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">d.)</span></b><span style="font-family: Georgia;"> The cognitive dissonance created by the struggle
between safe sex knowledge and core values is a powerful psychological
force.<span style="mso-spacerun: yes;"> </span>Additional HIV transmission
education is not the answer, and HIV testing comes too late.<span style="mso-spacerun: yes;"> </span>The fatalism and optimism inherent in spirituality
are too firmly entrenched within the African American worldview to be denied;
the only response is to use cultural values of similar importance as a
fundamental building block of HIV prevention campaigns.<span style="mso-spacerun: yes;"> </span>One potentially powerful appeal may be to
Family.<span style="mso-spacerun: yes;"> </span>Familial relationships,
and keeping the family together, would act as a significant existing cultural
touchstone to draw from.<span style="mso-spacerun: yes;"> </span>If HIV
prevention were framed as a duty to protect family and community rather than
just a duty to individual health it may resonate more with the target
audience.<span style="mso-spacerun: yes;"> </span>This reframing would
align the goals of the target audience with the goals of health promotion,
reducing cognitive dissonance and psychological reactance, and would allow
women to act on their health knowledge.<span style="mso-spacerun: yes;">
</span></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in;">
<span style="font-family: Georgia;">Although a significant and vital amount of
resources have recently been dedicated to eliminating HIV transmission in the
African American community and specifically in women, certain fatal social
science errors permeate current health interventions.<span style="mso-spacerun: yes;"> </span>Recognizing the flaws in individual-level, behavioral
interventions when applied to racial minorities is the first step to creating
socially sensitive and appropriate health campaigns.<span style="mso-spacerun: yes;"> </span>Any health campaign created to address the problem of HIV
prevalence in the African American female population should include elements of
social funding, should focus on HIV prevention rather than testing as an
outcome, should empower women to demand safe sex by popularizing a female-based
safe sex tool, and should reframe staying HIV-free using the core value of
Family or an equally powerful value for the African American community.<span style="mso-spacerun: yes;"> </span>The sooner this is implemented, the
sooner we will have an AIDS-free generation.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">REFERENCES</span></b></div>
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</span></span></span><span style="font-family: Georgia;">Nunn, <i style="mso-bidi-font-style: normal;">et al</i>. (March 2011). Low Perceived Risk
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<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Georgia;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">Robinson, Russell, and Aisha Moodie-Mills. (July
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<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Georgia;"><span style="mso-list: Ignore;">12.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">The National Bureau of Economics Research. <i style="mso-bidi-font-style: normal;">GEOGRAPHY AND RACIAL HEALTH DISPARITIES. <span style="mso-spacerun: yes;"> </span></i>(February 2003). </span><a href="http://www.centerforurbanstudies.com/documents/electronic_library/cuba/healthcare/geography_and_racial_disparities.pdf"><span style="font-family: Georgia;">http://www.centerforurbanstudies.com/documents/electronic_library/cuba/healthcare/geography_and_racial_disparities.pdf</span></a><span style="font-family: Georgia;">. </span></div>
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<span style="color: #302b2a; mso-bidi-font-family: Cambria; mso-bidi-font-size: 13.0pt; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Georgia;"><span style="mso-list: Ignore;">13.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: #1a1a1a; font-family: Georgia; mso-bidi-font-family: Arial; mso-bidi-font-size: 13.0pt;">U.S. Census Bureau. (2000). <i>Male-female ratio by race alone
or in combination and Hispanic or Latino origin for the United States: 2000
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<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Georgia;"><span style="mso-list: Ignore;">14.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">Chen, N., Meyer, J., & Springer, S. (February
2011). Advances in the prevention of heterosexual transmission of HIV/AIDS
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<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Georgia;"><span style="mso-list: Ignore;">15.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">Newsome, V., & Airhihenbuwa, C. (October 2012).
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</span><a href="http://ezproxy.bu.edu/login?url=http://hpp.sagepub.com/content/early/2012/10/04/1524839912460869.long"><span style="font-family: Georgia;">http://ezproxy.bu.edu/login?url=http://hpp.sagepub.com/content/early/2012/10/04/1524839912460869.long</span></a><span style="font-family: Georgia;"> </span></div>
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<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Georgia;"><span style="mso-list: Ignore;">16.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">The Sentencing Project. <i style="mso-bidi-font-style: normal;">Comparative International Rates of Incarceration: An Examination of
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<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Georgia;"><span style="mso-list: Ignore;">17.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">Aral, S., Adimora, A., & Fenton, Kevin. (August
2008). Understanding and responding to disparities in HIV and other sexually
transmitted infections in African Americans. </span><a href="http://ezproxy.bu.edu/login?url=http://www.sciencedirect.com/science/article/pii/S0140673608611186"><span style="font-family: Georgia;">http://ezproxy.bu.edu/login?url=http://www.sciencedirect.com/science/article/pii/S0140673608611186</span></a><span style="font-family: Georgia;"> </span></div>
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<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Georgia;"><span style="mso-list: Ignore;">18.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">Gallo, R. (2008, November 16). Inner Cities Need an
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<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Georgia;"><span style="mso-list: Ignore;">19.<span style="font: 7.0pt "Times New Roman";">
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<span style="mso-bidi-font-family: Cambria; mso-bidi-theme-font: minor-latin; mso-hansi-font-family: Georgia;"><span style="mso-list: Ignore;">20.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">Younge, Sinead. (2008). Risk Revisited: The
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Mollyhttp://www.blogger.com/profile/18395792142837014194noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-17826473831459662232013-01-01T11:45:00.000-08:002013-01-01T11:45:46.625-08:00Thinking Through “Baby Think It Over”: A Proposed Intervention for Teen Pregnancy Prevention--Kate Reed
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--></style>Introduction<br />
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"></span>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">“Baby
Think It Over” is a parenthood-simulation program created by Reality Works,
Inc. that is used mostly in middle schools as a mechanism to prevent teen
pregnancy.<span style="mso-spacerun: yes;"> </span>Students are each given
an infant simulator named RealCare Baby – a lifelike, life-size baby doll with computerized
responses.<span style="mso-spacerun: yes;"> </span>According to Reality
Works, the doll is set to cry at varying intervals, cueing the students to
feed, burp, diaper, or comfort it.<span style="mso-spacerun: yes;">
</span>An internal computer monitors how often and how quickly the students
respond to the crying, as well as if the doll is shaken, dropped, or otherwise
handled roughly.<span style="mso-spacerun: yes;"> </span>It even senses if
the students do not support the “infant’s” neck.<span style="mso-spacerun: yes;"> </span>The teens keep the doll over a weekend in order to
experience some of the demands of infant care.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="color: black; font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">At its peak, “Baby Think It Over” was used in more than 12,000
school districts and health and service organizations in the US
(RealityWorks).<span style="mso-spacerun: yes;"> </span>Schools that
decide to participate can adjust the program to fit their needs; it is up to
the individual school or program to determine which students will participate –
girls and/or boys, older or <a href="http://www.blogger.com/blogger.g?blogID=1572776051032236617" name="_GoBack"></a>younger.</span><span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"> Some schools and programs are unable to use
“Baby Think It Over” due to the enormous cost of the program; each infant
simulator costs around $700, and schools must also buy baby care supplies and
replace infant parts every few years (RealityWorks).<span style="mso-spacerun: yes;"> </span>“<span style="color: black;">Baby Think It Over”</span> is
unable to provide statistics showing that its doll works – the company wants to
collect the data but for now it relies on “strong anecdotal evidence” (<span style="background: white; color: black;">Drawbaugh).</span><span style="color: black;"><span style="mso-spacerun: yes;"> </span>In terms of wanted teen pregnancies,
the program has been found to have either no effect on the desires of students
to be teen parents or to actually increase the number who want to (Kralewski).<span style="mso-spacerun: yes;"> </span><span style="background: white;">Infant
simulators are an expensive and complex intervention for teen pregnancy, and
their effectiveness is questionable.<span style="mso-spacerun: yes;">
</span>One paper states that “simulated experiences can be a powerful strategy
for effective learning about complex decisions regarding the risks of sexual
activity and the realities of parenting” (Didion), while another paper argues
that the “effectiveness of using infant simulators to influence the perceptions
of teens about the reality of teen parenting is minimal”</span></span>
(Herrman)<span style="background: white; color: black;">.<span style="mso-spacerun: yes;"> </span></span><span style="color: black;"></span></span></div>
<div class="articlegraf" style="background: white; line-height: 200%; margin-bottom: .0001pt; margin: 0in; text-indent: .5in;">
<span style="background: white; color: black; font-family: Tahoma; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"><span style="mso-spacerun: yes;"> </span>“Baby Think It Over” has three
fundamental flaws that prevent it from ever being successful.<span style="mso-spacerun: yes;"> </span>First, the program has no clear goal
and bases its assumptions on the Theory of Reasoned Action.<span style="mso-spacerun: yes;"> </span>Second, the program induces
psychological reactance in its participants.<span style="mso-spacerun: yes;"> </span>Third, the program is ineffectively delivered and gives
mixed messages.<span style="mso-spacerun: yes;"> </span>The proposed
intervention takes a different stance on teen pregnancy prevention, and aims to
correct for the three fundamental flaws of the “Baby Think It Over” program previously
discussed.</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">Critique 1</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"><span style="mso-tab-count: 1;"> </span>A
major problem of the “Baby Think It Over” program is the lack of a clearly
defined goal.<span style="mso-spacerun: yes;"> </span>It wants to prevent
teen pregnancies, but it does not distinguish between wanted and unwanted teen
pregnancies.<span style="mso-spacerun: yes;"> </span>It also does not
specify whether the solution to teen pregnancy is safe sex or no sex at all.<span style="mso-spacerun: yes;"> </span>Ostensibly, <span style="background: white; color: black;">the goals of the project are to help students realize the
responsibility of having a baby, and presumably that they need to wait before
having children.</span><span style="mso-spacerun: yes;"> </span>However, <span style="background: white;">Richard Jurmain, the creator of the program, maintains
that the main lessons learned from the program are not about values but
"sleeplessness," which as he states, "is a compelling rationale
for not getting pregnant” (<span style="color: black;">Cheakalos).</span></span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">The
“Baby Think It Over” program is also based on the Theory of Reasoned Action,
and therefore makes incorrect underlying assumptions about why teens get
pregnant.<span style="mso-spacerun: yes;"> </span>According to the Theory
of Reasoned Action, people have rational decision-making processes and skills,
and decsions are influenced by two factors: a person’s attitude towards the
heavier and their perception of social norms (Edberg).<span style="mso-spacerun: yes;"> </span>If the goal of the program is to
prevent <i style="mso-bidi-font-style: normal;">wanted</i> teen pregnancies, then
the underlying assumptions </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">are that teens
actively choose to become pregnant, and that they want to become pregnant
because they do not understand how difficult parenting is.<span style="mso-spacerun: yes;"> </span>If the goal of the program is to
prevent <i style="mso-bidi-font-style: normal;">unwanted</i> teen pregnancies,
then the underlying assumptions are even more ridiculous: teens choose to have
sex, and choose to have unprotected sex, because, again, they do not understand
how difficult parenting is.<span style="mso-spacerun: yes;"> </span>The
problem with this is that human behavior is not always rational, especially
when erections are involved (Ariely).<span style="mso-spacerun: yes;">
</span>In fact, according to Dan Ariely’s book “Predictably Irrational,”
subjects were more than twice as likely to engage in risky sexual behavior and
25 percent less likely to use a condom when asked in a “hot” aroused state than
a “cold” non-aroused state.<span style="mso-spacerun: yes;"> </span>Also,
the majority of teen pregnancies are unplanned, meaning that no rational
decision – at least about the difficulty of parenting – was made at all
(Finer).<span style="background: white; color: black;"></span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">Critique 2</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"><span style="mso-spacerun: yes;"> </span>A second problem with “Baby Think It
Over” is the degree to which is induces psychological reactance in its
participants.<span style="mso-spacerun: yes;"> </span>The program gives
students infant simulators to convince them to wait to have children, and
therefore in order to be successful the program needs its participants to fail
at their parenting tasks.<span style="mso-spacerun: yes;"> </span>In
reality, some students inevitably end up scoring highly, thereby defeating the
whole purpose of “Baby Think It Over” – to prove that parenting is hard.<span style="mso-spacerun: yes;"> </span>In fact many students state that they
found “Baby Think It Over” to be easier than they expected it to be, and they
believe that real infant care will probably be even easier (Kralewski).<span style="mso-spacerun: yes;"> </span>More importantly though, according to
the theory of psychological reactance, giving teens a message that they
“cannot” do something – for example, be a parent – will make them want to do it
more.<span style="mso-spacerun: yes;"> </span>The theory posits that when
people feel that a freedom is threatened, they experience a motivational state
aimed at restoring that freedom (Silvia).<span style="mso-spacerun: yes;">
</span>“Baby Think It Over” induces psychological reactance because it is
attempting to take away teens’ freedom to have sex, something which
nearly-mature bodies and still-maturing minds are intensely concerned with.<span style="mso-spacerun: yes;"> </span><span style="background: white; color: black;"></span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">Critique 3</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"><span style="mso-tab-count: 1;"> </span>A
final critique of the “Baby Think It Over” program is the way it is delivered –
the instructor is not effective and the program has implicit mixed messages.<span style="mso-spacerun: yes;"> </span>Because teens as young as thirteen take
part in this program as a school project, it is important for the instructor to
be relatable and respectable.<span style="mso-spacerun: yes;"> </span>The
instructor is often not relatable to the students due to age and race
differences.<span style="mso-spacerun: yes;"> </span>The program is also delivered
with mixed messages: the students are told to take the project seriously and
reflect upon the hardships of being a teen parent, but at the same time they
are given bonus points if they take lots of pictures with their “baby” and create
“family” photo albums (Borr).<span style="mso-spacerun: yes;"> </span>As
previously stated, although the program is based on a premise that students
will fail, this is not always the case.<span style="mso-spacerun: yes;">
</span>Not only do students often find the project to be easy, they also find
it to be fun – some students throw baby showers and birthday parties for each
other and their “babies” (Borr).<span style="mso-spacerun: yes;"> </span>The
mixed messages, combined with the fact that they are coming from a non-similar,
not necessarily respected adult, do not create a strong lasting impression.</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">Proposed
Intervention</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"><span style="mso-tab-count: 1;"> </span>The
proposed intervention aims to correct the fundamental flaws present in “Baby
Think It Over” with a new intervention focused on empowerment and control.<span style="mso-spacerun: yes;"> </span><span style="background: white; color: black;">The data is unclear on whether or not infant simulators have the
potential to be effective in preventing teen pregnancy, even if the program
surround the simulators is changed.<span style="mso-spacerun: yes;">
</span>Therefore, the proposed intervention will abandon the use of infant
simulators.<span style="mso-spacerun: yes;"> </span>Also, because the
proposed intervention is not assuming that teens get pregnant for lack of
parenthood knowledge, an infant simulator is unnecessary anyways.</span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="background: white; color: black; font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"><span style="mso-tab-count: 1;"> </span>In
reality, teens get pregnant due to an interacting web of factors, but one of
the most significant underlying factors is a feeling that they are not in
control of their own lives.<span style="mso-spacerun: yes;"> </span>The
teenage brain is not fully developed, and teens are more likely to engage in
risky behavior, think less about consequences, and focus on only immediate
effects and consequences than a fully developed adult brain (Hedaya).<span style="mso-spacerun: yes;"> </span>When teens feel that their futures are
not under their own control, their inherent inability to think rationally is
compounded.<span style="mso-spacerun: yes;"> </span>In terms of sexual
behavior, they are more likely to engage in unprotected sex, have multiple
partners, and generally increase their risk for pregnancy (National
Campaign).<span style="mso-spacerun: yes;"> </span>The feeling of a lack
of control arises from a number of factors such as low socioeconomic status,
life stressors, living in an impoverished area, and community or cultural
norms.<span style="mso-spacerun: yes;"> </span>If teens live in an area
where no one reaches their goals then the teens will not expect to reach their
own goals either.<span style="mso-spacerun: yes;"> </span>Likewise, if
teens see their peers having children young then they will begin to think it is
the norm.</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="background: white; color: black; font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"><span style="mso-tab-count: 1;"> </span>What
the proposed intervention aims to do is break this cycle of learned
helplessness by empowering teens.<span style="mso-spacerun: yes;">
</span>The core value of the program is “control.”<span style="mso-spacerun: yes;"> </span>Teens in high risk areas will be part of small focus groups,
available at school or through community centers, where they will have
discussions and do exercises that focus on empowerment and controlling their
own lives.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">Defense 1</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"><span style="mso-tab-count: 1;"> </span>The
proposed intervention has a clearly defined goal: to make safe sex the natural
choice in order to prevent unwanted teen pregnancies.<span style="mso-spacerun: yes;"> </span>The intervention acknowledges that many teens will chose to
participate in sexual activity, and rather than explicitly attempting to
prevent that activity it will instead attempt to make it safe.<span style="mso-spacerun: yes;"> </span>The intervention aims to prevent
unwanted teen pregnancies because the majority of teen pregnancies are
unwanted, and because the underlying factors in wanted teen pregnancies are far
more complex and beyond the scope of the intervention.</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"><span style="mso-tab-count: 1;"> </span>In
order to make safe sex the natural choice, the intervention will focus on
empowering teens to realize why safe sex is the best option for them.<span style="mso-spacerun: yes;"> </span>The underlying assumption of the
intervention is that unwanted teen pregnancies happen because of a lack of
control.<span style="mso-spacerun: yes;"> </span>According to Kathryn Edin’s
book “Promises I Can Keep,” <span style="color: black;">women who have no access
to opportunities use children as validation; the unconditional love of a child
and the attention they bring is a replacement for academic or professional
success, intimacy, etc.<span style="mso-spacerun: yes;"> </span>In a way
“Baby Think It Over” reinforces this because other people often give
participants excessive attention while they are caring for their “baby” (Borr).<span style="mso-spacerun: yes;"> </span>To address this, the proposed
intervention will </span>empower teenagers to realize their opportunities,
dreams, and desires, and that getting pregnant will reduce the control they
have over their own futures.<span style="mso-spacerun: yes;"> </span>This
will be a lot more effective than patronizingly assuming that teens get
pregnant because they are ignorant to the trials of parenthood.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">Defense 2</span></div>
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<br /></div>
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<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"><span style="mso-tab-count: 1;"> </span>Where
“Baby Think It Over” induces psychological reactance by impeding on personal
freedom, the proposed intervention will instead make teens induce psychological
reactance on themselves by getting them to visualize themselves fulfilling
their dreams, so if they do something that prevents those dreams, such as
getting pregnant, then they are taking away their <i style="mso-bidi-font-style: normal;">own</i> freedom.<span style="mso-spacerun: yes;"> </span>The
intervention also aims to increase the number and kind of positive freedoms
teens feel they have.<span style="mso-spacerun: yes;"> </span>Many teens
have an optimistic bias about teen pregnancy, thinking, “It won’t happen to
me.”<span style="mso-spacerun: yes;"> </span>Optimistic bias is the
tendency of people to be unrealistically optimistic about their own future life
events and the expectation of others to be victims of misfortune rather than
themselves (Weinstein).<span style="mso-spacerun: yes;"> </span>Even if
teens do realize their susceptibility to the threat of teen pregnancy, they
often have an inverse illusion of control and feel like whether or not they get
pregnant is not under their control.<span style="mso-spacerun: yes;">
</span>The illusion of control is an expectancy of personal success greater than
is appropriately warranted due to an incorrect assumption of control over
chance situations (Langer).<span style="mso-spacerun: yes;">
</span>Therefore, an inverse illusion of control could be thought of as an
incorrect assumption of chance in situations which one does have control over; learned
helplessness in a sense (Langer).<span style="mso-spacerun: yes;"> </span>The
program will address these things by talking about different contraception
choices as well as healthy relationship practices, showing teens that pregnancy
is within their control and it is their freedom to exercise that control.</span></div>
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<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"><span style="mso-tab-count: 1;"> </span>It
is also important that the program not increase the stigma of being a teen
parent further.<span style="mso-spacerun: yes;"> </span>Many teenagers in
high risk areas have exposure to teen parents – they know teen parents, they
were the child of a teen parent, etc.<span style="mso-spacerun: yes;">
</span>Therefore, a program that is insensitive and not careful in its language
and underlying messages will increase psychological reactance by angering and
alienating the participants.<span style="mso-spacerun: yes;">
</span>Furthermore, it is important for teens who are already parents to know
that it is still possible, on some level, to achieve their dreams and
desires.<span style="mso-spacerun: yes;"> </span><span style="color: black;">The
program does not aim to say “you cannot achieve your dreams with a baby;” it
simply aims to say “reaching your goals is easier without a baby.”</span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">Defense 3</span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">“Baby
Think It Over” struggles to leave a lasting impression on its participants due
to its mixed messages and non-similar instructors.<span style="mso-spacerun: yes;"> </span>Communications theory and the theory of psychological
reactance both show that a message is more effective and persuasive if the
person delivering it likeable, familiar, and similar to the target
population.<span style="mso-spacerun: yes;"> </span>Furthermore, the
message itself should be clear and concise, have justification, and have
positive associations.<span style="mso-spacerun: yes;"> </span>For this
reason, the program will be delivered by role-models who are similar in race
and age to the target population, and likeable.<span style="mso-spacerun: yes;"> </span>The program will also engage familiar community leaders to
back the message, further increasing its effectiveness.<span style="mso-spacerun: yes;"> </span>For example, if the program is being
implemented in a school then a well-liked student body president will be
involved in delivering the program.</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">This
piece of the program is particularly necessary for encouraging condom
usage.<span style="mso-spacerun: yes;"> </span>Social expectation theory
shows that individuals take behavioral cues from groups by observing the social
norm (DeFleur).<span style="mso-spacerun: yes;"> </span>Therefore, if the
program makes condoms appear to be the social norm, they will in fact become
the norm.<span style="mso-spacerun: yes;"> </span>There are several ways
in which the program will attempt to make condoms the social norm.<span style="mso-spacerun: yes;"> </span>First, the familiar community leaders
will endorse them.<span style="mso-spacerun: yes;"> </span>Second, condoms
will be readily available and free in schools, community centers, apartment
complexes, and anywhere else the program is implemented.<span style="mso-spacerun: yes;"> </span>Third, advertising for condoms that is
created by the program will bear a promise of control over one’s own life and will
contain popular music and images.<span style="mso-spacerun: yes;">
</span>In this way, the program can attempt to alter social norms and make
condom usage the natural choice.</span></div>
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<br /></div>
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<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">Conclusion</span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;"><span style="mso-tab-count: 1;"> </span>“Baby
Think It Over” is a fundamentally flawed program for three reasons: it has
unclear goals and incorrect assumptions based on rational behavior patterns, it
induces psychological reactance in its participants, and it is delivered
ineffectively and with mixed messages.<span style="mso-spacerun: yes;">
</span>The proposed intervention to prevent unplanned teen pregnancy corrects
for those fundamental flaws by setting clear goals based on accurate
assumptions about teen sexual behavior, it is formatted to minimize
psychological reactance, and it is delivered in an effective way following theories
of communication and social norms.<span style="mso-spacerun: yes;">
</span>Ultimately, the proposed intervention would enhance teens’ feelings of
control over their own lives and help them to realize their life potential.<span style="mso-spacerun: yes;"> </span>Combined with effective advertising and
adjustment of social norms in the community, this would make safe sex the
natural choice.</span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Tahoma; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: Tahoma; mso-fareast-font-family: Dotum;">Works Cited</span></div>
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Mollyhttp://www.blogger.com/profile/18395792142837014194noreply@blogger.com1tag:blogger.com,1999:blog-1572776051032236617.post-46103411202814428832013-01-01T11:41:00.000-08:002013-01-01T11:41:01.454-08:00When Less is More: A Critique of Cigarette Health Warning Labels – Vania Lin<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">Background Information</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
U.S. Food and Drug Administration (FDA) sought to replace in September 2012 the
current text-only health warning labels on cigarette packaging with larger
warnings and graphic images.<span style="mso-spacerun: yes;"> </span>The
new labels consisted of messages such as “WARNING: Cigarettes cause fatal lung
disease.” and “WARNING: Smoking can kill you.” that are accompanied by images including
diseased lungs and corpses.<span style="mso-spacerun: yes;"> </span>One of
the stated goals of this change was to “empower youth to say no to tobacco” (1).<span style="mso-spacerun: yes;"> </span>Court proceedings in the case of <i style="mso-bidi-font-style: normal;">R.J. Reynolds Tobacco Co. v. U.S. Food and
Drug Administration</i>, the lawsuit tobacco companies brought forth against
the FDA, have delayed the implementation of the new warnings (1).<span style="mso-spacerun: yes;"> </span>With the U.S. Court of Appeals in Washington,
D.C., denying to rehear the case as of December 5, 2012, the final say on
implementation may be left up to the U.S. Supreme Court should the government
decide to appeal (2).</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">Overview of the Critique</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
effectiveness of the new graphic labels in preventing smoking initiation in
adolescents is questionable.<span style="mso-spacerun: yes;"> </span>In
particular, the warnings neglect to address the effects of branding on
adolescent smoking and the formation of social identity.<span style="mso-spacerun: yes;"> </span>The labels also overvalue the
importance of health to adolescents.<span style="mso-spacerun: yes;">
</span>In their failure to take into account the values that adolescents hold
in high regard, such as independence and reputation, the warnings have weak
impact on adolescent smoking prevention and may even encourage adolescents to
start smoking.<span style="mso-spacerun: yes;"> </span>Lastly, the labels
will likely trigger psychological reactance, which would incite rebellion
against the warnings and may even provoke smoking initiation.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">The Implications of Branding</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
graphic warning labels fail to address the importance of branding in adolescent
smoking and social identity.<span style="mso-spacerun: yes;"> </span>The
new labels may be more prominent, but they do nothing to eradicate the
associations that tobacco companies have designed cigarette packaging to convey.<span style="mso-spacerun: yes;"> </span>Adolescence is characterized by experimentation
and the formation of identity; it is the time in life when people are most
likely to start smoking. <span style="mso-spacerun: yes;"> </span>Escobedo,
Anda, Smith, Remington, and Mast (1990) found that smoking initiation sharply
increases after eleven years of age and reaches its peak between seventeen to
nineteen years of age before rapidly declining through 25 years of age and
gradually declining in older age groups (3).<span style="mso-spacerun: yes;"> </span>Tobacco companies, armed with this knowledge, aim to attract
people to smoking at a young age.<span style="mso-spacerun: yes;">
</span>In a revealing study conducted in Tracy, California, Henriksen,
Feighery, Schleicher, Haladjian, and Fortmann (2004) found that stores where
youths shopped at more frequently had almost three times the amount of tobacco marketing
materials and considerably more shelf space for the major cigarette brands
Marlboro, Camel, and Newport than other stores (4).<span style="mso-spacerun: yes;"> </span>This finding highlights the connection between marketing of
cigarettes by tobacco companies and adolescent smoking.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia;">Branding plays a large role in the marketing scheme:
the cigarette brand name, the visual logo, the pack design, and the color
scheme all come together to create branding signals that represent the brand’s
core values (5).<span style="mso-spacerun: yes;"> </span>Scheffels (2008),
in a series of interviews conducted with young smokers in Norway, found that
young smokers formed social identities and established social status based on their
choice of cigarette brand.<span style="mso-spacerun: yes;"> </span>For
example, the Scandinavian brand Prince, which contained a picture of a
cigarette on its red packaging, was seen as strong, harsh, and of low social
status, while Marlboro Light, with its gold-lettered white packaging and
foreign origin, was associated with femininity and higher social class
status.<span style="mso-spacerun: yes;"> </span>What is striking is that
Norway has banned advertising for tobacco since 1975; despite the ban on
advertising, tobacco companies have and continue to succeed in branding their
cigarette products to attract different populations of young people.<span style="mso-spacerun: yes;"> </span>The actions of the Scandinavian Tobacco
Company, which manufactures Prince cigarettes, support the assumption that
tobacco companies extensively research the effects of branding themselves—soon
after Scheffels conducted the interviews, the company replaced the blunt image
of the cigarette with that of subtle floating smoke on Prince packs (6).<span style="mso-spacerun: yes;"> </span>Without curbing the advertising effect
of the cigarette packing itself and severing the link between smoking and
social identity, the new warning labels are unlikely to have a large effect on
the prevention of adolescent smoking.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">Overvaluation of the Importance of
Health</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
graphic warning labels centered on the harmful health effects of smoking overestimate
the importance of health to youths.<span style="mso-spacerun: yes;">
</span>The effectiveness of the warnings is based on the assumptions that
adolescent smokers value health highly and that knowledge of the health risks
of smoking will deter youths from smoking.<span style="mso-spacerun: yes;"> </span>In contrast to these assumptions, Virgili, Owen, and
Severson (1991) found that adolescent smokers, compared to ex-smokers and
nonsmokers, had a harder time imagining the harmful health effects of smoking
in themselves and tended to downplay the severity of the health risks.<span style="mso-spacerun: yes;"> </span>Smokers also perceived greater benefits
of smoking relative to the risks of smoking (7).</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia;">Lee, Buchanan-Oliver, and Johnstone (2003) further
explored the relationships between adolescent characteristics and values and
smoking.<span style="mso-spacerun: yes;"> </span>They found that the sense
of being invulnerable persisted in adolescents despite their knowledge of the
health effects of smoking.<span style="mso-spacerun: yes;"> </span>The
authors characterized this aspect of adolescence as the “personal fable”:
adolescents have a hard time separating personal beliefs from universal
principles.<span style="mso-spacerun: yes;"> </span>In the case of
smoking, adolescents may rationalize that, although smoking does cause harmful
health effects, these conditions would occur in other people but not in
themselves because of their inherent uniqueness and difference from others.<span style="mso-spacerun: yes;"> </span>This denial mechanism contributed to the
study participants’ heavy focus on the benefits of smoking, such as being
perceived as cool or sophisticated, and their relatively light focus on the
negative aspects of smoking.<span style="mso-spacerun: yes;"> </span>The
authors also found that adolescents were motivated to smoke by the belief that
smoking was an act of rebellion; risk-taking was a declaration of independence
and a way to build reputation and establish social identity.<span style="mso-spacerun: yes;"> </span>As one participant succinctly put it,
“You do things because they are bad for you.<span style="mso-spacerun: yes;"> </span>‘Cause you do things to take a risk” (8).<span style="mso-spacerun: yes;"> </span>In overvaluing the importance of health
and failing to take into account qualities that adolescents value highly, cigarette
labels emphasizing health risks are unlikely to be effective in preventing adolescent
smoking and may even have the opposite undesirable effect of encouraging
smoking among adolescents.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">The Effects of Psychological Reactance</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
graphic labels will likely trigger psychological reactance in adolescents and
exacerbate the problem of adolescent smoking.<span style="mso-spacerun: yes;"> </span>The theory of psychological reactance asserts that people
believe that they are free to make their own choices and shape their own
behavior.<span style="mso-spacerun: yes;"> </span>When they are faced with
a force, such as a persuasive message, that is seemingly trying to dictate
their choice or behavior, they will act to restore their freedom.<span style="mso-spacerun: yes;"> </span>One way to do so is to rebel against
the force (9).</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia;">Dillard and Shen (2005) described the three aspects
of a message that contribute to psychological reactance: dominance, explicitness,
and reason. <span style="mso-spacerun: yes;"> </span>Dominance is the
degree to which the message imparts the belief that the source can control its
audience.<span style="mso-spacerun: yes;"> </span>Explicitness is the
extent to which the message conveys the source’s purpose. <span style="mso-spacerun: yes;"> </span>Reason is the justification the message
provides to convince the audience to adopt the source’s view.<span style="mso-spacerun: yes;"> </span>In general, dominance in a message
incites anger and psychological reactance, while reason decreases psychological
reactance.<span style="mso-spacerun: yes;"> </span>The effect of
explicitness varies and depends on context, but usually works in favor of
persuasion and generates positive emotions (10).</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
elements of the new graphic warnings will likely incite psychological reactance
in adolescents.<span style="mso-spacerun: yes;"> </span>The messages are
highly dominant: the capital letters of “WARNING,” along with the severe messages
and extreme images, combine to make the labels take on an authoritative and
almost condemning tone.<span style="mso-spacerun: yes;"> </span>The labels
are explicit in delivering their message, which is likely not a positive factor
here in convincing adolescents not to smoke but rather an instigator of anger
and psychological reactance.<span style="mso-spacerun: yes;"> </span>Their
explicitness makes clear that the government is trying to influence the
adolescents’ behavior through the warnings.<span style="mso-spacerun: yes;"> </span>The reason provided in the messages is tenuous: smoking
certainly causes the conditions described by the messages and depicted by the
images in some people, but their extreme nature may cause youths to dismiss these
warnings as scare tactics.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia;">Erceg-Hurn and Steed (2011) showed that graphic
labels triggered heightened psychological reactance.<span style="mso-spacerun: yes;"> </span>They measured the level of psychological reactance in smokers
after the smokers were exposed to text-only or graphic labels, both of which
were in use in Australia at the time of the study.<span style="mso-spacerun: yes;"> </span>The tested labels contained messages such as “Smoking
Kills.” and “Smoking Causes Mouth and Throat Cancer”; photographs accompanied
the graphic labels.<span style="mso-spacerun: yes;"> </span>Erceg-Hurn and
Steed found that 51.2% of smokers experienced no psychological reactance after
viewing text-only labels; only 8% of the smokers who did experience reactance
experienced it at a moderate to high degree.<span style="mso-spacerun: yes;"> </span>In contrast, over 80% of smokers experienced psychological
reactance after viewing graphic labels, and 30.4% of these smokers experienced
a moderate to high level of reactance (9).<span style="mso-spacerun: yes;"> </span>These results can reasonably be generalized to adolescents—adolescents,
with their tendency to rebel, may experience even greater levels of
psychological reactance than adults.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia;">Furthermore, Miller, Burgoon, Grandpre, and Alvaro (2006)
determined that psychological reactance was a major risk factor for smoking behavior.<span style="mso-spacerun: yes;"> </span>They surveyed students in grades six
through twelve (ten to twenty years of age) to examine the significance of
variables that may contribute to smoking behavior.<span style="mso-spacerun: yes;"> </span>They found that increased psychological reactance, decreased
age, poor school performance, previous experimentation with smoking, and having
friends who smoke were the major predictors of smoking behavior.<span style="mso-spacerun: yes;"> </span>Poor communication with parents was
also a predictor of smoking behavior, though to a lesser extent.<span style="mso-spacerun: yes;"> </span>In addition, psychological reactance was
a significant risk factor even among adolescents who did not smoke and had not
previously experimented with smoking (11). <span style="mso-spacerun: yes;"> </span>The findings of these studies demonstrate that the new
graphic labels have a high likelihood of triggering psychological reactance in
adolescents and, contrary to their goal, may prompt some adolescents to begin
smoking.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">Proposed Alternative Intervention</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>An
effective alternative approach may be to utilize plain packaging and warning
messages focused on independence and self-affirmation rather than on
health.<span style="mso-spacerun: yes;"> </span>In plain packaging, the
color, size, material, and the opening method of cigarette packs are
standardized.<span style="mso-spacerun: yes;"> </span>Packs are
distinguished by their brand names only, which appear in the same color, size,
and font and at the same location on all packs.<span style="mso-spacerun: yes;"> </span>No other writing, excluding health warnings, or visual
images are allowed (12).<span style="mso-spacerun: yes;"> </span>Plain
packaging would thus effectively eliminate the associations created through branding.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia;">The warnings would focus on the aspects of
independence and control rather than on health and would draw upon the theory
of self-affirmation.<span style="mso-spacerun: yes;"> </span>The messages would
be phrased in the form of questions.<span style="mso-spacerun: yes;">
</span>The goal is to prompt adolescents to question the effect that smoking
has on their freedom and control without triggering psychological reactance.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">The Power of Plain Packaging</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Replacing
the current multitude of cigarette packaging designs with a single,
standardized plain design eliminates the venue for branding.<span style="mso-spacerun: yes;"> </span>Branding relies on the coordination of
elements including the brand name, the color scheme, and visual logos to create
distinct characteristics for each cigarette brand; branding can only be
accomplished if tobacco companies are able to differentiate the cigarette brands
with unique traits.<span style="mso-spacerun: yes;"> </span>Plain
packaging blocks this route by standardizing all pack designs.<span style="mso-spacerun: yes;"> </span>The only aspect that would be different
between each brand would be the brand name—and even that would appear in
standardized font and at the same location on each pack. <span style="mso-spacerun: yes;"> </span>Wakefield, Germain, and Durkin (2008) demonstrated
that plain packaging successfully removed brand associations. <span style="mso-spacerun: yes;"> </span>In the study, smokers rated the
attractiveness of cigarette packs that are shown both in their original
packaging and in progressively plainer packaging.<span style="mso-spacerun: yes;"> </span>Participants also rated the smokers of these cigarettes on
various qualities, including stylishness, class, and confidence.<span style="mso-spacerun: yes;"> </span>Lastly, participants rated how
satisfying smoking the cigarettes from each pack would be.<span style="mso-spacerun: yes;"> </span>Wakefield et al. found that smokers
rated original packaging as most attractive, with the ratings dropping as the
packaging became progressively plainer.<span style="mso-spacerun: yes;">
</span>Participants gave smokers of plain packs lower ratings on positive
qualities (e.g., less stylish, less sociable, less mature) than smokers of
original packs.<span style="mso-spacerun: yes;"> </span>They also
responded that smoking cigarettes from plain packs would be less satisfying and
that the tobacco would be of poorer quality (13).<span style="mso-spacerun: yes;"> </span>These findings show that plain packaging reduces the
attractiveness of cigarette packs and removes much of the positive associations
(e.g., trendiness, youth, class) that tobacco companies seek to brand their
products with.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">A Shift in the Focus of Warnings</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Warnings
on the cigarette packs focusing on independence and control would likely have a
greater impact on youths than those focusing on health.<span style="mso-spacerun: yes;"> </span>Adolescents value independence and
autonomy highly, while health is not as valued in part because of the sense of
infallibility.<span style="mso-spacerun: yes;"> </span>Messages that focus
on health would likely trigger the adolescents’ cognitive “personal fable”
defense.<span style="mso-spacerun: yes;"> </span>For example, when asked
about cigarette health warnings, one adolescent responded, “No, I don’t think
that I am going to die younger, I don’t believe that” (8).<span style="mso-spacerun: yes;"> </span>In contrast, messages that frame
smoking as threats to their independence and control bring the warnings much
closer to the adolescents’ lives.<span style="mso-spacerun: yes;"> </span>Take
for example the following message: “You are independent and in control: why let
nicotine addiction change this?”<span style="mso-spacerun: yes;">
</span>The message centers the issue on independence and control, importance
aspects of adolescence; this increases the likelihood that adolescents would
pay attention to the message.<span style="mso-spacerun: yes;"> </span>The
message also alerts them to the fact that they are no longer infallible—the
very act of smoking, what they thought was a way to rebel against authorities,
may now take away their freedom.<span style="mso-spacerun: yes;"> </span>As
such, warnings on cigarette packs that focus on the effects that smoking has on
freedom and control would be more effective in gaining the attention of
adolescents than those that focus on health.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">The Usage of Self-Affirmation and
Questions</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Incorporating
self-affirmation into the warnings on the cigarette packs and phrasing the
warnings in the form of questions would help reduce psychological reactance in
adolescents.<span style="mso-spacerun: yes;"> </span>The theory of
self-affirmation posits that people are motivated to protect their
self-integrity and self-worth and that threats to these aspects of their
identity drive people to react defensively.<span style="mso-spacerun: yes;"> </span>However, when another aspect of their identity is affirmed
in some way in the presence of a threat, the need for defensiveness is lowered
(14).<span style="mso-spacerun: yes;"> </span>Hogan and Speakman (2006)
utilized this concept in developing a “covert persuasion trick”: “Resistance is
diminished when people agree with the presented point of view.<span style="mso-spacerun: yes;"> </span>Affirm the individual’s point of view”
(15). <span style="mso-spacerun: yes;"> </span>Harris and Napper (2005)
examined the responses of young women to messages describing the link between
alcohol and breast cancer.<span style="mso-spacerun: yes;">
</span>Participants in the self-affirmation condition were asked to<span style="mso-spacerun: yes;"> </span>write about the most important value in
their life, the reason for its importance, and how they incorporated the value
in their daily lives.<span style="mso-spacerun: yes;"> </span>Participants
in the control group were asked to write about why the least important value in
their lives might be important to others.<span style="mso-spacerun: yes;">
</span>All the participants were exposed to information regarding alcohol and
breast cancer afterwards.<span style="mso-spacerun: yes;"> </span>Harris
and Napper found that the participants in the self-affirmation group, some of
whom drank a significant amount, were more receptive to and more willing to
consider the personal relevance of health messages regarding the connection
between alcohol and breast cancer than those in the control group (14).</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia;">In a similar vein of investigation, Armitage,
Harris, Hepton, and Napper (2008) demonstrated the use of self-affirmation in a
study involving adult smokers.<span style="mso-spacerun: yes;"> </span>Participants
in the self-affirmation group were asked about past acts of kindness, whereas
participants in the control group were asked about unrelated issues (e.g.,
asked for their opinion on whether chocolate was the best ice cream
flavor).<span style="mso-spacerun: yes;"> </span>All participants were then
presented with antismoking information that described the harmful health
effects of smoking and were asked a series of questions regarding their smoking
behavior (a measure of risk), their view of the importance of smoking cessation
(a measure of acceptance), and their intention to quit (a measure of intention).<span style="mso-spacerun: yes;"> </span>The participants were offered leaflets
containing information on how to quit smoking, and the experimenter covertly recorded
this as a measure of effect on behavior.<span style="mso-spacerun: yes;">
</span>The authors found that participants in the self-affirmation group showed
significantly greater acceptance of the message and greater influence by the
message in intention and behavior (16).</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia;">These findings demonstrate the effectiveness of
self-affirmation in decreasing defensiveness and promoting changes in
health-related behavior.<span style="mso-spacerun: yes;"> </span>The study
conducted by Armitage et al. is particularly relevant, as it addresses the
issue of smoking cessation.<span style="mso-spacerun: yes;"> </span>In
preventing smoking initiation in adolescents, self-affirmation can similarly be
used to decrease defensiveness, specifically psychological reactance, when
delivering warnings on cigarette packs.<span style="mso-spacerun: yes;">
</span>The previously used example message “You are independent and in control:
why let nicotine addiction change this?” embodies this principle.<span style="mso-spacerun: yes;"> </span>The first part of the message “You are
independent and in control” is a self-affirmation mechanism: adolescents would
self-affirm that they are independent and in control of their lives.<span style="mso-spacerun: yes;"> </span>This reduces the defensiveness that is
elicited by the second part of the message “why let nicotine addiction change
this?”<span style="mso-spacerun: yes;"> </span>Presented by itself, this
part of the message would appear to be a direct attack on adolescents’ behavior
and would provoke strong defensiveness and psychological reactance.<span style="mso-spacerun: yes;"> </span>However, with the mitigating effect of
the self-affirming part of the message, adolescents are more likely to
experience less defensiveness and psychological reactance and to consider the
personal relevance of the message.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia;">Phrasing the warnings on the cigarette packs as
questions would reduce psychological reactance as well.<span style="mso-spacerun: yes;"> </span>Glock, Müller, and Ritter (2012) showed
smokers cigarette packs that had text-only health warning labels, graphic
health warning labels, health warnings phrased as questions, or no health
warning labels printed on them.<span style="mso-spacerun: yes;">
</span>They found that participants perceived higher risks for smoking-related
diseases after viewing cigarettes packs that contained warnings phrased as
questions or no warning labels.<span style="mso-spacerun: yes;">
</span>The authors hypothesized that this may be due to lower levels of
defensiveness that would otherwise have interfered with risk perception, an
indirect measure of psychological reactance.<span style="mso-spacerun: yes;"> </span>Here, lower perceived risk would indicate a higher level of
defensiveness.<span style="mso-spacerun: yes;"> </span>Furthermore, past
research literature has shown that self-generated arguments are more persuasive
than those originating externally; this may be why the warnings phrased as
questions were more effective in the study.<span style="mso-spacerun: yes;"> </span>Although the absence of warning labels appeared to be
effective as well, the total lack of information on the harmful effects of
smoking is undesirable.<span style="mso-spacerun: yes;"> </span>As such,
warnings phrased as questions may be the best method of delivering antismoking
messages (17).</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia;">The message “You are independent and in control:
why let nicotine addiction change this?” draws upon these findings by phrasing
the warning as a question.<span style="mso-spacerun: yes;"> </span>The
question format avoids a tone of dominance.<span style="mso-spacerun: yes;"> </span>Instead of delivering an authoritative statement, the
message poses a question to adolescents and invites them to consider the
issue.<span style="mso-spacerun: yes;"> </span>The message is explicit in
its meaning, but is not condemning; the clarity of the message serves to
enhance the self-affirming aspects of the message.<span style="mso-spacerun: yes;"> </span>The message contains a reason that adolescents can identify
with: the message acknowledges the importance of independence and control to
adolescents and asks them to weigh these values against smoking and addiction.<span style="mso-spacerun: yes;"> </span>The combined effects of lowered dominance,
heightened explicitness, and heightened reason in the message reduce the level
of psychological reactance and increase the likelihood that adolescents will be
receptive to and consider the meaning of the warning.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">Conclusion</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Rather
than implementing graphic cigarette health warning labels, instituting plain
packaging of cigarettes and using warning messages that focus on independence
and control may be more effective in preventing smoking initiation among
adolescents.<span style="mso-spacerun: yes;"> </span>Messages should
furthermore embody self-affirming qualities and be presented in the format of
questions.<span style="mso-spacerun: yes;"> </span>The combination of
plain packaging and self-affirming, questioning cigarette warnings eliminates
the effects of branding, draws attention to the warnings through the focus on
independence and control, and reduces psychological reactance.<span style="mso-spacerun: yes;"> </span>Together, these measures maximize the
effectiveness of cigarette warnings and their impact on adolescents.</span></div>
<div class="MsoNormalCxSpLast" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">REFERENCES</span></b></div>
<div class="MsoListParagraphCxSpFirst" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">U.S. Food and Drug Administration. <i style="mso-bidi-font-style: normal;">Cigarette Health Warnings - Overview: Cigarette Health Warnings</i>.
Silver Spring, MD: U.S. Food and Drug Administration.
http://www.fda.gov/TobaccoProducts/Labeling/Labeling/CigaretteWarningLabels/ucm259214.htm.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Associated Press. Appeals court denies rehearing on decision
blocking graphic health warnings on cigarette packs. <i>Washington Post</i>. http://articles.washingtonpost.com/2012-12-05/business/35625639_1_cigarette-packs-new-warnings-cigarette-smoke.</span></div>
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<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Escobedo LG, Anda RF, Smith PF, Remington PL, & Mast EE.
Sociodemographic characteristics of cigarette smoking initiation in the United
States: Implications for smoking prevention policy. <i>JAMA: The Journal of the
American Medical Association </i><span style="mso-bidi-font-style: italic;">1990</span>;
<i>264</i>(12):1550–1555.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Henriksen L, Feighery EC, Schleicher NC, Haladjian HH, &
Fortmann SP. Reaching youth at the point of sale: cigarette marketing is more
prevalent in stores where adolescents shop frequently. <i>Tobacco Control </i><span style="mso-bidi-font-style: italic;">2004</span>; <i>13</i>(3):315–318.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Grant IC, Hassan LM, Hastings GB, MacKintosh AM, & Eadie
D. The influence of branding on adolescent smoking behaviour: exploring the
mediating role of image and attitudes. <i>International Journal of Nonprofit
and Voluntary Sector Marketing </i><span style="mso-bidi-font-style: italic;">2008<i>;</i></span>
<i>13</i>(3):275–285.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Scheffels J. A difference that makes a difference: young
adult smokers’ accounts of cigarette brands and package design. <i>Tobacco
Control </i><span style="mso-bidi-font-style: italic;">2008</span>; <i>17</i>(2):118–122.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Virgili M, Owen N, & Severson HH. Adolescents’ smoking
behavior and risk perceptions. <i>Journal of Substance Abuse </i><span style="mso-bidi-font-style: italic;">1991</span>; <i>3</i>(3):315–324.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Lee CK-C, Buchanan-Oliver M, & Johnstone M-L. New
Zealand adolescents’ perception of smoking and social policy implications. <i>Social
Marketing </i><span style="mso-bidi-font-style: italic;">2003</span>; <i>11</i>(1):45–59.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Erceg-Hurn DM, & Steed LG. Does exposure to cigarette
health warnings elicit psychological reactance in smokers? <i>Journal of
Applied Social Psychology </i><span style="mso-bidi-font-style: italic;">2011</span>;
<i>41</i>(1):219–237.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Dillard JP, & Shen L. On the nature of reactance and its
role in persuasive health communication. <i>Communication Monographs </i><span style="mso-bidi-font-style: italic;">2005</span>; <i>72</i>(2):144–168.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">11.</span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Miller CH,
Burgoon M, Grandpre JR, & Alvaro EM. Identifying principal risk factors for
the initiation of adolescent smoking behaviors: the significance of
psychological reactance. <i>Health Communication </i><span style="mso-bidi-font-style: italic;">2006</span>; <i>19</i>(3):241–252.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">12.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Freeman B, Chapman S, & Rimmer M. The case for the plain
packaging of tobacco products. <i>Addiction </i><span style="mso-bidi-font-style: italic;">2008</span>; <i>103</i>(4):580–590.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">13.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Wakefield MA, Germain D, & Durkin SJ. How does
increasingly plainer cigarette packaging influence adult smokers’ perceptions
about brand image? An experimental study. <i>Tobacco Control </i><span style="mso-bidi-font-style: italic;">2008</span>; <i>17</i>(6):416–421.</span><span style="font-family: Georgia;"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">14.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Harris PR, & Napper L. Self-affirmation and the biased
processing of threatening health-risk information. <i>Personality and Social
Psychology Bulletin </i><span style="mso-bidi-font-style: italic;">2005</span>; <i>31</i>(9):1250–1263.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">15.</span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Hogan K,
& Speakman J. <i>Covert Persuasion: Psychological Tactics and Tricks to Win
the Game</i>. Hoboken, NJ: Wiley, 2006.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">16.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Armitage CJ, Harris PR, Hepton G, & Napper L. Self-affirmation
increases acceptance of health-risk information among UK adult smokers with low
socioeconomic status. <i>Psychology of Addictive Behaviors </i><span style="mso-bidi-font-style: italic;">2008</span>; <i>22</i>(1):88–95.</span></div>
<div class="MsoListParagraphCxSpLast" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">17.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; mso-bidi-font-family: "Times New Roman";">Glock S, Müller BC, & Ritter S. Warning labels
formulated as questions positively influence smoking-related risk perception. <i>Journal
of Health Psychology </i><span style="mso-bidi-font-style: italic;">2012</span>; <i style="mso-bidi-font-style: normal;">0</i>(0):1-11.</span></div>
Mollyhttp://www.blogger.com/profile/18395792142837014194noreply@blogger.com1tag:blogger.com,1999:blog-1572776051032236617.post-42151070618436927402013-01-01T11:38:00.000-08:002013-01-01T11:38:36.114-08:00Minnesota Blue Cross Blue Shield Anti-Obesity Campaign - Marie Leinberger
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<div class="Body" style="line-height: 200%;">
<span style="font-family: "Georgia Bold";"></span><span style="font-family: "Georgia Bold";">Part
One: Your Body Is An Epidemic.</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: "Georgia Bold";">Introduction</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Since
the 1980’s, the US government has recognized America’s increasing collective
BMI as a serious health concern.<span style="mso-spacerun: yes;">
</span>However, only in the past decade or two has any effort been put towards
fighting back against the increasing bulk of America.<span style="mso-spacerun: yes;"> </span>The problem is that almost every campaign against the
“obesity epidemic” has directed financial resources and creative energy at the
wrong part of the issue.<span style="mso-spacerun: yes;"> </span>Campaigns
have dedicated millions of dollars towards fighting the symptom, and not the
root cause, of obesity.<span style="mso-spacerun: yes;"> </span>The recent
Minnesota Blue Cross/Blue Shield campaign against both adult and childhood
obesity is no different.<span style="mso-spacerun: yes;"> </span>The three
television adds used for that campaign will be critiqued here.<span style="mso-spacerun: yes;"> </span>For clarity’s sake, I will refer to the
ad featuring the mother buying unhealthy food as the “first ad”, the ad
featuring the father buying fast food as the “second ad” and the ad featuring
the procrastination behaviors as the “third ad”.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
first two ads focus on the issue of parental responsibility for childhood
obesity.<span style="mso-spacerun: yes;"> </span>The third ad attempts to
address a lack of personal responsibility for obesity and the tendency towards
procrastination in adopting health lifestyle habits.<span style="mso-spacerun: yes;"> </span>In the first two ads, there is a lightbulb moment for the
adults in which they come to the sudden realization that their own unhealthy
behaviors have been noticed and appropriated by the children around them.<span style="mso-spacerun: yes;"> </span>The third ad involves everyday people
engaging in unhealthy personal behaviors while claiming they will change
“tomorrow” with a clear underlying message that they probably will not.<span style="mso-spacerun: yes;"> </span>These campaigns are relatively new, but
there are several reasons they will fail.<span style="mso-spacerun: yes;">
</span>Using three different theories of behavior, these ads can be broken down
into the individual aspects that will render them ineffective in creating the
types of behavioral change necessary to fight obesity.<span style="mso-spacerun: yes;"> </span>The first critique will focus on
how these ads model the very behaviors they are attempting to discourage,
visually normalizing the unhealthy behaviors.<span style="mso-spacerun: yes;"> </span>These ads are using the concept of “social nudging” in
exactly the incorrect way.<span style="mso-spacerun: yes;"> </span>The
second critique is that the first two ads assume that the Health Belief Model
is effective, when there is ample evidence to show that it is not.<span style="mso-spacerun: yes;"> </span>The third critique will focus on the
theory of psychological reactance and how all three ads seem to not consider it
at all.<span style="mso-spacerun: yes;"> </span>All three ads are meant to
produce feelings of guilt, shame and lowered self esteem as a result of
unhealthy behavioral choices, as if this will motivate behavior change, when in
fact we know that those feelings produce just the opposite effect.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<br /></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: "Georgia Bold";">Critique
One - Social Nudging and Tipping Points</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>All
three of these public health ads feature very specific behaviors.<span style="mso-spacerun: yes;"> </span>In the first two ads, parents are
buying or eating very unhealthy foods.<span style="mso-spacerun: yes;">
</span>In the third ad, consumption of chips, ice cream, burgers, fries,
massive buffet plates, and slushies all occur. <span style="mso-spacerun: yes;"> </span>In the third ad, sedentary and lazy behavior are also
featured.<span style="mso-spacerun: yes;"> </span>The ads violate the
principle that modeling a behavior has powerful influence over the choices of a
population exposed to that modeling (1).<span style="mso-spacerun: yes;">
</span>Social science research has shown that when people participates in a
behavior with a high enough percentage, the rest of the population will
eventually follow the herd (2).<span style="mso-spacerun: yes;">
</span>The idea that modeling an unhealthy behavior to a population and then
telling them “...but do not do this!” is not logical and actually contributes
to an environment which is “tipping” more towards unhealthy behaviors than
healthy behaviors (1).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>These
ads do not produce the social encouragement that is necessary for people to
feel supported when changing their behaviors.<span style="mso-spacerun: yes;"> </span>The ads normalize behaviors such as laying on the couch all
day, eating mass amounts of unhealthy food and purchasing unhealthy products
because they are modeled by “typical” people in recognizable social
situations.<span style="mso-spacerun: yes;"> </span>Visually (imagine if
one were to turn off the sound), all three ads attach identity to, and
normalize, the following behaviors: the average white mother grocery shops for
chips, ice cream and soda, the African American business man takes the elevator
to work, the white working man has a tray of fast food for lunch, the soccer
mom eats burgers by the pool, the pretty blond eats from the buffet line and
the young Asian American man lays on the couch all day (3-4).<span style="mso-spacerun: yes;"> </span>Viewers can identify with these people,
and are thus ‘nudged’ towards acting the same way (2).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>These
ads appeal to the strong core value of social acceptance.<span style="mso-spacerun: yes;"> </span>Instead of creating social support for
making healthy choices, they show social acceptance of the exact behaviors they
are attempting to discourage.<span style="mso-spacerun: yes;">
</span>This is an example of “social nudging”, which has a strong influence on
personal behavior (2).<span style="mso-spacerun: yes;"> </span>When the
third ad shows unhealthy behavior as normalized, but verbally attests that
healthy behaviors will be adopted “tomorrow”, the tongue in cheek aspect of
this type of intervention is overridden by the social nudge to participate in
those unhealthy behaviors, that is, until “tomorrow”.<span style="mso-spacerun: yes;"> </span>There is no social nudging to actually change the behaviors
which contribute to obesity; instead, there is social nudging to participate in
just thinking about changing the behaviors.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>If
the incidence of messages, products and behaviors spread just like viruses do,
as postulated by Gladwell in The Tipping Point, the obesity epidemic is no
different (5).<span style="mso-spacerun: yes;"> </span>All three of these
anti obesity ads violate principles of the Tipping Point theory.<span style="mso-spacerun: yes;"> </span>Contagion, a major principle of the
Tipping Point theory states that words, images and trends in behavior are
contagious between people, just as viruses are (5).<span style="mso-spacerun: yes;"> </span>The images in all three ads are planted in the viewers mind
each time the ad is seen.<span style="mso-spacerun: yes;"> </span>Chips,
ice cream, pizza, watching TV, lounging by a pool are all images people are
familiar with, and most people already associate these things with positive,
happy and familiar situations.<span style="mso-spacerun: yes;">
</span>Preforming these activities(unhealthy eating) in response to the
environmental stimuli (sitting by the pool/lunching at a fast food restaurant)
will reinforce the unhealthy behaviors because they give the viewer a feeling
of reward for conforming to a modeled social norm (1).<span style="mso-spacerun: yes;"> </span>The real life choice between the ice
cream and the fruit at the grocery store will be impacted by the memory of the
mother buying the ice cream in the ad.<span style="mso-spacerun: yes;">
</span>The real life choice between the apple slices and the french fries at
McDonald’s will be influenced by the memory of the man and his tray of junk
food.<span style="mso-spacerun: yes;"> </span>Those public choices will
influence the choices of other people in the environment, and so on and so
forth, jumping contagiously from person to person, just like a flu virus (5).</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>These
ads are all essentially creating massive road blocks on the path to achieving
the critical mass of behavior change that is required to reach the tipping
point of enough people adopting healthy behaviors to fight obesity.<span style="mso-spacerun: yes;">
</span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: "Georgia Bold";">Critique
Two - Health Belief Model</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>These
ads follow the components of the Health Belief Model.<span style="mso-spacerun: yes;"> </span>Showing many different types of people is an effective way
of reaching a large diverse group of people and convincing them that no matter
what they look like, they are susceptible to obesity(6).<span style="mso-spacerun: yes;"> </span>These ads show that obesity is a
problem for adults and children of all races.<span style="mso-spacerun: yes;"> </span>Everyone is potentially at risk (6).<span style="mso-spacerun: yes;"> </span>The severity of the consequences of
eating unhealthy food<span style="mso-spacerun: yes;"> </span>is shown
through the portrayal of overweight children and the conversation about the mass
amounts of food the boys fathers can consume(3-4).<span style="mso-spacerun: yes;"> </span>Other sources have widely reported on the health problems
that can result from obesity in childhood, and the children shown in these ads
are not just a little chubby, they are obese.<span style="mso-spacerun: yes;"> </span>The perceived benefits of changing the unhealthy behavior is
clear,<span style="mso-spacerun: yes;"> </span>i.e. becoming less
obese.<span style="mso-spacerun: yes;"> </span>The “push to act” in these
ads is the motivation of parental love and responsibility (6).<span style="mso-spacerun: yes;"> </span>The desire to protect and foster the
health of your child is used as the motivation for change.<span style="mso-spacerun: yes;"> </span>The last piece of the HBM, self
efficacy, is only hinted at, but the message is that now the parents know how
their choices are effecting the children, they have to make healthier choices,
put down the fast food tray and eat healthier foods (6).<span style="mso-spacerun: yes;"> </span>The problem with all of this is, of
course, that the HBM does not actually cause people to change their behavior
(7).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
HBM asserts that facts are only valid when they are observed (8).<span style="mso-spacerun: yes;"> </span>In these ads, the people are buying
unhealthy food and they and their children are obese.<span style="mso-spacerun: yes;"> </span>This is presented as a true, observed, direct cause and
effect relationship.<span style="mso-spacerun: yes;"> </span>Unhealthy
food consumption leads to obesity, therefore, if you cease eating the unhealthy
food, you will cease to be obese.<span style="mso-spacerun: yes;">
</span>While this may be true, it will not create change because the HBM does
not account for economic or social factors on behavior change (8).</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>These
ads place all the responsibility for obesity and childhood obesity on
individual people.<span style="mso-spacerun: yes;"> </span>These ads fail
to address the economic, social and environmental causes of obesity, all
important aspects of behavior change that the HBM fails to address(8).<span style="mso-spacerun: yes;"> </span>Within this campaign, there is no
corresponding social service project aimed at making it easier for adults to
make better choices.<span style="mso-spacerun: yes;"> </span>There is no
social support or financial support for buying healthier foods or participating
in healthy activities.<span style="mso-spacerun: yes;">
</span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Advertising
influences on food choice are strong as well, which the HBM also fails to take
into account.<span style="mso-spacerun: yes;"> </span>Food companies have
created advertising environments which make it almost impossible to avoid
unhealthy food choices (9).<span style="mso-spacerun: yes;">
</span>Television ads promoting unhealthy foods to kids promise magical things
to children who eat sugary cereals, super powers to children who drink
unhealthy drinks and increased social status to those who eat unhealthy
lunches.<span style="mso-spacerun: yes;"> </span>Constant bombardment with
this powerful advertising means parental “choice” in what products to buy is
often dictated by their children, not the other way around (9).<span style="mso-spacerun: yes;"> </span>Adults are also not immune to food
advertising (9).<span style="mso-spacerun: yes;"> </span>This mother
probably knows the bucket of ice cream is unhealthy, but she is buying it
because she has seen a thousand and one ads telling her how amazing it is.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Neither
ad addresses the issue of cost.<span style="mso-spacerun: yes;"> </span>It
assumes that the mother and the man have unlimited ability to purchase
healthier choices and they are failing to do so because they o not understand
the true impact of their choices.<span style="mso-spacerun: yes;">
</span>Healthy options can be more expensive than cheaper foods, due in large
part to government subsidizing of corn, soy and wheat products, making
unhealthy food artificially cheaper than fruits and vegetables (9).<span style="mso-spacerun: yes;"> </span>The purchasing of unhealthy food is
often not due to lack of knowledge about how unhealthy ice cream and fast food
are, but rather financial constraint (9).<span style="mso-spacerun: yes;">
</span>Socio-economic class is not a matter of personal choice.</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Neither
ad takes into account any of these various factors, and instead depends on the
HBM.<span style="mso-spacerun: yes;"> </span>Assuming the HBM is
successful, the mother has now realized that her own personal buying habits
have been appropriated by her daughter, and now that she knows this, she will
change her buying habits.<span style="mso-spacerun: yes;"> </span>Her
daughter will now make healthier choices as well.<span style="mso-spacerun: yes;"> </span>These principles remain true for the second ad, when the man
experiences the lightbulb moment as he is bringing his unrealistically full
fast food tray to his table and over hears two young boys trying to one up each
other on how much their fathers can eat at one sitting.<span style="mso-spacerun: yes;"> </span>Now that the man knows that the young
boys have noticed and appropriated his unhealthy behaviors, he will be
motivated to change those behaviors in order to protect the health of the
children.<span style="mso-spacerun: yes;"> </span>Neither of these things
will actually happen, and the ads will have little to no effect on obesity
because they depend on a flawed theory of behavior.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<br /></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: "Georgia Bold";">Critique
Three - Psychological Reactance</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Another
reason these ads will fail is because they produce psychological reactance in
the viewer.<span style="mso-spacerun: yes;"> </span>Psychological
reactance produces a very low intention to comply with the message of the ad
(10). <span style="mso-spacerun: yes;"> </span>While these ads achieve
success in presenting people who are similar to the viewer, the ads are
designed to cause the viewer to feel guilt over their unhealthy eating habits.<span style="mso-spacerun: yes;"> </span>The ads are trying to convey the
message that unhealthy eating is shameful because it causes childhood
obesity.<span style="mso-spacerun: yes;"> </span>As seen in anti-smoking
campaigns, ads that engender feelings of guilt or shame actually increased
rates of smoking in the viewers(11).<span style="mso-spacerun: yes;">
</span>Campaigns against marijuana smoking in teens did the same thing.<span style="mso-spacerun: yes;"> </span>Appealing to the core values of
rebellion in teens has been extremely effective in ad campaigns for cigarettes,
and the core value of health in most of the anti smoking campaigns just can not
compete (11).<span style="mso-spacerun: yes;"> </span>Health and wellness
are the core values in these ads.<span style="mso-spacerun: yes;">
</span>The adults are ashamed of their food choices because they are
unhealthy.<span style="mso-spacerun: yes;"> </span>This will likely
produce increased amounts of stress, causing viewers to eat more than they
would have if they felt calm and supported (12).<span style="mso-spacerun: yes;"> </span>Unlike smoking, eating is a biological necessity, so these
ads might produce an even stronger psychological reactance effect than the
anti-smoking campaigns (10).<span style="mso-spacerun: yes;">
</span>Feeling stressed and ashamed combined with the biological need to eat
would magnify the effect of the reactance (12).<span style="mso-spacerun: yes;"> </span>The core value of adults is not health or wellness, nor is
it parental affection (10).<span style="mso-spacerun: yes;"> </span>These
ads have failed to identify and appeal to the core values of their audience.</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Another
way these ads produce psychological reactance is that they portray socially
accepted practices at the same time they are telling the audience that they
must cease these practices.<span style="mso-spacerun: yes;">
</span>Telling a population what they should not do is a very good way of
getting that population to do exactly the opposite.<span style="mso-spacerun: yes;"> </span>One analysis of anti obesity ads showed that the lowest intent
to comply rates were found in campaigns which mandated or forbade certain
activities (10).<span style="mso-spacerun: yes;"> </span>The core value of
rebellion does not completely fade away with adulthood, and core core values of
freedom and choice are strong (13).<span style="mso-spacerun: yes;">
</span>These ads take away the very person choice of what food to eat at a
meal, and in order to regain that feeling of control, people may choose to eat
exactly the foods they want (12).<span style="mso-spacerun: yes;">
</span>Given the national addiction to fat, sugar and salt, the foods people
“want” tend to be the very foods featured in the ads.<span style="mso-spacerun: yes;"> </span>If psychological reactance were to be measured with
questions such as “How guilty did this ad make you feel?” “How angry did this
ad make you feel?” or “Did this ad make you more or less likely to eat a
healthy meal” it would have been clear to the producers of this ad that it
would be ineffective.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<br /></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: "Georgia Bold";">Part
Two: Your Body Is A Temple</span></div>
<div class="Body" style="line-height: 200%;">
<br /></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: "Georgia Bold";">Intervention:</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
intervention I propose to address the three critiques of the MN anti-obesity
campaign is two pronged.<span style="mso-spacerun: yes;"> </span>Part one
of the intervention is a Television/Social Media ad campaign featuring
celebrities who have been open about their choice to follow a healthy
diet.<span style="mso-spacerun: yes;"> </span>Alec Baldwin, Bill Clinton,
Kevin Eubanks, Paul McCartney, Russell Brand, Peter Dinklage, Brad Pitt and
Mike Tyson are options for the male celebrities.<span style="mso-spacerun: yes;"> </span>Natalie Portman, Kristin Bell, Ellen DeGeneres, Leona Lewis,
Olivia Wilde, Sandra Oh, Carrie Underwood, Shania Twain, Ashley Judd and Betty
White will be included for the female celebrities.<span style="mso-spacerun: yes;"> </span>The first ad will feature the celebrities in the campaign
merchandise (available for purchase) against a simple background.<span style="mso-spacerun: yes;"> </span>In the style of the “Don’t Vote” ad,
the celebrities will have lines such as “Do not eat vegetables”... “Do not go for
a walk, there is something on TV you’ve only seen four times...” ... “Do not
drink that water”... “Do not eat {Insert Vegetable/Fruit Name Here}”.<span style="mso-spacerun: yes;"> </span>These phrases would all start with some
variation of “Don’t”.<span style="mso-spacerun: yes;"> </span>At the end
of the ad, the newly designed sexy brand symbol(yet to be designed) would flash
across the screen with the simple message “Your Body Is A Temple”.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
second ad would feature the same celebrities, this time “caught” in typical
paparazzi shots, eating a wide variety of vegetables and fruits, whole
grains(oatmeal/dark bread/dark pasta, always recognizable things, nothing
unfamiliar to the general public) and nuts/seeds.<span style="mso-spacerun: yes;"> </span>Images would also be included of walking, running, biking,
doing yoga.<span style="mso-spacerun: yes;"> </span>Some images or video
clips will be sexy, some will be funny, but all will feature a healthy
behavior.<span style="mso-spacerun: yes;"> </span>This time however,
images and “home movie” type video of “typical” American people(including young
children) enjoying healthy food and activities will be spliced in between the
celebrity shots, given equal time and culminating in a final image of all the
images on the screen at the same time in small squares, filling up the whole
screen.<span style="mso-spacerun: yes;"> </span>The song playing in all
the ads will be popular and there will be several different image/video montage
sets.<span style="mso-spacerun: yes;"> </span>The slogan “Your Body is A
Temple” and the brand symbol will then flash over the images to end the
commercial.<span style="mso-spacerun: yes;"> </span>Both of these
commercials will be released to television and social media sites such as
Facebook, Youtube, Twitter and Tumblr.<span style="mso-spacerun: yes;">
</span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>In
the second prong of the intervention, people will be encouraged to post
pictures of their own healthy behaviors with the hash tag “TempleBod” and
receive in response motivational messages and coupons for healthy food.<span style="mso-spacerun: yes;"> </span>Products will also be produced and sold
with the logo and slogan “TempleBod” and “My Body Is a Temple”.<span style="mso-spacerun: yes;"> </span>All proceeds from these sales will be
donated to local farmers markets so that they may double the value of SNAP
benefits.<span style="mso-spacerun: yes;"> </span>While some farmers
markets do this, not all are in a financial position to do so.<span style="mso-spacerun: yes;"> </span>All profits of merchandise sales will
go towards this initiative.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<br /></div>
<div class="Body" style="line-height: 200%;">
<br /></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: "Georgia Bold";">Defense
One - A Better Use of Social Nudging and Tipping Points</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
ad featuring paparazzi shots of people eating healthy food in the Temple
campaign uses social nudging and tipping point theory to influence the behavior
of the viewer.<span style="mso-spacerun: yes;"> </span>Social nudging can
be used to great effect to get people to change their behaviors.<span style="mso-spacerun: yes;"> </span>Social nudging can be achieved through
a very simple mechanism: telling people what other people are doing (2).<span style="mso-spacerun: yes;"> </span>The scientific and health community
does not know exactly how to combat obesity, but they have several very well
accepted theories.<span style="mso-spacerun: yes;"> </span>Eating more
vegetables and fruits, whole grains, smaller portions and lots of water are all
commonly accepted theories of how to lose weight and keep it off.<span style="mso-spacerun: yes;"> </span>Telling, or more accurately, showing
the viewers of the Temple campaign that people everywhere are eating more
fruits and vegetables will socially nudge them into eating more healthily
themselves.<span style="mso-spacerun: yes;"> </span>Using celebrities adds
another layer of influence.<span style="mso-spacerun: yes;"> </span>The
power of celebrity has been used in almost every successful ad campaign for new
product.<span style="mso-spacerun: yes;"> </span>Healthy behaviors should
be treated just as a new product is.<span style="mso-spacerun: yes;">
</span>Selling healthy behaviors must begin with telling the viewer that
everyone else is participating, and they should too.<span style="mso-spacerun: yes;"> </span>Using positive messages instead of negative ones will
increase the power of the social nudge (2).</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
tipping point theory comes into play with the second ad as well. This theory
states that the bulk of the population needs to see that a certain percent of
the population is participating in a behavior before they “get on board” with
that behavior (5). This campaign will make it seem as though that percentage
has already been achieved.<span style="mso-spacerun: yes;"> </span>Through
including many short duration images or video clips(no more than 1-2 seconds in
duration) depicting healthy behaviors, and then keeping those images on the
screen (in a smaller form) to create a “quilt” of images of people being
healthy, the illusion of mass participation will be achieved.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: "Georgia Bold";"><span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: "Georgia Bold";">Defense
Two - Anti-Health Belief Model </span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Many
people feel as though they have been hearing messages about how terrible the
obesity rates are in America for a very long time.<span style="mso-spacerun: yes;"> </span>It is unrealistic to assume that people are not aware of the
epidemic.<span style="mso-spacerun: yes;"> </span>People know they are at
risk for obesity, they know the health consequences that come after obesity as
well.<span style="mso-spacerun: yes;"> </span>With a rate pushing 50% in
some populations, most people know someone who has gotten sick or died from
obesity related complications.<span style="mso-spacerun: yes;"> </span>The
Temple campaign ads assume that knowledge already exists.<span style="mso-spacerun: yes;"> </span>The problem is not that adults are
unaware that their choices influence their health and the health of the
children around them.<span style="mso-spacerun: yes;"> </span>The problem
is they are not socially supported in making better choices.<span style="mso-spacerun: yes;"> </span>It is not a matter of personal choice
in many situations, it is a matter of social support and economic ability
(8).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
second prong of the Temple Campaign will be geared towards addressing this part
of the issue.<span style="mso-spacerun: yes;"> </span>The merchandise will
be designed to appeal to adults as well as children, and include a wide range
of products, from inexpensive to designer level.<span style="mso-spacerun: yes;"> </span>The celebrities in the TV ads will all wear the merchandise
as well as promote it during a variety of events.<span style="mso-spacerun: yes;"> </span>All proceeds from the sale of the merchandise will go
to supporting SNAP use at farmers markets.<span style="mso-spacerun: yes;"> </span>Enabling farmers markets to double the value of SNAP
benefits will make it easier for the population most at risk for obesity to
gain access to healthy foods.<span style="mso-spacerun: yes;">
</span>Partnering with farmers markets will also stimulate local
economies.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<br /></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: "Georgia Bold";">Defense
Three - Taking Advantage of Psychological Reactance</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Instead
of trying to limit the production of psychological reactance in both of the
ads, one ad attempts to harness its power.<span style="mso-spacerun: yes;"> </span>Most people are aware that unhealthy eating is bad for them,
but research has shown a sharp decrease in intent to participate in ads which
engender feelings of shame or negativity (10).<span style="mso-spacerun: yes;"> </span>Instead of appealing to the core value of health, this ad
will appeal to the core value of freedom, a much stronger value (13).<span style="mso-spacerun: yes;"> </span>Taking away someones freedom of choice
in what to eat is a powerful motivator to take that freedom back (14).<span style="mso-spacerun: yes;"> </span>Telling people to not eat vegetables, to
not eat fruit, to not eat nuts and seeds or whole grains will motivate them to
take back their control over eating exactly those items.<span style="mso-spacerun: yes;"> </span>Shame and guilt over unhealthy eating
habits will be replaced by a rebellious motivation to eat healthier food.
Hopefully the tongue in cheek nature of this ad will also amuse the viewer
sufficiently so that they will remember it for long after seeing it, in order
to be continuously influenced.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>There
has also been research showing that ads which never mention “obesity” or
“overweight” are much more positively viewed (10). Neither ad mentions obesity
as the target issue, which would be seen as targeting and negative.<span style="mso-spacerun: yes;"> </span>Instead, these ads promote similarity,
a common way to combat reactance (14). Both ads also feature healthy normal
weight individuals, but they never bring attention to that fact.<span style="mso-spacerun: yes;"> </span>Instead, the concept of similarity in
reducing psychological reactance is used in choosing celebrities who represent
a broad range of body types, races, ages, genders, disability status and sexual
orientation.<span style="mso-spacerun: yes;"> </span>In the second ad,
non-celebrities will also be featured, opening up more possibilities for
diversity, including socio-economic class and geographic region.<span style="mso-spacerun: yes;"> </span>Most people who view both ads will see
someone who looks like them engaging in healthy behaviors, decreasing the
psychological reactance (14).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="Body" style="line-height: 200%;">
<br /></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: "Georgia Bold";">Conclusion</span></div>
<div class="Body" style="line-height: 200%;">
<span style="font-family: "Georgia Bold";"><span style="mso-tab-count: 1;"> </span></span><span style="font-family: Georgia;">The issue of obesity in America is more serious
than any other chronic health issue in recent memory.<span style="mso-spacerun: yes;"> </span>The facts and figured are sobering.<span style="mso-spacerun: yes;"> </span>Many children who are obese may have
shorter lifespans than their parents.<span style="mso-spacerun: yes;">
</span>The physical ramifications of obesity are only one part of the epidemic,
the emotional impacts of obesity are important as well.<span style="mso-spacerun: yes;"> </span>Being an obese person can lead to
discrimination in the workplace and bullying at school.<span style="mso-spacerun: yes;"> </span>Interventions should not only consider
how to influence the physical health of the public, but also the emotional
health.<span style="mso-spacerun: yes;"> </span>The MN intervention shamed
obese adults, blaming them for childhood obesity.<span style="mso-spacerun: yes;"> </span>These ads will not effect obesity rates and they might have
a detrimental effect on the mental health of the viewer.<span style="mso-spacerun: yes;"> </span>Assuming obesity is an issue of
personal choice, that it is based around a lack of information, and can be
influenced by knowledge alone is a mistake. The misuse of social nudging, the
dependence on the health belief model and completely ignoring the impact of psychological
reactance are all weaknesses of this ad campaign.</span><span style="font-family: "Georgia Bold";"> </span><span style="font-family: Georgia;">The issue of obesity
is far too serious an issue to not put serious efforts into developing a
research supported, effective campaign to fight back.<span style="mso-spacerun: yes;"> </span>Until such a campaign is developed, organizations such as MN
Blue Cross Blue Shield should stop employing ineffective and offensive ads. </span><span style="font-family: "Georgia Bold";"></span></div>
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<span style="font-family: "Georgia Bold";">Resources</span></div>
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<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">DeFleur ML, Ball-Rokeach SJ. </span><span style="font-family: "Georgia Italic";">Theories of Mass Communication</span><span style="font-family: Georgia;"> (5<sup>th</sup> edition), Chapter 8 (Socialization
and Theories of Indirect Influence), pp. 202-227. White Plains, NY: Longman
Inc., 1989.</span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">Following the herd (Chapter 3). In: Thaler RH,
Sunstein CR. Nudge: Improving Decisions About Health, Wealth, and Happiness.
New Haven, CT: Yale University Press, 2008, pp. 53-71.</span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">Minnesota Blue Cross Blue Shield.<span style="mso-spacerun: yes;"> </span>Better Example Campaign. <a href="http://www.youtube.com/watch?v=1gCTX2EfUUs"><span style="color: #000099;">http://www.youtube.com/watch?v=1gCTX2EfUUs</span></a>
</span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">Minnesota Blue Cross Blue Shield. Better Example
Campaign <a href="http://www.youtube.com/watch?v=Vtil_kFMvoU"><span style="color: #000099;">http://www.youtube.com/watch?v=Vtil_kFMvoU</span></a></span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">Introduction. In: Gladwell M. The Tipping Point:
How Little Things Can Make a Big Difference. Boston: Little, Brown and Company,
2000, pp. 3-14.</span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">Individual health behavior theories (chapter 4).
In: Edberg M. Essentials of Health Behavior: Social and Behavioral Theory in
Public Health. Sudbury, MA: Jones and Bartlett Publishers, 2007, pp. 35-49.</span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">Ogden J. Some problems with social cognition
models: a pragmatic and conceptual analysis. Health Psychology 2003;
22:424-428.</span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">Thomas LW. A critical feminist perspective of the
health belief model: implications for nursing theory, research, practice, and
education. Journal of Professional Nursing 1995; 11:246-252.</span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia;">HBO. Weight of the Nation Parts 1-4. 2012.http:/
theweightofthenation.hbo.com/</span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia;"><span style="mso-spacerun: yes;"> </span>Puhl, R. Peterson LJ, and Luedicke
J.<span style="mso-spacerun: yes;"> </span>Fighting obesity of obese
persons? Public perceptions of obesity-related health messages. International
Journal of Obesity 2012; 0: 1-9</span></div>
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<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">11.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia;">Bauer UE,
Johnson TM, Hopkins RS, Brooks RG. Changes in youth cigarette use and
intentions following implementation of a tobacco control program: Findings from
the Florida Youth Tobacco Survey, 1998-2000. JAMA 2000; 284:723-728. </span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">12.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia;">West, L.
Jezabel.<span style="mso-spacerun: yes;"> </span>Is it hard enough to be a
fat kid without the government telling you you’re an epidemic?. Weighty
Issues.<span style="mso-spacerun: yes;"> </span><a href="http://jezebel.com/5945955/its-hard-enough-to-be-a-fat-kid-without-the-government-telling-you-youre-an-epidemic?post=52940676"><span style="color: #000099;">http://jezebel.com/5945955/its-hard-enough-to-be-a-fat-kid-without-the-government-telling-you-youre-an-epidemic?post=52940676</span></a></span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">13.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia;">Menashe CL,
Siegel M. The power of a frame: an analysis of newspaper coverage of tobacco
issues – United States, 1985—1996. Journal of Health Communication 1998;
3(4):307-325.</span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">14.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia;">Silvia PJ.
Deflecting reactance: The role of similarity in increasing compliance and
reducing resistance. Basic and Applied Social Psychology 2005; 27:277-284.</span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">15.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia;">Abrams, L. The
Atlantic.<span style="mso-spacerun: yes;"> </span>Think of the (Fat)
Children: Minnesota's 'Better Example' Anti-Obesity Campaign. 2012.<span style="mso-spacerun: yes;"> </span><a href="http://www.theatlantic.com/health/archive/2012/09/think-of-the-fat-children-minnesotas-better-example-anti-obesity-campaign/262674/"><span style="color: #000099;">http://www.theatlantic.com/health/archive/2012/09/think-of-the-fat-children-minnesotas-better-example-anti-obesity-campaign/262674/</span></a></span></div>
<div class="Body" style="margin-left: 13.0pt; mso-list: l0 level1 lfo1; tab-stops: list 13.0pt; text-indent: -13.0pt;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">16.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia;">Simmons-Duffin,
S. NPR News. New Anti Obesity Ads Blaming Overweight Parents Spark
Criticism.<span style="mso-spacerun: yes;"> </span>The Salt, <a href="http://www.npr.org/blogs/thesalt/2012/09/27/161831449/new-anti-obesity-ads-blaming-overweight-parents-spark-criticism"><span style="color: #000099;">http://www.npr.org/blogs/thesalt/2012/09/27/161831449/new-anti-obesity-ads-blaming-overweight-parents-spark-criticism</span></a></span></div>
Mollyhttp://www.blogger.com/profile/18395792142837014194noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-47574646058136680912013-01-01T11:31:00.000-08:002013-01-01T11:31:40.544-08:00The Dangers of ‘Fat Shaming’ and Parent-Child Interventions: Rethinking Obesity Interventions- Emily Hall <div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
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<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">There is no denying that obesity has become a public
health epidemic that needs immediate attention, especially among America’s
youth. Currently, 1 in 3 children ages 11-19 are overweight or obese and nearly
1 in 6 children are obese with a BMI above the 95<sup>th</sup> percentile of
the CDC’s recommended growth charts (1). Overweight and obese children are at
an increased risk for many health conditions such as cardiovascular disease,
type-2 diabetes in addition to various psychological problems related to the
social stigma of being overweight (2- 241S). It is also likely for many
children that these health problems will continue into adulthood: overweight
children have a 70% chance of becoming obese adults, which rises to 80% if 1
parent is overweight or obese (1). </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 3.0pt; margin-right: 0in; margin-top: 0in; text-indent: 33.0pt;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">In order to
counteract this dangerous trend, several public health organizations have
designed interventions to highlight how parental obesity is related to childhood
obesity. However, many of these programs rely on a tactic known as ‘fat
shaming’ which relies on the stigma against obesity as motivation for children
(and their parents) to adopt healthier lifestyles and lose weight (3-4). Examples
of such anti-obesity campaigns include Georgia’s Strong4Life campaign (4) and
Blue Cross and Blue Shield of Minnesota’s ‘Better Example’ campaign (5). Both
have sparked national debates over the use of fat shaming in their TV and
billboard advertisements. Anti-obesity campaigns focusing on the parent-child
relationship and using weight stigma as a call to action are detrimental to
obesity interventions since they do not take into account the entire ecological
model of health promotion, are based on changing attitudes through the Theory
of Reasoned Action, and rely on fat shaming to create positive behavior change
when in reality it leads to psychological reactance.</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 3.0pt; margin-right: 0in; margin-top: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt;">Individual-level Interventions and the Ecological Model of Health
Promotion</span></b><span style="font-family: Georgia; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt;"><span style="mso-tab-count: 1;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Applied to health promotion by McLeroy et al., ecological
models of behavior describe the individual, social and environmental factors
that contribute to an individual’s actions (6-351). Although individual factors
play a role in the model, social and environmental influences are shown to be
greater predictors of behavior. Individual-oriented behavior change
interventions, such as child anti-obesity campaigns that use fat shaming, often
lead to victim blaming and inaction (6-352). Social and environmental forces
maintain and reinforce unhealthy eating behaviors, so intervening only on an
individual level ineffective (6-353) and ignores many of the group-level
factors contributing to the problem.</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>The
levels of influence identified within McLeroy et al.’s ecological model for
health promotion are intrapersonal factors, interpersonal processes,
institutional factors, community factors, and public policy (6-355). Anti-obesity
campaigns based on fat shaming are only utilizing intrapersonal and
interpersonal factors, as they are specifically aimed at changing the behavior
of obese children and their parents (5). Since they are focused on intervening
on the individual level, these campaigns assume that the direct causes of
behavior come from within the individual or familial influence rather than the
larger social and political environment. Concerning most health behaviors,
motivation to act is not only the result of an individual’s knowledge and
attitudes about health but influence from outside environmental forces out of
the individual’s control (6-356). </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>This
is especially true of the convergence of environmental and social influences
that have led to obesity epidemic in the U.S. Rather than just the result of
individual lifestyle choices, the growing rate of weight gain can also be
attributed to a series of environmental influences stemming from widespread
lifestyle changes. These include the overall reduction in physical activity and
increase in the availability of inexpensive, energy dense foods (7-853). </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">For example, obesity rates in the last 30 years have risen
in tandem with the increase in restaurant portion sizes. Items at restaurants,
especially at fast food establishments, have gotten 2 to 5 times larger since
the 1980s. Studies conducted in natural eating environments have illustrated
that when presented with a small and large portion choice, individuals are more
likely to choose the larger portion (7-905). The amount of food offered to an
individual as a portion has a great influence on their caloric intake, which in
turn impacts their weight. Children are particularly susceptible to weight gain
due resulting from this trend of increasing portion sizes: children with higher
BMIs consume portions up to 100% larger than those routinely eaten by children with
lower BMIs (8-907).</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Changes in overall eating habits of Americans have greatly
contributed to the rising trend of childhood obesity. Consuming meals made
outside the home is very common due to an increasing number of both two income
and single parent households and expansion of the restaurant industry. The
increase in portion sizes at restaurants is attributable in part to consumer
demand for economic value leading to fast food establishments offering larger
portions of calorie dense food for lower costs as a marketing strategy (8-908).
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">The rise in fast food consumption among families is also
attributable to the changes in economic structures and workplace expectations that
have occurred in the last two generations—the “9 to 5” workday is disappearing,
leaving parents with less time to prepare meals for their children. This
emphasis on high productivity in the workplace has also left many adults
without the time to engage in physical activity for themselves or encourage it
among their children. It is clear that current social norms encourage obesity
and are influential forces dictating individual health behaviors (7-854). </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Anti-obesity interventions that focus only on individuals
and their interpersonal interactions, such as those between parents and their
children, fail to address the influences that higher level factors have on
health behaviors. According to the ecological model of health promotion, at the
community level resources available for health services or encouraging healthy
lifestyles may be limited (6-364) and therefore dictate an individual’s eating
habits more than personal food preference. This model also states that community
power dictates the public agenda and those with the most severe health problems
are often have the least access to participating in the community and
influencing the agenda. McLeroy et al. describes these disenfranchised groups
as the poor, uneducated, unemployed and those with socially stigmatized medical
conditions (6-365).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Across the U.S., childhood obesity is growing the fastest
among low income households where levels of parental education are also low,
although this relationship is moderated by ethnicity (9-5). Therefore,
disregarding the amount of community power that these families wield as
compared to more educated and affluent community members has led to
interventions that are ineffective due to their ignorance of the community
power structure (6-365). The stigmatization of obesity seen in the Strong4Life
and Better Example campaigns marginalizes obese children even further (10),
making the intervention not only unsuccessful in provoking community level
change but may even be harmful to the parents and children whose health they
are trying to improve. </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Appealing to Parents through the Theory
of Reasoned Action</span></b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>The
Theory of Reasoned Action uses social psychology to explore the relationships
between an individual’s behaviors, beliefs, attitudes and intentions. It states
that behavioral intention is the most important predictor of action. In this
theory, intention is influenced by an individual’s attitude towards performing
a behavior and by subjective norms about the behavior within the individual’s peer
group. The Theory of Reasoned Action also assumes that all other factors that
could influence behavior are experienced only through the model and cannot
predict behavior independently. This includes environmental or cultural factors
(11-16). </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>Blue
Cross Blue Shield Minnesota’s ‘Better Example’ campaign uses the Theory of
Reasoned Action through trying to change parents’ attitudes towards certain
lifestyle habits, such as eating large portions of fast food, and the negative
impact that they have on their children. The slogan used in many of their
commercials, “Today is the day we set a better example for our kids,” (5) also
illustrates that this campaign seeks to address the subjective norms that
overweight parents with children who are overweight or obese have about their
eating habits and how it influences their children. Through attempting to
change parents’ attitudes about how their behavior impacts their children, this
campaign seeks to influence their intentions and therefore their health
behaviors. </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>One
flaw in the Theory of Reasoned Action is its emphasis on intention leading
directly to behavior. This emphasizes individual cognition above environmental
influence when making decisions (11-16). The Theory of Reasoned Action also
assumes that individuals systematically process and the information that is
presented to them and make decisions based on a rationed thought process
(12-253). <span style="mso-spacerun: yes;"> </span>When applying these
assumptions to other health behaviors such as HIV prevention, research has
shown that being informed about protection had little impact on changing the
rate of unprotected sex among homosexual men. Instead, socioeconomic status and
perceived severity of illness were the biggest predictors of using protection
when engaging in risky sexual activity (12-254).<span style="mso-spacerun: yes;"> </span>Therefore, individual attitudes and beliefs alone cannot be
depended upon to lead to behavioral change, since much of behavior is
influenced instead through the social structures that govern everyday actions (12-255).
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Similar to the impact of individual attitudes on HIV
prevention behavior, parental attitudes towards obesity are not the greatest
predictors of a healthy lifestyle for their children that include a balanced
diet and adequate physical exercise. Even a person’s food preference is a
result of their socioeconomic and cultural environment rather than individual,
rational thought considering nutritional benefits and potential impact on
weight (13-250S). The externality theory of obesity, supported by many
behavioral researchers, <span style="mso-spacerun: yes;"> </span>states
that obese individuals are more susceptible to overeating since they are more
receptive to external cues rather than internal cues such as lack of hunger or
attitudes about food consumption (13-251S).</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-spacerun: yes;"> </span>The Theory of
Reasoned Action also postulates that external factors only impact behavior
through an individual’s attitudes (11-6), which is clearly illustrated to be
false concerning overeating behavior and other activities that lead to obesity.
A study conducted by Craeynest et al. on the attitudes of obese and non-obese
children concerning food intake and physical activity concluded that obese
children did not have a negative attitude towards healthy food or physical
activity. However, when given the opportunity they ate larger portions of food
and engaged in sedentary activities more often than the non-obese participants.
This illustrates the discrepancy between the attitudes of obese children and
their behavior (14-1118), which cannot be accounted for by the Theory of
Reasoned Action. Since childhood obesity is not only the product of individual
or parental attitudes towards a healthy lifestyle (6-356), basing an
intervention on this theory will not lead to a substantial change in obesity
rates among children or their parents. </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Fat Shaming and Psychological Reactance </span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>Both
the Strong4Life and Better Example campaigns have been criticized for fat
shaming, or using the societal stigma against being overweight as motivation
for parents and children to adopt healthier lifestyles (3-4). Supporters of
these campaigns claim that obesity is such a serious and prevalent problem that
parents and children need to be confronted with these realities through any
means possible (5). However, a recent analysis of anti-obesity public health
campaigns conducted at Yale University has determined that weight stigma is not
an effective tool for encouraging weight loss. Instead, promoting the stigmatization
of obese individuals leads to serious psychological health problems,
exacerbates health disparities, and discredits effective obesity interventions
(15-1) through provoking psychological reactance. </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Psychological reactance results from being pressured by
social influence to act in a certain way, which threatens individual autonomy.
In response to this perceived threat, individuals feel the need to respond
reactively or against the message of the influence to restore their personal
freedom (16-277). Fat shaming invokes psychological reactance through
stereotyping overweight individuals as lazy, unsuccessful, unintelligent, and
lacking in self-discipline as an incentive to change their behavior. A
psychologically reactive response ensures that the opposite happens: overweight
individuals who are targeted by weight stigmatizing anti-obesity ads actually
increase the risk of unhealthy behaviors. This often results in further weight
gain and therefore poor physical health outcomes, but also adverse
psychological outcomes (15-1). Anti-obesity campaigns that highlight personal
responsibility for weight gain have also been shown to be received negatively
by the targeted audience rather than inspire motivation for change (15-5).</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>Georgia’s
Strong4Life campaign has generated significant controversy for its use of fat
shaming, with TV ads using dialogue such as, “Being fat takes the fun out of
being a kid,” and “It’s hard to be a little girl if you’re not,” and featuring
images of overweight and obese children (10). <span style="mso-spacerun: yes;"> </span>As discussed in <i style="mso-bidi-font-style: normal;">Fat
Shame: Stigma and the Fat Body in American Culture</i>, weight stigmatization
is especially detrimental to the psychological health of women and girls due to
historical gender norms. According to Western cultural ideology, women are weak
and lacking in self-discipline as compared to men and are therefore more
susceptible to individual blame for being overweight (3-49).The ads used by the
Strong4Life campaign perpetuate this idea, presenting images of children, many
female, who look depressed and isolated. As Farrell stated to CNN, “[These ads]
teach us that we should feel sorry for fat kids and that it’s normal to tease
and abuse them” (10).<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>The
prejudice against overweight individuals resulting from weight stigma may
further marginalize populations that already suffer discrimination due to their
race or socioeconomic status. One result of weight stigmatization has been the
avoidance of doctors and healthcare providers by obese individuals (17-89). Obesity
contributes to many chronic conditions that need significant medical treatment
(2-241S), and stress responses to stigmatization can exacerbate these
conditions (17-89), so fat shaming is doubly detrimental to overweight and
obese individuals. Rather than perpetuating weight stigma, anti-obesity
campaigns should focus on creating an atmosphere of empowerment that inspires
the target audience to engage healthier behaviors (15-1). </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Rethinking Anti-Obesity Campaigns: An
Alternative Approach<span style="mso-tab-count: 1;"> </span></span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">In order to combat all of the downfalls of parent-child
focused obesity interventions that use fat shaming, many changes need to be
made to the theoretical basis and execution of these campaigns. First, the
parent-child obesity problem should be addressed in the context of the
community while utilizing the upper levels of the ecological model of health
promotion. Instead of using an individual level theory such as the Theory of
Reasoned action, advertising theory provides the means to present an obesity
intervention to parents that makes behavior change look attractive and
beneficial. Lastly, instead of using ‘fat shaming’ to encourage behavior
change, an effective intervention presents concrete lifestyle change ideas and messages
of empowerment for the target audience to use to their benefit. </span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt;">Community Level Interventions and the Ecological Model of
Health Promotion </span></b></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span></span></b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">There are a
multitude of benefits to planning public health interventions at a community
level, as the community has often played a central role in public health
planning (6-362). Communities include “mediating structures’” such as informal
social networks, churches and other voluntary associations that provide social
identity to individuals and are an important influence on behavior. McLeroy et
al. emphasize the importance of community social structures, asserting that
without the support of these mediators convincing individuals to change their
behavior is nearly impossible (363). As stated earlier, community structure
also dictates the power that certain groups may have to change their behavior
which needs to be taken into account when planning public health campaigns and
interventions (364). </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>Since
the current obesity epidemic is being driven primarily by environmental
influences (7-853), a community level intervention can better address these
factors and their impact on the target population of obese parents and
children. Therefore, an intervention aimed at decreasing the prevalence of
obesity should begin a long-term campaign for social change that will result in
large enough political and economic incentives to change the environment to be
more conducive to healthy lifestyle choices. At the same time, the current
needs of the growing population of obese parents and children can be addressed
through providing individuals with strategies to resist environmental factors
that contribute to weight gain (854). </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-spacerun: yes;"> </span><span style="mso-tab-count: 1;"> </span>Some
proposed interventions to combat the influence of increasing portion sizes
available in fast food and the popularity of sedentary behavior (7-905) as part
of a comprehensive anti-obesity include encouraging mindful eating, increasing
physical activity and other changes. These methods can be used by entire
families, but must be supported by the community in order to be successful
(18-71). Communities that already have public spaces such as parks or gardens
can encourage an increase in community activity through well designed signage
(18-72) or organizing events such as walking clubs with free participation. In
addition, community level interventions can advocate for an expansion of
nutrition labeling on fast food since many parents are unaware of the contents
of what they and their children are eating or the exact caloric content
(18-73). </span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt;">Incorporating Advertising Theory
into Anti-Obesity Campaigns </span></b></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt;"><span style="mso-tab-count: 1;"> </span></span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span></span></b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">The two flaws in
the Theory of Reasoned Action that make it a poor basis for an anti-obesity
campaign is that it assumes that intentions lead directly to behavior and that
decisions to change behaviors are shielded from outside environmental forces (11-16).
As illustrated by the failure of Georgia’s Strong4Life and Minnesota’s Better
Example campaign to lead to actual behavioral change (5), appealing to
individual intentions is not an adequate technique to decrease the prevalence
of obesity in the U.S. Using a different approach, advertising theory allows
anti-obesity campaigns to reach a larger number of people and influence their
behavior on a population level. </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">This is done with presenting the target audience with what
they want, or a “promise” that the idea that is being sold will fulfill their
desires (20-3). To utilize this idea within anti-obesity campaigns, public
health practitioners should realize that the “promise” that individuals are
seeking is not health but rather freedom from the burden of being obese (3-4).
The target audience of obesity interventions rate public health messages that
do not mention the word ‘obese’ or ‘fat’ as more motivating than those that
invoke personal responsibility for weight gain, which illustrates the desire
for freedom from this stigma (15-5).</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Obesity interventions can provide the promise of freedom
from the constraints of excess weight by crafting advertisements that focus on
the positive promotion of behavioral changes such as eating healthier foods and
engaging in regular physical activity (15-6). If presented through actors that
appear carefree and happy while doing these and other healthy lifestyle
activities, preferably with their family members, obese parents will not only
be more motivated to change their behavior, but they will also feel less
stigmatized by the intervention (15-6). </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">The use of advertising theory rather that the Theory of
Reasoned Action in anti-obesity campaigning skirts the issue of ignoring
environmental influences on behavior and harnesses an important resource that
has been traditionally used to promote obesity epidemic rather than prevent it
from growing. Analyses of television ads created to sell fast food products to
children have concluded that over 50% of the commercials feature high fat, high
sugar, and high sodium content foods (19-409). These advertisements have been
shown to contribute to the obesity epidemic through reinforcing unhealthy
eating habits and making the consumption of larger portion sizes appear to be
the social norm (19-411). <span style="mso-spacerun: yes;"> </span>If
advertising theory is a powerful enough tool to contribute to the rise in
obesity rates, it can be harnessed by public health interventions to promote
the opposite through “selling” healthy lifestyle changes. </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Empowerment and Avoiding Psychological
Reactance</span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>The
use of fat shaming in anti-obesity interventions is damaging to the mental
health of both parents and children (15-1) and should be abandoned by public health
practitioners entirely as a tactic to motivate healthy behavior. Children
especially should not be stigmatized through anti-obesity advertisements, as
these were found to cause the most extreme negative response to weight loss and
diet change messages (15-7) In fact, the public health community should work to
eradicate prejudice against overweight and obese individuals to ensure that
they feel confident that they can change their lifestyle (15-6). Health
practitioners are not immune to the societal stigma against obesity, which
impacts the quality of care given to individuals that they deem as ‘fat’
(17-89).</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>The
link between body size and social standing is especially important to consider
when addressing the obesity epidemic, as the experiences of how overweight and
obese individuals experience discrimination due to their size have a great
impact on how they view their health and ability to change (3-3). Fat shaming
is not the result of the health dangers associated with being overweight, but
the social connotations associated with fatness: laziness, greed, stupidity,
ugliness etc. This has led a cultural stigma against fatness that often
supersedes discussion about obesity’s impact on an individual’s physical health
(3-4).<span style="mso-spacerun: yes;"> </span>It is a societal misconception
that obesity is solely the result of poor individual lifestyle choices. Media
outlets that perpetuate this idea do not motivate positive behavior change, as
discussed earlier, but contribute to the barriers that make fighting obesity a
difficult challenge for public health practitioners (17-90).</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">An approach to anti-obesity interventions that is not
supportive of <span style="mso-spacerun: yes;"> </span>fat shaming can work
against the detrimental impact of weight stigma and also reduce the amount of
psychological reactance experienced by the target audience (15-1).<span style="mso-spacerun: yes;"> </span>Psychological reactance can also be
lessened through communicating the desired message to the target audience
through individuals that are similar to the audience, and therefore are
perceived as more credible (16-277). Similarity between the communicator and
the audience has been shown to not only increase the positive force towards
compliance but also reduce the negative force of resistance that leads to
reactance (16-278). </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Therefore, anti-obesity interventions focusing on families
should communicate its messages through actors who are overweight or obese but
have chosen to adopt lifestyle changes to improve the health of their families.
These could include paying closer attention to nutrition labels and utilizing
community spaces for family physical activities (18-72). Featuring resources
within community also illustrates that obesity is a problem that impacts the
entire community rather than targeting isolated individuals. </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Yale University’s analysis of anti-obesity campaigns
suggests that best received messages were multivariate, or suggested a
multitude of behavior changes to be adopted on a community rather than
individual level (15-6). Through combining the use of actors similar to the target
audience to deliver positive messages of empowerment, anti-obesity
interventions can be used not only to encourage healthy behaviors but also work
against weight stigma. This will hopefully begin to reduce the physical,
psychological and societal barriers against weight loss experienced by
overweight and obese individuals. </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>As
the rate of obesity continues to rise steadily in the U.S. among children and
adults (1), anti-obesity campaigns are a necessary vehicle to providing health
education and motivation for lifestyle change on a community level. However,
public health interventions should avoid the mistakes made by Georgia’s
Strong4Life and Minnesota’s Better Example campaigns (5), including focusing
only on the parent-child relationship, depending on the Theory of Reasoned
action to cause behavior change, and relying on fat shaming as inspiration for
transformation. This approach can be remedied through adopting community-level
intervention techniques as described by McLeroy et al.’s ecological model of
health promotion (6-355), using advertising theory to promote a healthy
lifestyle as the means of gaining freedom from stigma, and using empowerment
and rather than shaming as the primary motivation for behavior change. </span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 115%;"><span style="mso-spacerun: yes;"> </span>REFERENCES</span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">(1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia; font-size: 12.0pt;">American Heart Association. <i style="mso-bidi-font-style: normal;">Statistical Fact Sheet 2012 Update: Overweight
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<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">(3)</span></span><span style="font-family: Georgia; font-size: 12.0pt;">Farrell, A. <i style="mso-bidi-font-style: normal;">Fat Shame: Stigma and the Fat Body in American Culture</i>. New York,
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<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">(5)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: Georgia; font-size: 12.0pt;">Abrams, L. <i style="mso-bidi-font-style: normal;">Think of the (Fat) Children: Minnesota’s ‘Better Example’ Anti- Obesity
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<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">(6)</span></span><span style="font-family: Georgia; font-size: 12.0pt;">McLeroy, K., B<a href="http://www.blogger.com/blogger.g?blogID=1572776051032236617" name="_GoBack"></a>ibeau,
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<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">(7)</span></span><span style="font-family: Georgia; font-size: 12.0pt;">Hill, J., Wyatt, H., Reed, G., and
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<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">(8)</span></span><span style="font-family: Georgia; font-size: 12.0pt;">Ledikwe, J., Ell0-Martin, J., and
Rolls, B. Portion Sizes and the Obesity Epidemic. <i style="mso-bidi-font-style: normal;">Portion Sizes and the Obesity Epidemic</i>. Paper presented at the
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<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">(9)</span></span><span style="font-family: Georgia; font-size: 12.0pt;">Ogden, C., Lamb, M., Carroll, M.,
and Flegal, K. <i style="mso-bidi-font-style: normal;">Obesity and Socioeconomic
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Mollyhttp://www.blogger.com/profile/18395792142837014194noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-41287481263871496042013-01-01T11:26:00.000-08:002013-01-01T11:26:08.036-08:00“Rightsizing” vs. Downsizing: The Impact of the Food Labeling Mandate on Obesity Rates –Amy Glynn
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<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Introduction</span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>Obesity
continues to be a national epidemic with one-third of children and two-thirds
of adults overweight or obese (20).<span style="mso-spacerun: yes;"> </span>Obese individuals face many chronic diseases
including an increased risk of Type II diabetes, cardiovascular disease,
hypertension, obstructive sleep apnea, and may face psychological and economic
consequences (11).<span style="mso-spacerun: yes;"> </span>Proper
nutrition is an important factor in fighting obesity (20).<span style="mso-spacerun: yes;"> </span>According to the National Restaurant
Association, Americans eat four to five meals commercially prepared each week (14).<span style="mso-spacerun: yes;"> </span>With half of Americans dining out in
the past year, fast food and chain restaurants have been targeted as a major
contributor to the increasing obesity rates (21).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">One strategy to promote healthier eating is to require
calorie labeling in chain and fast food restaurants so that consumers can make
educated decisions about the food they purchase and consume.<span style="mso-spacerun: yes;"> </span>In 2008, New York City became the first
U.S. jurisdiction to implement this type of legislation (7).<span style="mso-spacerun: yes;"> </span>Although specific regulations vary
across the nation, the 2010 Patient Protection and Affordable Care Act requires
fast food and chain restaurants with twenty or more locations in each state to
visibly post the caloric content of regular menu items (22).<span style="mso-spacerun: yes;"> </span>Now more than thirty cities and states
in the United States have introduced legislation which mandates food labeling (7).<span style="mso-spacerun: yes;"> </span>This policy is designed to provide
information in order to help consumers make healthier food choices.<span style="mso-spacerun: yes;"> </span>This report analyzes the effectiveness
of calorie labeling legislation using relevant theories, critiques the design
of the intervention, and then provides an alternative approach to curtailing
the obesity epidemic.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Critique #1: Ignores Theory of Cognitive
Dissonance</span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>The
food labeling mandate is based on the assumption that if individuals are given
knowledge about the nutritional factors of the food they are about to consume,
they will in turn alter their attitudes and perceptions about unhealthy food
choices, and change their behaviors to pick more nutritious food choices (8).<span style="mso-spacerun: yes;"> </span>This concept of providing knowledge to
influence attitudes in order to change behaviors, fails to consider the theory
of cognitive dissonance (6,8).<span style="mso-spacerun: yes;">
</span>Cognitive dissonance is when people reconcile conflicting beliefs to
rationalize their decision (6).<span style="mso-spacerun: yes;"> </span>Festinger’s
theory of cognitive dissonance explains why humans seek to reach consonance
between their expectations and realities (8).<span style="mso-spacerun: yes;"> </span>To achieve this agreement, Festinger claims people will
decrease the significance of one of the conflicting elements, add factors of
consonance, or change the dissonant qualities (8).<span style="mso-spacerun: yes;"> </span>Thus, just posting nutritional factors about regular food items
may not be enough to influence people’s rationalization for eating unhealthy
food items.</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Most Americans know that fast food is not a very healthy
food option.<span style="mso-spacerun: yes;"> </span>Yet, people continue
to go to fast food restaurants.<span style="mso-spacerun: yes;">
</span>Many consumers who dine-out cite the importance of taste, quality,
convenience, and affordability offered at restaurants (9).<span style="mso-spacerun: yes;"> </span>The theory of cognitive dissonance
provides an understanding of why people, who probably already know fast food is
not healthy, continue to purchase these items.<span style="mso-spacerun: yes;"> </span>The theory of cognitive dissonance shows that people will reconcile
the knowledge that fast food is bad with a rationalization to eat it.<span style="mso-spacerun: yes;"> </span>For example, perhaps the person had a
bad day so might feel he deserves a Big Mac, or he has been eating healthy all
week so this is a little splurge.<span style="mso-spacerun: yes;"> </span>Although
nutritional education is important, this knowledge has to compete with matters
of taste, affordability, convenience, and other unrelated health factors.<span style="mso-spacerun: yes;"> </span>Unfortunately fast food companies take
advantage of these other desires by heavily advertising and promoting these
core values (9).<span style="mso-spacerun: yes;"> </span>People value
their bad food choices, and will continue to reconcile the health consequences associated
with eating fast food and the desire to indulge in it.</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Although the food labeling mandate may provide new
information to the customers, it does not necessarily result in a change in
behavior.<span style="mso-spacerun: yes;"> </span>In order to be
effective, behavior change must come first, then attitude transformation and
knowledge follows (8).<span style="mso-spacerun: yes;"> </span>This
concept is supported by the fact that although consumers were more aware of
health content post-food labeling, studies on current food labeling mandates
have not found any significant impact on calorie consumption (15).<span style="mso-spacerun: yes;"> </span>Regardless of whether detailed
nutritional facts are provided or not, people continue to rationalize why
eating a milkshake and fries is a justifiable health decision.</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Critique #2: Fails to Convince Consumers
of Harm, Focus on Individual Behavior</span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span></span></b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">The food label
mandate utilizes the health belief model (HBM) in order to change people’s
behavior to buy healthier food items.<span style="mso-spacerun: yes;">
</span>The HBM is based on the assumption that decisions about one’s health is
like a cost-benefit analysis (3).<span style="mso-spacerun: yes;"> </span>Consumers
must feel personally susceptible to the health problem, feel the problem can
cause severe harm, know appropriate actions to avoid harm, and believe the
costs will outweigh the benefits (or vice versa) (13).<span style="mso-spacerun: yes;"> </span>This model oversimplifies the
decision-making process by assuming behaviors are reasoned (but as discussed
before, people do not make rational decisions).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">The menu label policy assumes that when consumers see
nutritional facts, they in turn will weigh the risks with the benefits, thereby
changing their purchasing behavior.<span style="mso-spacerun: yes;">
</span>However, a study of the New York City food labeling menu policy found
that although calorie information on menus increased consumers’ awareness of
nutritional content, there was not a significant change in calories purchased
after the calorie labeling was put into place (7).<span style="mso-spacerun: yes;"> </span>This fact emphasizes the flaw in the HBM which assumes there
is a straight line from intent (see how unhealthy a food item is so intend to
not buy it ) to behavior change (buy the unhealthy product regardless of
nutritional content).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Providing nutritional information alone does not necessarily
convince consumers that they are susceptible to the harmful effects junk food
may have on them.<span style="mso-spacerun: yes;"> </span>Obese adults
have a higher chance of developing diabetes, cardiovascular disease, and have
higher rates of mortality from these chronic diseases (3).<span style="mso-spacerun: yes;"> </span>However, these long-term potential
threats are usually overcome by the temptation of fast foods and immediate
pleasure it gives individuals. Similar to the addictive process found in
substance abusers, studies have found links between high-sugar diets and
addiction (3).<span style="mso-spacerun: yes;"> </span>This food “high”
interferes with an individual’s ability to make a rationale decision.<span style="mso-spacerun: yes;"> </span>The HBM ignores these environmental and
biological factors that hinder individual food-making decisions (16).<span style="mso-spacerun: yes;"> </span>The food labeling policy places the responsibility
to choose healthy foods at the individual level.<span style="mso-spacerun: yes;"> </span>However, research has shown that environmental conditions
can easily override the physical and psychological systems in an individual,
thus hindering a person’s capability to make reasoned decisions (4).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">In addition, this intervention assumes that everyone will
be able to read and understand the food labeling menu at the same level, in
order to take actions to select healthier decisions.<span style="mso-spacerun: yes;"> </span>This model does not take into account the uneven levels of
understanding appropriate caloric intake information since no educational
component is incorporated alongside food labeling.<span style="mso-spacerun: yes;"> </span>In fact, most consumers can not clearly distinguish between
nutrient content and health claims (23).<span style="mso-spacerun: yes;">
</span>Thus, providing detailed nutritional information may just confuse
consumers or complicate their food choice decisions.<span style="mso-spacerun: yes;"> </span>Most restaurants already have a green check mark next to
healthier items or specify low fat/low sodium items.<span style="mso-spacerun: yes;"> </span>This simple check mark provides a more clear and consistent
message that is easier for consumers to process (15).<span style="mso-spacerun: yes;"> </span>Furthermore, studies have shown that consumers assume food
claims have already been approved and regulated by governmental authorities
even if this is not valid (23).<span style="mso-spacerun: yes;"> </span>Thus,
it is imperative that nutritional information about food items is presented in
an easily understandable, clear, and consistent manner.</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">According to Cialdini’s <i style="mso-bidi-font-style: normal;">The Psychology of Persuasion</i>, both humans and animals have an
automatic response built into their system called “fixed-action patterns” (5).<span style="mso-spacerun: yes;"> </span>This automatic response is stimulated
by the “trigger feature.”<span style="mso-spacerun: yes;"> </span>For
example, by walking into a Panera Bread cafe, the smell of bread can trigger
people’s response to consume carb-heavy items.<span style="mso-spacerun: yes;"> </span>The idea of an automatic response explains the concept of
mindless eating: it is an automatic behavior triggered by food placed in front
of someone (15).<span style="mso-spacerun: yes;"> </span>Although the
nutritional factors in fast food restaurants are meant as a visual cue to
prevent this automatic response of mindlessly eating to occur, it is not a
persuasive enough cue to effectively alter behavior (18).<span style="mso-spacerun: yes;"> </span>In fact, one study found that “most
consumers only read labels when they are contemplating buying a new product for
the first time or when an alternative brand is on special” (23).<span style="mso-spacerun: yes;"> </span>This suggests that just having the
information available to consumers may not even be enough for people to notice and
become more knowledgeable about what they are purchasing.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Critique #3: Americans have Little Self-Control,
Especially during Hot State</span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">The food labeling mandate also assumes that people have
the self-control to decline junk food temptations if they know the nutritional
information.<span style="mso-spacerun: yes;"> </span>This assumes that
people are rational beings, and can control their desire for junk food with
information.<span style="mso-spacerun: yes;"> </span>However, most people
know when they walk into a Pizza Hut they are not making the healthiest dinner
choice, yet people continue to go there. <span style="mso-spacerun: yes;"> </span>Providing nutritional information about the greasy pizza sold
at Pizza Hut may give consumers more detailed nutritional facts on their food
choice, and just reinforces what most already know: greasy pizza is not that
healthy.<span style="mso-spacerun: yes;"> </span>So why do people continue
to go to these unhealthy fast food and restaurants?</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">According to Ariely’s <i style="mso-bidi-font-style: normal;">Predictably
Irrational</i> book, people have very little self-control.<span style="mso-spacerun: yes;"> </span>In fact, he argues individuals in cool
states are able to make more rational, long-term decisions vs. individuals in
hot states where immediate gratification is available, which make it difficult
for people to stick to their more rational decisions chosen in cool states (1).<span style="mso-spacerun: yes;"> </span>A fast food restaurant places people in
a hot state where temptation of delicious foods overcomes people’s rational,
cool state mindset.<span style="mso-spacerun: yes;"> </span>A restaurant
with so many immediate gratifications influences people’s decision-making
abilities by appealing to their emotion-provoking mindset.<span style="mso-spacerun: yes;"> </span>People see and smell the greasy pizza,
signals are sent to their brain, and now their logical mindset to make reasoned
decisions is overcome by an emotional need for pizza.</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Unfortunately, a visible nutrition label does not have
much power or influence over this arousal provoking temptation (7, 15).<span style="mso-spacerun: yes;"> </span>Studies have shown that when the food
labeling mandate was implemented in New York City,<span style="mso-spacerun: yes;"> </span>only half of customers even noticed the caloric information,
and only a quarter of those that noticed said the information influenced their
food choices (7).<span style="mso-spacerun: yes;"> </span>However, even
the few who did say the calorie labeling influenced their food choices did not
actually purchase fewer calories (7).<span style="mso-spacerun: yes;">
</span>This public health intervention bases its design on the premise that
people can activate their self-control, but when people are in a hot state with
lots of temptations, it is not easy to stick to one’s self-control. </span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Alternative Approach: “Rightsizing” Your
Food Options</span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Dan Airely and Klaus Wertenbroch from MIT conducted a
study about how people deal with their self-control problems (2).<span style="mso-spacerun: yes;"> </span>For example, why do people on a diet,
enter a restaurant saying they will not buy that banana split sundae, yet when
the time comes and temptation arises, the dieters purchase the sundae, and then
later may feel bad about their food choice decision? <span style="mso-spacerun: yes;"> </span>These two researcher examined ways students handle
procrastination with paper deadlines.<span style="mso-spacerun: yes;">
</span>They found that although students did not request early paper deadlines,
they did readily accept the early deadlines when offered (2).<span style="mso-spacerun: yes;"> </span>This finding suggests an externally
imposed intervention is a means to help deal with issues of self-control and
effective decision-making.<span style="mso-spacerun: yes;"> </span>This
behavioral science approach can be applied to public health as a way to
activate self-control and improve people’s food making decisions (15).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">This report’s alternative approach attempts to apply
Ariely’s study in a public health context.<span style="mso-spacerun: yes;"> </span>People for the most part know that they overeat (12).<span style="mso-spacerun: yes;"> </span>Perhaps an imposed restriction on
portion size may be a more effective approach than food labeling to reduce
calories consumed while still maintaining the value people give to their food
choices.<span style="mso-spacerun: yes;"> </span>Instead of simply
providing information about the food, this report suggests a campaign to
“rightsize” food options (15).<span style="mso-spacerun: yes;">
</span>This campaign will create a community of people fighting for more food
choices by proposing wait staff and cashiers ask customers if they want to “rightsize”
their food by reducing it to a smaller size or suggesting sides like fresh
fruit and vegetables (instead of fries and a Coke).<span style="mso-spacerun: yes;"> </span>This campaign to “rightsize” one’s meal will promote
healthier food choices and give people control over their decision-making.</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">It is important to note that although this report is
pointing out the flaws to food labeling interventions and offering an
alternative campaign approach, it is not suggesting that providing nutritional
information to consumers is detrimental.<span style="mso-spacerun: yes;">
</span>Obesity prevention requires a multi-faceted solution to change how much
individuals both consume and expend.<span style="mso-spacerun: yes;">
</span>Focusing on what individuals consume is just one aspect of the energy
balance equation (what people take in and what people burn off).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Intervention Section 1: Apply Behavior
Change First, so Knowledge and Attitude Follow</span></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Policies to eliminate unhealthy behaviors have been aimed
at helping individuals manage self-control.<span style="mso-spacerun: yes;"> </span>Banning all unhealthy food products would be ideal, but is
not a viable option.<span style="mso-spacerun: yes;"> </span>Providing
information about the food choices is how the food labeling policy attempts to
help individuals manage self-control but fails to consider people are not
rational decision-makers.<span style="mso-spacerun: yes;"> </span>Thus,
instead of providing knowledge first to the consumers in order to evoke
behavior change, the proposed alternative intervention is to change the
environment in which food choices are made.<span style="mso-spacerun: yes;"> </span>People will always use cognitive dissonance theory to
rationalize their irrational decisions.<span style="mso-spacerun: yes;">
</span>Thus, public health advocates should assume people will make irrational choices
and focus on environmental change first then knowledge and attitude will follow
(19).</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">To change behavior, the default for people’s food choice
environment should be healthy options.<span style="mso-spacerun: yes;">
</span>Unfortunately in most cases, people are asked if they want to supersize
their value meal as opposed to substitute their milkshake for fruit.<span style="mso-spacerun: yes;"> </span>People will continue to go out to eat
and buy meals that are not the healthiest.<span style="mso-spacerun: yes;"> </span>According to the 2011 Food & Health Survey, taste, price,
and where their food comes from continue to be the leading motivators of
consumers’ food choices, not nutritional factors (9).<span style="mso-spacerun: yes;"> </span>People want tasty, affordable food choices, and this is what
companies leverage by advertising the taste and affordability of their products.<span style="mso-spacerun: yes;"> </span>Companies utilize pricing strategies to
get consumers to buy more such as buy one Big Mac get another one half
priced.<span style="mso-spacerun: yes;"> </span>These pricing mechanisms,
manipulate people’s perception of normal portion sizes (15).<span style="mso-spacerun: yes;"> </span>Instead of promising healthy options,
which are not high on consumers’ lists of core values, public health officials need
to promote an environment where healthy options are the default.<span style="mso-spacerun: yes;"> </span></span></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Intervention Section 2: “Rightsizing” Group
Effort Reframes Core Values</span></b></div>
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<br /></div>
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<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">In order to implement a healthier
environment, a “rightsizing” movement must be instilled.<span style="mso-spacerun: yes;"> </span>According to communication theory, in
order for a message to be effective the person delivering it must be likeable,
familiar, and similar to the people the message is intended to reach (5).<span style="mso-spacerun: yes;"> </span>In addition, people are more likely to
be persuaded if the message is associated with positive images (5).<span style="mso-spacerun: yes;"> </span>Thus, it is important all consumers of
various ages, backgrounds, and weights rally to promote the “rightsizing”
campaign in order to appeal to a broader audience.<span style="mso-spacerun: yes;"> </span>The focus is on “rightsizing” rather than on “downsizing”
portion sizes because not only does it evoke a more positive reference, but
“rightsizing” also suggests that consumers have been wronged by the food
industry thus they are demanding their “rights” back.<span style="mso-spacerun: yes;"> </span>This slogan can be used to communicate the mission of the
“rightsizing” campaign so consumers have the power over their life.</span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; tab-stops: 337.5pt; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">The theory of persuasion focuses not on <i style="mso-bidi-font-style: normal;">changing </i>people’s core values, but
reframing it in a way to instill behavior change (5).<span style="mso-spacerun: yes;"> </span>Just like in the 84% smoking campaign which created a
non-smoker identity, there should be a “rightsizing” identity.<span style="mso-spacerun: yes;"> </span>This new identity for people to
associate with enables individuals to be part of a “rightsizing” community which
advocates for control over their food portions.<span style="mso-spacerun: yes;"> </span>The core value of control and freedom resonates very
strongly with most Americans, especially compared to the core value of health
which the food labeling policy tried to leverage (16).<span style="mso-spacerun: yes;"> </span>Reframing healthy food decisions as a
means to regain autonomy will reinforce consumers’ own core values but position
it in a way that encourages healthy behaviors (16).<span style="mso-spacerun: yes;"> </span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">Intervention Section 3: Promote
Intervention during Hot State to Regain Control</span></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span></span></b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">So how do we get people
to resist the temptation of junk food to start a movement about “rightsizing”
food portion sizes?<span style="mso-spacerun: yes;"> </span>One way to
give Americans some self-control over their food choices is by going beyond
just the visual cues of posting nutritional information, but actually having
wait staff and cashiers ask customers if they would like to “rightsize” their
meal (15).<span style="mso-spacerun: yes;"> </span>Instead of the typical questions
asked at restaurants like “do you want fries with that” or “would you like to supersize
that for an extra fifty cents,” the “rightsizing” campaign can advocate for
healthier food prompts.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">In a study done by Schwartz et al., diners at a local
Chinese fast-food restaurant perceived their portion sizes as too big but would
not ask for smaller sizes on their own; however, they were willing to accept
smaller sizes when prompted by wait staff (15).<span style="mso-spacerun: yes;"> </span>When researchers had wait staff ask customers if they would
like a smaller portion size, thirty-three percent of customers accepted the
smaller size.<span style="mso-spacerun: yes;"> </span>Interestingly
enough, more customers (21%) accepted the smaller portion size before food
nutritional facts were presented than after (14%).<span style="mso-spacerun: yes;"> </span>Calorie labeling did not impact the amount of calories
purchased, instead more calories were eaten after the food labeling policy was
enacted (15).</span></div>
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<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;">It is important to note that this study was conducted in
three parts, a) to assess the baseline where wait staff do not offer smaller
portion sizes, b) to see if people accepted a smaller portion size at a
discount rate, and c) to examine whether customers accepted the smaller portion
size without a discount rate.<span style="mso-spacerun: yes;">
</span>Study investigators found that there was no difference in acceptance
rates among the smaller portion sizes with or without the twenty-five cent
discount (15).<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>The results showed that people who received the smaller
portion size ate significantly fewer calories than those who did not (15).<span style="mso-spacerun: yes;"> </span>In fact, those that chose smaller
entrée sizes did not overcompensate by ordering desserts or other food options
later on.<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>Why
did asking someone if they wanted less food result in fewer calories eaten when
simply posting the nutritional information did not?<span style="mso-spacerun: yes;"> </span>This case is similar to the study mentioned above about
procrastination.<span style="mso-spacerun: yes;"> </span>Students
performed better when their teacher imposed an earlier paper deadline than when
the students self-imposed an earlier deadline.<span style="mso-spacerun: yes;"> </span>The rationale behind why they performed better or why
customers ate healthier is that the imposed deadline or smaller size food
prompt interrupted customers’ expected ordering flow process, which activated
customers’ self-control.<span style="mso-spacerun: yes;"> </span>The
environment was changed, thereby allowing for behavioral change (2).<span style="mso-spacerun: yes;"> </span>The mindless eating process was
disrupted by the waiter.<span style="mso-spacerun: yes;"> </span>Customers
who entered the restaurant were thrown into the hot stage of thinking by the
food temptations, but were brought back into their rational, cold stage when
the waiter interrupted their normal decision process flow (1).<span style="mso-spacerun: yes;"> </span>Thus, customers were better able to
make a more reasoned decision about their food choice.</span></div>
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<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>Thaler
and Sunstein’s book, <i style="mso-bidi-font-style: normal;">Nudge</i>, further
this point of reasoning by their explanation of the two systems of thought:
automatic and reflective.<span style="mso-spacerun: yes;"> </span>The
automatic system is where rapid and instinctive decisions occur, whereas the
reflective stage is when people deliberate and think through their decision (19).<span style="mso-spacerun: yes;"> </span>Thaler gives the example of a way to
increase organ donation rates is to automatically place people as organ donors
when they renew driver licenses, so the default is to opt into the program, not
opt out (19).<span style="mso-spacerun: yes;"> </span>Thaler suggests
making the default to be an organ donor will drastically increase the number of
people who are organ donors.<span style="mso-spacerun: yes;"> </span>This
concept can be applied to food choices where the default should be vegetables
as sides and fruit for dessert, so people are more likely to eat healthier,
rather than having to ask for these substitutions.</span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt;">Conclusion</span></b></div>
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<br /></div>
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<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"><span style="mso-tab-count: 1;"> </span>Making
healthy food decisions is difficult given all the temptations and unhealthy
environment in which Americans live.<span style="mso-spacerun: yes;">
</span>In order for public health advocates to effectively change behavior, a
group effort that disrupts the normal decision-making process is needed to
“rightsize” food choices and give people the autonomy to take control of their
lives.<span style="mso-spacerun: yes;"> </span>Although the food labeling
intervention provides important information, it is not a powerful enough message
to get people to actually change their behaviors. Focusing on reframing
existing core values and utilizing the strength of a large community will help
overcome the bombardment of unhealthy temptations and advertisements that
continue to exist so that healthy eating becomes the default.</span><br clear="ALL" style="page-break-before: always;" />
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 20.0pt; line-height: 200%;">References</span></b><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%;"></span></div>
<div style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span style="font-family: Georgia; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia;">Ariely, Dan
and Klaus Wertenbroch.<span style="mso-spacerun: yes;">
</span>“Procrastination, Deadlines, and Performance: Self-Control by
Precommitment.”<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">Psychological Science.</i> 2002; 13(3).</span></div>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Ariely,
Dan.<span style="mso-spacerun: yes;"> </span>“Predictably Irrational,
Revised and Expanded Edition: The Hidden Forces That Shape Our Decisions.”<span style="mso-spacerun: yes;"> </span>New York: Harper Perennial, 2010.</span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Baker JL,
Olsen LW, Sorenson TIA.<span style="mso-spacerun: yes;"> </span>“Childhood
body-mass index and the risk of coronary heart disease in adulthood.<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">New
England Journal of Medicine</i>.<span style="mso-spacerun: yes;">
</span>2007; 357(23): 2329-2337</span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Brownell,
Kelly, R. Kersh, D. Ludwig, R. Post, R. Puhl, M. Schwartz, W. Willett.<span style="mso-spacerun: yes;"> </span>“Personal Responsibility and Obesity: A
Constructive Approach to a Controversial Issue.”<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">Health Affairs</i>.<span style="mso-spacerun: yes;"> </span>2010; 29(3): 379-387.</span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Cialdini
RB.<span style="mso-spacerun: yes;"> </span>Influence: <i style="mso-bidi-font-style: normal;">The Psychology of Persuasion</i> (Intro-Ch.
1: Weapons of Influence).<span style="mso-spacerun: yes;"> </span>New
York: Harper Collins Publishers, 2007: pp. xi-xiv and 1-16.</span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Edberg,
M.<span style="mso-spacerun: yes;"> </span>“Essentials of Health Behavior:
Social and Behavioral Theory in Public Health: Individual Health Behavior
Theories (Ch. 4).<span style="mso-spacerun: yes;"> </span>Massachusetts:
Jones and Bartlett Publishers. 2007, pp.35-49.</span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Elbel, Brian,
R. Kersh, V. Brescoll, and L. Dixon.<span style="mso-spacerun: yes;">
</span>“Calorie Labeling and Food Choices: A First Look at the Effects on
Low-Income People in New York City.”<span style="mso-spacerun: yes;">
</span><i style="mso-bidi-font-style: normal;">Health Affairs.</i> 28(6). 2009.</span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Festinger,
Leon.<span style="mso-spacerun: yes;"> </span>“A Theory of Cognitive
Dissonance.”<span style="mso-spacerun: yes;"> </span>California: Standford
University Press, 1957</span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span class="citation"><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Food Insight.<span style="mso-spacerun: yes;"> </span>“2011 Food and
Health Survey: Consumer Attitudes Toward Food Safety, Nutrition, and
Health.”<span style="mso-spacerun: yes;"> </span>2011.<span style="mso-spacerun: yes;"> </span><</span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;"><a href="http://www.foodinsight.org/Resources/Detail.aspx?topic=2011_Food_Health_Survey_Consumer_Attitudes_Toward_Food_Safety_Nutrition_Health">http://www.foodinsight.org/Resources/Detail.aspx?topic=2011_Food_Health_Survey_Consumer_Attitudes_Toward_Food_Safety_Nutrition_Health</a>
></span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span class="citation"><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></span><span class="citation"><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Janz, N. K.; Becker, M. H. (1 January 1984). "The Health Belief
Model: A Decade Later". <i>Health Education & Behavior.</i></span></span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">11.</span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Kaiser Foundation: State Health Facts. Percentage of
High School Students Not meeting Recommended Physical Activity Level, 2009.
Kaiser Foundation: 2009. <<span style="color: #0065ff;"><a href="http://www.statehealthfacts.org/comparemaptable.jsp?typ=2&ind=766&cat=2&sub=27&sortc=1&o=a%20">http://www.statehealthfacts.org/comparemaptable.jsp?typ=2&ind=766&cat=2&sub=27&sortc=1&o=a
</a></span>></span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">12.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Pew Research
Center.<span style="mso-spacerun: yes;"> </span>“Eating more: enjoying
less.”<span style="mso-spacerun: yes;"> </span>Washington DC: Pew Research
Center 2011.<span style="mso-spacerun: yes;"> </span><<a href="http://www.pewsocialtrends.org/2006/04/19/eating-more-enjoying-less/">www.pewsocialtrends.org/2006/04/19/eating-more-enjoying-less/</a>
></span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">13.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">National
Cancer Institute.<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">Theory at a Glance: A Guide for Health
Promotion Practice.</i> Part 2.<span style="mso-spacerun: yes;">
</span>Bethesda, MD NCI, 2005, pp9-21.<span style="mso-spacerun: yes;">
</span></span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">14.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">National Restaurant
Association. “Americans’ Dining-Out Habits.” 2000.<span style="mso-spacerun: yes;"> </span><<a href="http://www.restaurant.org/tools/magazines/rusa/magarchive/year/article/?articleid=138">http://www.restaurant.org/tools/magazines/rusa/magarchive/year/article/?articleid=138</a>></span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">15.</span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Schwartz, Janet, J. Riis, B. Elbel, and D.
Ariely.<span style="mso-spacerun: yes;"> </span>“Inviting Consumers to
Downsize Fast-Food Portions Significantly Reduces Calorie Consumption.”<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">Health
Affairs,</i> 31(2). 2012.</span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">16.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Siegel,
Michael and CL Menashe.<span style="mso-spacerun: yes;"> </span>“The Power
of a Frame: An Analysis of Newspaper Coverage of Tobacco Issues – United
States, 1985-1996.<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">Journal of Health Communication</i>.
1998;3(4): 307-325.</span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">17.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Stein K. A
national approach to restaurant menu labeling: the Patient Protection and
Affordable Health Care Act, section 4205. <i>Journal of American Dietetic
Association</i>. 2010;110(9):1280-1289</span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">18.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Swartz,
Jonas, D. Braxton, and A. Viera.<span style="mso-spacerun: yes;">
</span>“Calorie menu labeling on quick-service restaurant menus: an updated systematic
review of the literature.”<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">International Journal of Behavioral
Nutrition and Physical Activity.</i> 2011.</span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">19.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Thaler,
Richard and C. Sunstein.<span style="mso-spacerun: yes;"> </span>“Nudge:
Improving Decisions about Health, Wealth, and Happiness.”<span style="mso-spacerun: yes;"> </span>Connecticut: Yale University Press,
2008.</span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">20.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Trust for
America’s Health. <i>F as in Fat: How Obesity Threatens America’s Future. </i>Washington
D.C.: Trust for America’s Health, 2011. <</span><span lang="X-NONE" style="color: #0065ff; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;"><a href="http://www.healthyamericans.org/assets/files/TFAH2011FasInFat10.pdf">http://www.healthyamericans.org/assets/files/TFAH2011FasInFat10.pdf</a>
></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;"></span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">21.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">U.S. Census
Bureau, Statistical Abstract of the United States: 2012. Table 1240 Adult
Participation in Selected Leisure Activities by Frequency. <a href="http://www.census.gov/compendia/statab/2012/tables/12s1240.pdf">http://www.census.gov/compendia/statab/2012/tables/12s1240.pdf</a>
</span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">22.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">U.S Food and
Drug Association.<span style="mso-spacerun: yes;"> </span>New Menu and
Vending Machines Labeling Requirements.<span style="mso-spacerun: yes;">
</span>2012.<span style="mso-spacerun: yes;">
</span><span style="mso-spacerun: yes;"> </span>< <a href="http://www.fda.gov/food/labelingnutrition/ucm217762.htm">http://www.fda.gov/food/labelingnutrition/ucm217762.htm</a>>.<span style="mso-spacerun: yes;"> </span></span></h1>
<h1 style="margin-left: .5in; mso-list: l7 level1 lfo13; text-indent: -.25in;">
<span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-family: Georgia; mso-bidi-font-weight: bold; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">23.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="X-NONE" style="font-family: Georgia; font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;">Williams,
Peter.<span style="mso-spacerun: yes;"> </span>“Consumer Understanding and
Use of Health Claims for Foods.”<span style="mso-spacerun: yes;">
</span><i style="mso-bidi-font-style: normal;">Nutrition Reviews; </i>Vol 63, No.
7. 2005.</span></h1>
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Mollyhttp://www.blogger.com/profile/18395792142837014194noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-6678596841160489092013-01-01T11:23:00.000-08:002013-01-01T11:23:08.215-08:00Is Strong4Life Strongly Flawed? A Critique of Georgia’s campaign to end childhood obesity – Ashley Floreen<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";"> </span>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span>One
of the greatest public health issues today is the growing rate of childhood
obesity in the United States.<span style="mso-spacerun: yes;">
</span>Within the past thirty years, the obesity rate has nearly tripled,
resulting in 17% of children and adolescents meeting the criteria for obese
(1).</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">In 2011, the Strong4Life campaign was initiated by the
Children’s Healthcare of Atlanta to combat the growing childhood obesity
epidemic in Georgia.<span style="mso-spacerun: yes;"> </span>According to
Strong4Life, nearly 40% of children in Georgia are obese and are now at risk
for diseases such as hypertension and Type II Diabetes that were previously
only seen in adult populations.<span style="mso-spacerun: yes;">
</span>The Strong4Life campaign addresses the dangers of childhood obesity by
providing ways to decrease obesity by promoting healthy eating habits,
increasing exercise, and offering support to families (2). </span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">However, in addition to its website, Strong4Life launched
numerous advertisements on television and on billboards which shamed obese
children and parents.<span style="mso-spacerun: yes;"> </span>One ad,
featured in black and white, has a child named Bobby sitting across from his
mother who is also obese, and asking “Mom, why am I fat?” The mother says
nothing.<span style="mso-spacerun: yes;"> </span>A billboard shows a photo
of an obese young girl with the message “WARNING. It’s hard to be a little girl
if you’re not” (3). <span style="mso-spacerun: yes;"> </span>While there
are numerous sides to this particular public health campaign, the advertisements
and billboards carry a flawed message because they do not recognize a number of
issues: perceived dangers and risks associated with obesity, how behavior is
influenced by a child’s environment, a positive role model for children, and
the importance of providing solutions for childhood obesity and a pathway to
success.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Perceived Dangers of Childhood Obesity</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Strong4Life claims that 75% of Georgia parents do not
recognize their child as obese (2).<span style="mso-spacerun: yes;">
</span>Although that statement of truth is effective for raising awareness of
the issue, it fails to explain the health risks that accompany obesity.<span style="mso-spacerun: yes;"> </span>As a result, the population may not
believe they are at risk for obesity and therefore will not take action to
prevent this condition or reverse the effects if they have already been
diagnosed.<span style="mso-spacerun: yes;"> </span>This theory is known as
the Health Belief Model, which originated from a failed tuberculosis screening
in the 1950s sponsored by the United States Public Health Service.<span style="mso-spacerun: yes;"> </span>The screening was free and conveniently
located directly in neighborhoods across America, yet very few people actually
took advantage of this service.<span style="mso-spacerun: yes;">
</span>Godfrey Hochbaum, a USPHS social psychologist, developed the Health
Belief Model after discovering that people were more likely to get screened if
they believed they were at risk of contracting tuberculosis and that there was
a benefit to getting an early diagnose.<span style="mso-spacerun: yes;">
</span>It now comprises of six major components: Perceived Susceptibility,
Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, and
Self Efficacy (4).</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">The Strong4Life ads and billboards completely disregard this
theory.<span style="mso-spacerun: yes;"> </span>For example, the ad with
Bobby facing his mother contains nothing of perceived susceptibility because it
does not show the child or parent feeling at risk for being classified as
obese, nor does it discuss the perceived severity of obesity, in that neither
child nor parent acknowledges any consequence of being obese.<span style="mso-spacerun: yes;"> </span>Additionally, the audience does not
gain any perceived benefits because no positive outcomes of losing weight are
discussed, nor do they recognize any perceived barriers because no negative
consequences of not losing weight are mentioned (4).<span style="mso-spacerun: yes;"> </span>The ad ends with Bobby and his mother simply staring at each
other, with no motivating event that would suffice as a cue to action to change
the behavior that led them to become obese.<span style="mso-spacerun: yes;"> </span>It also lacks self-efficacy, or the mother and son’s belief
that they could actually change their behavior. On the contrary, the silence at
the end of the ad suggests the disease is so depressing and severe that the
child and his mother are beyond help.<span style="mso-spacerun: yes;">
</span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Environmental Factors</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Another flaw to the Strong4Life billboards and ads is the
lack of understanding as to why so many children in Georgia are obese.<span style="mso-spacerun: yes;"> </span>Without acknowledging the underlying
reason for the disease, it is nearly impossible to change the behavior needed
to reverse the effects of obesity and halt this epidemic.<span style="mso-spacerun: yes;"> </span>According to the Ecological Perspective,
a person’s behavior both affects and is affected by many levels of influence.<span style="mso-spacerun: yes;"> </span>Additionally, behavior is shaped by and
shapes the social environment of the person, or reciprocal causation.<span style="mso-spacerun: yes;"> </span>Five levels of influence were created
by McLeroy and colleagues, defined as: Intrapersonal Level, Interpersonal
Level, Institutional or Organizational Factors, Community Level, and Public
Policy (5).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">At the intrapersonal level, an adolescent may feel ashamed
of her weight and know that she should change her eating habits.<span style="mso-spacerun: yes;"> </span>However, she may also be afraid to make
this step because she knows it will require more work to prepare healthy foods
and she will miss the comfort of her favorite junk foods.<span style="mso-spacerun: yes;"> </span>At the interpersonal level, she sees
all of her classmates eating the same school lunches in the cafeteria, who tell
her they do not think she needs to eat differently because they all eat the
food she does and are not worried about their health.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">At the organizational level, her mother may be the only
caretaker for her and she does not have time to go grocery shopping because she
is working two jobs to support her family.<span style="mso-spacerun: yes;"> </span>Additionally, the local supermarket may be located in an unsafe
neighborhood and it is not wise for the young adolescent to walk to the store
herself to buy healthy food.<span style="mso-spacerun: yes;">
</span>Researchers found that the average BMI was higher for those living in
disadvantaged neighborhoods or whose supermarket was located in a disadvantaged
neighborhood (6).<span style="mso-spacerun: yes;"> </span>Moreover, there may
not be any safe parks for her and her friends to go to for exercise after
school, if her state is experiencing budget cuts.<span style="mso-spacerun: yes;"> </span>This public policy limits the likelihood in which she is
able to increase her daily physical activity.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Another example of environmental issues responsible for
childhood obesity revolves around peers.<span style="mso-spacerun: yes;">
</span>According to the Social Norms Theory, a person’s behavior is influenced
by their perception of how others in their social circle behave (7). If fifteen
year old Susie sees all of her friends eating pizza and fries for lunch every
day at school and they are also overweight, Susie will believe this is normal.<span style="mso-spacerun: yes;"> </span>Fortunately, the good news is that
based on the Social Norms Theory, people can just as easily be taught to
partake in healthy behavioral choices if those around them do the same (7).<span style="mso-spacerun: yes;"> </span>If Susie and her friends learn in
health class about the importance of eating fruits and vegetables and
exercising on a daily basis, they will likely feed off of each other’s positive
behavior and increase the likelihood of maintaining their new lifestyle.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">The ability for humans to conform to social influences, even
when they know people are not doing what is right or healthy (choosing soda
over water, pizza over salad) was illustrated by social psychologist Solomon
Asch.<span style="mso-spacerun: yes;"> </span>Asch conducted a series of
experiments to determine this theory.<span style="mso-spacerun: yes;">
</span>When given a test, without the judgment or influence of others,
participants gave the correct answers.<span style="mso-spacerun: yes;">
</span>However, when others gave an incorrect answer, participants also gave an
incorrect result nearly one-third of the time, against their better judgment
(8).<span style="mso-spacerun: yes;"> </span>This phenomenon can also be
applied to making healthy choices.<span style="mso-spacerun: yes;">
</span>If a person is in line at the cafeteria and knows that bottled water is
the best choice for him, but he sees everyone in front of him choosing soda, he
is more likely to fall under the social influence of others and be nudged to
choose soda over water, despite his awareness of the calories and sugar he
would consume with soda.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Lack of Positive Role Models</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">There is no doubt surrounding the notion that people model
their own behaviors after those around them.<span style="mso-spacerun: yes;"> </span>In Strong4Life’s commercial of the mother and her son, it is
clear that the obese mother leads the audience to believe that the boy is fat
because she herself is fat.<span style="mso-spacerun: yes;"> </span>This
is the opposite role model which that should be featured.<span style="mso-spacerun: yes;"> </span>Instead of having a healthy physician
or a soccer coach as model to explain to the child why he is obese and set
goals to improve his health, the public only sees an obese parent, highlighting
the mother as the cause of the problem instead of offering healthy role models.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Albert Bandura recognized this concept and created the
Social or Observational Learning Theory in the 1960s.<span style="mso-spacerun: yes;"> </span>One of the main concepts in this theory is the idea of
imitation combined with reinforcement (9).<span style="mso-spacerun: yes;"> </span>For instance, if a child sees his mother eating ice cream to
relieve her stress after a busy day at work, the child is likely to imitate his
mother and also use food to comfort his stress.<span style="mso-spacerun: yes;"> </span>Strong4Life uses this theory in a negative way not only in
the commercial described above, but on a billboard featuring a boy and stating
“He has his father’s eyes, his laugh, and maybe even his diabetes” (10). This
automatically assumes children will inherit the same diseases as their parents,
if their parents are overweight.<span style="mso-spacerun: yes;">
</span>Although it is a risk factor, the focus should not be giving up on our
nation’s youth and letting them become obese.<span style="mso-spacerun: yes;"> </span>Instead, it should re-direct its focus to producing positive
role models who practice healthy behaviors to teach families how to change
their lives and improve their health.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">No Plan of Action to Change Behavior</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Another flaw in the Strong4Life billboards and ads is the
lack of a plan to help people make lifestyle changes slowly.<span style="mso-spacerun: yes;"> </span>For obese individuals and families, it
is crucial that they understand this is not a diet, this is a new way of
life.<span style="mso-spacerun: yes;"> </span>The Stages of Change Model, founded
by Prochaska and DiClemete, illustrates this theory quite well.<span style="mso-spacerun: yes;"> </span>This model is based on comparing the
experiences of smokers who quit on their own without professional help and
smokers who receive treatment to stop smoking.<span style="mso-spacerun: yes;"> </span>The main belief is that changing behavior is not a process
that happens overnight (5).<span style="mso-spacerun: yes;">
</span>Instead, it explains how there is a process to adapting a new lifestyle
which occurs in stages.<span style="mso-spacerun: yes;"> </span>The first
stage is precontemplation, during which the person has no intent to take action
to change his behavior within six months.<span style="mso-spacerun: yes;">
</span>The second stage is contemplation, in which the person does intend to
take action within six months.<span style="mso-spacerun: yes;"> </span>In
the third stage, preparation, the individual plans to change his behavior
within thirty days and is making a plan to follow through on this new
path.<span style="mso-spacerun: yes;"> </span>The fourth stage, action,
occurs when the individual has changed his behavior for less than six
months.<span style="mso-spacerun: yes;"> </span>In the final stage, maintenance,
the individual has successfully changed his behavior for longer than six months
(5).<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">The Stages of Change Model is not a straight path to
success.<span style="mso-spacerun: yes;"> </span>Instead, it shows that
the process of achieving a new lifestyle takes many steps and can often include
relapsing to a previous stage (a woman starts eating McDonald’s again, a smoker
who has not smoked in three months lights up with friends at a bar one
night).<span style="mso-spacerun: yes;"> </span>A billboard featuring an
obese child with the statement “Big bones didn’t make me this way. Big meals
did” (10) offers no explanation or hope that this child, or any child, could
change their behavior.<span style="mso-spacerun: yes;"> </span>There are
no facts about his weight resulting in hypertension or the benefits of eating
fresh fruits and vegetables to improve his cholesterol.<span style="mso-spacerun: yes;"> </span>There is no motivation for the young
girl to make specific plans in order to contemplate losing weight to prevent
other kids from teasing her.<span style="mso-spacerun: yes;">
</span>Bobby’s mother does not help him develop an action plan or create goals
to help them both eat less and increase physical activity.<span style="mso-spacerun: yes;"> </span>While one tagline mentions the
dangerous relationship between diabetes and obesity, none of the statements
offer social support or feedback when a setback occurs or reinforce goals
already met.<span style="mso-spacerun: yes;"> </span>Additionally, they do
not provide hope that maintenance is even plausible, given that one ad states
“Fat kids become Fat adults” (10).<span style="mso-spacerun: yes;">
</span>This particular slogan completely undermines everything in this model
and simply assumes children will be heavy throughout their entire lives and
nothing can be done to change this fact.<span style="mso-spacerun: yes;">
</span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Additionally, this theory believes individuals in an
audience can be at different stages.<span style="mso-spacerun: yes;">
</span>For example, a thirteen year old girl may know she is obese and has
heard the dangers from her pediatrician and is going to her first appointment
with a nutritionist next week when she sees these billboards on her way home
from school.<span style="mso-spacerun: yes;"> </span>She suddenly feels
hopeless and eats two large candy bars to console herself and begins to lose
faith that she can successfully change her behavior.<span style="mso-spacerun: yes;"> </span>Across the street, an eight year old boy named Joe, whose
father is also obese, views the ad with Bobby and his mother and realizes that
if nobody is telling Bobby to change his behavior, and he has obese parents
like him, there is no reason Joe should change his behavior either.<span style="mso-spacerun: yes;"> </span>Tina, meanwhile, is eleven years old
and has lost fifteen pounds in the past five months and is on her way to
achieving her goal of losing twenty five pounds by her twelfth birthday in
eight weeks.<span style="mso-spacerun: yes;"> </span>Where are the models
for her to look at who are making similar healthy choices and who can offer
encouragement to keep her on the right track?<span style="mso-spacerun: yes;"> </span>Without a clear message showing children at different
stages of weight loss and choosing healthy options, the campaigns will not
invoke the results intended.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Intervention to a New, Healthy
Lifestyle</span></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">A new way to combat the alarming increase in childhood
obesity is to frame the message in a way that teaches families how to change
their lives, not shaming them into the dark.<span style="mso-spacerun: yes;"> </span>My intervention is to create a new campaign which highlights
healthy choices such as choosing fruits and vegetables, increasing physical
activity, showing the importance of families eating meals together, and having
a success story in a popular role model share her experience with children so
they can model their behavior after her, as well as setting small goals
families can achieve together with tips to maintain their new lifestyle.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">The Strong4Life ads and billboards were created in black and
white, undertook a negative tone in the messages displayed, and were seen as
stigmatizing obese children and blaming their parents for failing to look out
for their health.<span style="mso-spacerun: yes;"> </span>However, one
study found that public health obesity campaigns were most likely to see
positive results from those that focused on promoting healthy eating through
fruits and vegetables as well as promoting multiple positive health
behaviors.<span style="mso-spacerun: yes;"> </span>On the other hand,
people responded negatively to campaigns which stigmatized obesity (11).<span style="mso-spacerun: yes;"> </span>This study shows the importance of
framing the issue of obesity not as something to be ashamed of, but merely a
problem that can be improved upon by making small changes to everyday living.
An additional study further proved the dangers of stigmatizing obese people in
that it poses a significant risk to their psychological health and may even
interfere in obesity prevention programs (12).</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Instead of having a billboard featuring a child in a black
and white photo looking ashamed of her weight and not having a happy childhood,
the billboard will feature a picture of children of all different ethnic
backgrounds enjoying a picnic and eating fruits, vegetables, and drinking
water, not sugary drinks.<span style="mso-spacerun: yes;"> </span>The
slogan will read “Healthy Food Choices Makes Happy Kids”.<span style="mso-spacerun: yes;"> </span>This ad frames healthy behaviors in a
way that results in happy children.<span style="mso-spacerun: yes;">
</span>Instead of negatively stigmatizing obesity and blaming parents for not
caring about their children’s health, this ad connects healthy with happy,
leading parents to see that their children will actually be happier and feel
better about themselves if they consume healthy foods.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Regarding advertising on television, instead of having a son
and his mother staring at each other in the dark, not knowing why they are
obese, an ad could feature a group of boys of all shapes and sizes attending a
basketball clinic with Michael Jordan.<span style="mso-spacerun: yes;">
</span>According to Dr. Seigel’s lecture on October 4<sup>th</sup> regarding
the Communication Theory, familiarity is a major component of a successful
campaign.<span style="mso-spacerun: yes;"> </span>If a celebrity whom the
audience is familiar with is the messenger, the message of the campaign will be
more effective because that person will be more influential. <span style="mso-spacerun: yes;"> </span>Moreover, the recipients of the message must
like the person delivering the message in order for the campaign to be
effective.<span style="mso-spacerun: yes;"> </span>Additionally, showing
children of all sizes shows how this ad applies for everyone and not solely
overweight children.<span style="mso-spacerun: yes;"> </span>As noted in
the Stages of Change Model, children could be just beginning to make changes in
their lifestyle or they could be having their first day of a sports clinic.<span style="mso-spacerun: yes;"> </span>Michael Jordan could remind them of the
importance of keeping active so they can keep up with him on the basketball
court.<span style="mso-spacerun: yes;"> </span>This increases a general
healthy behavior which applies to children of all sizes, whether they are obese
or not and promotes a healthy lifestyle for everyone.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Another ad could feature a group of young teenage girls in a
community drama club. Some are eating healthy snacks while talking to their
friends.<span style="mso-spacerun: yes;"> </span>The teacher could
announce the special mentor for the day is here, and the girls gather around in
awe as Jennifer Hudson walks in.<span style="mso-spacerun: yes;">
</span>Jennifer became a spokeswoman for Weight Watchers and has shed 80
pounds.<span style="mso-spacerun: yes;"> </span>She is not only a
celebrity, but she is a success story for lifestyle behavior changes that have
paid off.<span style="mso-spacerun: yes;"> </span>Jennifer states in
article for Good Housekeeping “</span><span lang="EN" style="color: black; font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-ansi-language: EN;">The only
way you can sustain a permanent change is to create a new way of thinking,
acting, and being” (13). <span style="mso-spacerun: yes;"> </span>Jennifer</span><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";"> is likely in the maintenance stage in the Stages of Change,
as her weight has been kept off for over two years.<span style="mso-spacerun: yes;"> </span>She could act as a positive role model for young people to
aspire to when looking to change their current eating habits and recognize the
achieving and maintaining a healthy weight is possible.<span style="mso-spacerun: yes;"> </span>Jennifer would speak to the adolescents
about how important it is to eat well so they can perform their best and
improve their health while increasing self-esteem.<span style="mso-spacerun: yes;"> </span>By having a male role model (Michael Jordan) and a female
role model (Jennifer Hudson) children of both genders are able to relate to a
healthy individual to further their changes of emulating the healthy celebrity’s
behavior. Furthermore, the messages from Michael Jordan and Jennifer Hudson are
positive messages and meant to empower young people to make healthy
decisions.<span style="mso-spacerun: yes;"> </span>This is crucial in the
success of a campaign, as it gives the freedom and power to the audience, not
invoking a response to being told what is best for them.<span style="mso-spacerun: yes;"> </span></span><span lang="EN" style="color: black; font-family: Verdana; mso-ansi-language: EN;"></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">Another advertisement could feature a young mother sending
her smiling children off to school with water bottles.<span style="mso-spacerun: yes;"> </span>She will say “Did you know fruit juice
and sugary beverages are the number one reason for childhood obesity? I didn’t,
until our pediatrician’s office gave us this list of healthy behaviors when our
son’s weight increased this year.<span style="mso-spacerun: yes;">
</span>Instead of drinking juice which contains excess sugar and calories, my
kids drink water at school, and they love their new colorful water
bottles.<span style="mso-spacerun: yes;"> </span>Plus, you will not
believe all the money I save at the Piggly Wiggly each week!”<span style="mso-spacerun: yes;"> </span>This advertisement follows the Health
Belief Model in that it recognizes a common problem (excessive consumption of
sugary drinks) followed by an action cue to solve the problem by switching to
water, and illustrates self-efficacy in that it is a normal mother who became
aware of an issue and easily solved the problem.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">The choice of language in a public health campaign is
crucial for appealing to a targeted audience.<span style="mso-spacerun: yes;"> </span>By using words such as “did you know” instead of telling
people what to do by forcing facts and regulations at people, it follows the
Psychological Reactance theory by not confronting the consumer or taking their
freedom away. As Paul Silvia notes in Deflecting Reactance: The Role of
Similarity in Increasing Compliance and Reducing Resistance, people will react
by trying to regain control if any source of such freedom is removed (14).<span style="mso-spacerun: yes;"> </span>Florida’s “Truth” campaign exemplifies
this theory, in that the tone of the message matters greatly.<span style="mso-spacerun: yes;"> </span>Youth did not want to be told that
smoking is<a href="http://www.blogger.com/blogger.g?blogID=1572776051032236617" name="_GoBack"></a> as simple as choosing life over death, nor did
they wish to be bombarded by messages of what to do.<span style="mso-spacerun: yes;"> </span>Instead, they wanted to be presented with the facts and left
to make decisions on their own (15).</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">My campaigns will feature positive messages from both
celebrities, which increase the influence of the product (healthy lifestyle) to
the audience, and average citizens of Georgia, or peers, who also carry weight
in convincing others to follow their lead and do what is best for their
health.<span style="mso-spacerun: yes;"> </span>The people of Georgia will
feel empowered by these billboards and advertisements<span style="mso-spacerun: yes;"> </span>to make healthy decisions but also realize that these many
small changes in behavior are not simply steps to losing weight, they are steps
towards a longer, brighter, and healthier future, allowing themselves the
ability to follow their dreams and not succumb to the weight of obesity.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<br /></div>
<div class="MsoNormalCxSpLast" style="line-height: 200%;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia; font-size: 12.0pt; line-height: 200%; mso-bidi-font-family: "Times New Roman";">References</span></b></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";">Centers for Disease Control and
Prevention. Overweight and Obesity: Childhood Overweight. Atlanta, GA: Centers
for Disease Control and Prevention. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal;">
<a href="http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/index.htm"><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";">http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/index.htm</span></a><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";"></span></div>
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<span class="MsoHyperlink"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; text-decoration: none; text-underline: none;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span></span><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";">Strong4Life.
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<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span class="MsoHyperlink"><span style="color: windowtext; font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; text-decoration: none; text-underline: none;">Teegardin C. Grim Childhood Obesity
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<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">4)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";">Edberg M. Individual health behavior
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<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">5)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";">Theories and Applications (pp.10-21).
In Theories at a Glance. A Guide for Health Promotion Practice. NIH
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<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">6)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";">Inagami S, Cohen DA, Finch BK, Asch SM.
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<span class="MsoHyperlink"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; text-decoration: none; text-underline: none;"><span style="mso-list: Ignore;">7)<span style="font: 7.0pt "Times New Roman";"> </span></span></span></span><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";">Best
Practices: Social Norms. </span><a href="http://wch.uhs.wisc.edu/13-Eval/Tools/Resources/Social%20Norms.pdf"><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";">http://wch.uhs.wisc.edu/13-Eval/Tools/Resources/Social%20Norms.pdf</span></a><span class="MsoHyperlink"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span class="MsoHyperlink"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; text-decoration: none; text-underline: none;"><span style="mso-list: Ignore;">8)<span style="font: 7.0pt "Times New Roman";"> </span></span></span></span><span class="MsoHyperlink"><span style="color: windowtext; font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; text-decoration: none; text-underline: none;">Thaler R, Sunstein C. Following the Herd (pp. 53-71). In:
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<span class="MsoHyperlink"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; text-decoration: none; text-underline: none;"><span style="mso-list: Ignore;">9)<span style="font: 7.0pt "Times New Roman";"> </span></span></span></span><span class="MsoHyperlink"><span style="color: windowtext; font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; text-decoration: none; text-underline: none;">DeFleur M, Ball-Rokeach S. Socializing and theories of
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<span class="MsoHyperlink"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; text-decoration: none; text-underline: none;"><span style="mso-list: Ignore;">10)<span style="font: 7.0pt "Times New Roman";"> </span></span></span></span><span class="MsoHyperlink"><span style="color: windowtext; font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; text-decoration: none; text-underline: none;">Victory: Strong for Life Billboards Coming Down. 2012. http://www.mamavation.com/2012/02/victory-strong-4-life-billboards-coming-down.html</span></span></div>
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<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">11)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; font-size: 12.0pt;">R
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1-9.</span><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";"></span></div>
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<span class="MsoHyperlink"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; text-decoration: none; text-underline: none;"><span style="mso-list: Ignore;">12)<span style="font: 7.0pt "Times New Roman";"> </span></span></span></span><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";">Puhl,
R Obesity Stigma: Important Considerations for Public Health. American Journal
of Public Health. 2010; </span><span lang="EN" style="font-family: Georgia; font-size: 12.0pt; mso-ansi-language: EN; mso-bidi-font-family: "Times New Roman";">1019–1028.</span><span class="MsoHyperlink"></span></div>
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<span class="MsoHyperlink"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; text-decoration: none; text-underline: none;"><span style="mso-list: Ignore;">13)<span style="font: 7.0pt "Times New Roman";"> </span></span></span></span><span style="font-family: Georgia; font-size: 12.0pt;">Jennifer Hudson’s Weight-loss
Wisdom. Good Housekeeping. </span><a href="http://www.goodhousekeeping.com/family/celebrity-interviews/jennifer-hudson-diet-tips#category1-3"><span style="font-family: Georgia; font-size: 12.0pt;">http://www.goodhousekeeping.com/family/celebrity-interviews/jennifer-hudson-diet-tips#category1-3</span></a><span class="MsoHyperlink"></span></div>
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<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">14)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; font-size: 12.0pt;">Silvia
P. Deflecting Reactance: The Role of Similarity in Increasing Compliance and
Reducing Resistance. Basic and Applied Psychology 2005; 27(3), 277-284.</span><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";"></span></div>
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<span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;"><span style="mso-list: Ignore;">15)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: Georgia; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";">Hicks J. The Strategy Behind Florida’s
“truth” Campaign. Tobacco Control 2001; 10:3-5.</span></div>
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Mollyhttp://www.blogger.com/profile/18395792142837014194noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-47373177961469799652013-01-01T11:19:00.000-08:002013-01-01T11:19:16.231-08:00HPV Vaccine: Getting Young Men In On It Using Social And Behavioral Science Theories– Mary Buckley<div class="MsoNormal">
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<span style="font-family: Georgia;">Human papillomavirus (HPV) is the most common
sexually transmitted disease in the United States and a known risk factor for oropharyngeal
and anogenital cancers, especially cervical cancer. The US Food and Drug
Administration approved Gardasil for HPV vaccination in 2006. Gardasil protects
against four strains of HPV, two of which cause about 70% of cervical cancer while
the other two cause about 90% of anogenital warts <span style="mso-no-proof: yes;">(1)</span>. There is enormous public health potential for reduction in
negative outcomes associated with HPV infection if a large enough number of
young people are vaccinated and are no longer able to acquire or transmit
infection to sexual partners. Individual immunity is important, but a large
enough population vaccination provides protection to those who are still susceptible.
Thus, regardless of individual risk, vaccination decreases the greater risk of
the general population <span style="mso-no-proof: yes;">(2)(3)</span>.<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: Georgia;">The FDA initially approved HPV vaccination for use
among young women, recommending that young women age 11-12 be vaccinated, with
catch-up vaccination recommended up to age 26. The idea is to have women
vaccinated long before their first sexual encounter and, in doing so, prevent
future cervical cancer caused by infection. However, in 2009, Gardasil was
approved for use in boys and young men age 9-26 <span style="mso-no-proof: yes;">(4)</span>
and is now recommended by the Centers for Disease Control and Prevention (CDC)
for young men between the ages of 11 and 12 with catch-up vaccination
recommended up to age 21 <span style="mso-no-proof: yes;">(5)</span>. </span></div>
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<span style="font-family: Georgia;">The CDC currently provides educational information
on their website and in pamphlets regarding HPV in both men and women. Since
the age recommendation for vaccination is 11-12, much of the information
provided by the CDC is directed toward parents. However, there is information
that is geared toward young adults who are learning to make their own health
decisions. Furthermore, young adults will receive this information from their
primary care physicians who will recommend vaccination if it has not already
been administered. This paper will focus on the age group of young adults,
specifically the target audience of young males for whom HPV vaccine was most
recently recommended. There is no formal “campaign” directed toward this
audience, but this paper will critique the current model of recommending HPV
vaccination to young men.<span style="mso-spacerun: yes;"> </span></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">Critique 1: Public Health Paradigm In
Marketing</span></b></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>The
CDC’s current marketing of the HPV vaccine (both for young men and for young women)
employs the traditional public health paradigm by using the core values of
health and safety. Although heath and safety are strong core values for those
working on public health campaigns at the CDC, they are not the ultimate core values
of the general public, especially not of the audience of young males to whom the
CDC is trying to “sell” the importance of HPV vaccination. The CDC presents
“fact sheets” that provide information specifically for men <span style="mso-no-proof: yes;">(6)</span> and general information about the vaccine and
dangers of HPV infection for both genders <span style="mso-no-proof: yes;">(7)</span>.
</span></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span>According to the CDC’s information, men
should receive the HPV vaccine to prevent genital warts and cancers of the anus,
penis, and oropharynx <span style="mso-no-proof: yes;">(6)</span>. However, a
majority of the general information on HPV vaccine focuses on prevention of
cervical cancer. Cervical cancer is the second most common cancer among women
worldwide and its burden is strongly associated with socioeconomic disparities <span style="mso-no-proof: yes;">(1)</span>. Although cervical cancer caused by HPV is certainly
a major public health concern, the use of cervical cancer prevention as the
means of promoting vaccination excludes the male audience. </span></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>To
maintain use of the health core value in promoting HPV vaccination among males,
the CDC provides a lot of information about the serious health effects of HPV
infection experienced by males. As mentioned above, these health effects
include some types of cancer in addition to genital warts. Gardasil protects
boys and men against most types of HPV that can cause anal cancers and genital
warts. However, the CDC fact sheet goes on to express how uncommon these health
problems are among straight men and men who are immunocompetent <span style="mso-no-proof: yes;">(6)</span>. So, even if men are concerned about the
health problems associated with HPV infection, they are unlikely to be
motivated to request HPV vaccination solely by reading this information on a
fact sheet. They might actually be dissuaded from vaccination upon learning
that they are not among a group that can be seriously affected by HPV infection.</span></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Menashe
and Siegel describe the importance of a strong frame and use of framing theory
in their article “The Power of a Frame: An Analysis of Newspaper Coverage of
Tobacco Issues – United States, 1985-1996.” Although their article discusses
the framing battle between tobacco companies and tobacco control organizations,
the concept of framing theory applies to any public health campaign. When
developing a frame, core values other than health are much more compelling.
Tobacco companies have been successful for so long because their campaigns
consistently target very strong, human core values such as personal freedoms
and civil liberties <span style="mso-no-proof: yes;">(8)</span>. These core
values have kept the tobacco companies’ argument relevant despite the
ever-growing wealth of information about health implications of smoking and
tobacco use. As seen in the case of HPV vaccination, the core value of health
does not hold up amid changes in vaccination recommendations.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Furthermore,
appealing to the core value of health provides a platform for arguments about
vaccine safety and potential side effects or risks associated with HPV
vaccination. Regardless of gender, an argument exists regarding the safety of
vaccines. The CDC’s fact-sheet for men directly addresses this concern by referencing
the many successful studies carried out to determine the safety of Gardasil in
both men and women. Researchers have not found any serous adverse events associated
with HPV vaccination <span style="mso-no-proof: yes;">(6)(7)</span>. However, the
concern about adverse events often gains a great deal of media coverage when it
is brought up. Therefore, the health core value can be taken away from the
vaccination campaign and used against it in an anti-vaccination argument about
dangerous side effects. </span></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Social
marketing has gained a lot of popularity among public health organizations and
public health campaigns are using commercial marketing concepts to promote
behavior change. In their overview of the use of social marketing in public
health promotion, Sonya Grier and Carol Bryant describe the importance of
offering benefits that the consumer (not the public health professional) truly
values when developing a marketing strategy <span style="mso-no-proof: yes;">(9)</span>.
As such, the most important aspect of marketing is researching what it is that
people want most and then using that information to “package” the product in ways
that fulfill those deepest desires. The CDC does two things in its HPV vaccine
promotion that contradict the recommendations of Grier and Bryant. With health
as a core value, young men who choose to be vaccinated against HPV will
generally not receive a valued benefit in return for their decision. Health
information about HPV does not touch at the deepest held values of young males
in the United States. Additionally, the HPV vaccine campaign does not take into
account the fact that it is not possible to simultaneously appeal to all types
of people. Successful social marketers know “it is not possible to be ‘all
things to all people’” <span style="mso-no-proof: yes;">(9)</span>. The CDC’s
information sheets are not making use of marketing to the values of the
specific population of interest. The “HPV and Men- Fact Sheet” has images of
happy young men and provides information specific to the gender, but the message
is not packaged in a way that appeals to their values.</span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">Critique 2: </span></b></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>In
addition to the weakness of the core value around which the HPV vaccine message
is developed, the way in which that message is given to its audience violates
communications theory. Communications theory holds that the context of a
message affects how persuasive that message is to its audience. The message
about HPV vaccination being given to young men is not likable and does not have
positive associations. When and where people encounter a message is crucial to
how they respond to the information. </span></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>In
their 1965 paper “Facilitating Effects Of ‘Eating-While-Reading’ On
Responsiveness to Persuasive Communication,” Janis et al. describe the tendency
of people to yield to persuasion when they are engaging in a gratifying
activity.<span style="mso-spacerun: yes;"> </span>Their experiments
focused on changing opinions of study participants (undergraduate students)
given persuasive written communications in the setting of eating free food or
no food <span style="mso-no-proof: yes;">(10)</span>. When students were eating,
they were more likely to accept the messages that they were given. These study
results were significant, but certainly did not elucidate a novel concept.
Salesmen, businessmen, and lobbyists often use the same strategy when they
“soften up” clients <span style="mso-no-proof: yes;">(10)</span>. They present
their message to clients around a dinner table or at a café rather than in a
conference room or office. The HPV vaccine promotion fails to take this
strategy of persuasive communication into account. The CDC provides information
to young men in the form of health pamphlets that are normally distributed at
health care centers. Also, much of the information provided by the CDC is
geared toward medical professionals who are encouraged to bring it to the
attention of their patients. A doctor’s office is not an environment that is
often associated with gratifying experiences. In fact, a doctor’s office may
have the opposite effect because of the association with illness.</span></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>In her chapter “Thinking Positively: Using Positive Affect
When Designing Health Messages,” Jennifer Monahan describes “heuristic appeals”
as the “first step in enhancing the likelihood that individuals will engage in
thoughtful processing” <span style="mso-no-proof: yes;">(11)</span>. So, unlike
the Janis et al. experiment affecting students’ acceptance of messages at one point
in time, Monahan emphasizes that repeated exposure to the positive heuristic
cue leads to a positive feeling toward the message <span style="mso-no-proof: yes;">(11)</span>.<span style="mso-spacerun: yes;"> </span>HPV infection is
not something that necessarily affects most people’s everyday lives, so it
would make sense that young men would not seek out and evaluate information on
HPV vaccination. Therefore, only receiving information from a doctor or in a
health information setting can make the initial association with the message
negative or, at best, neutral. </span></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>A
primary exposure to a message that can be associated with a mood or feeling
influences subsequent decisions related to that message. The CDC does not take
advantage of the possibility to harness the primary exposure and associate it
with a positive mood or feeling.</span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">Critique 3: </span></b></div>
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<span style="font-family: Georgia;">Not only does the CDC choose the wrong setting to communicate
the message to young males, but also the person delivering the message violates
the communication theory concept of similarity. The HPV vaccine message to
young men comes primarily though patient/health care provider counseling. Therefore,
there is a lack of similarity between the messenger and the target audience
that can foster psychological reactance. Psychological reactance emerges when
individuals feel that their freedom is threatened. Social psychologist Jack Brehm,
who developed the theory, explains that when people sense a threat to their
freedom, they try to reestablish that freedom by acting in the opposite manner
of that being directed <span style="mso-no-proof: yes;">(12)</span>. Although it
might not seem as though doctors are threatening the freedom of young men
regarding HPV vaccination, the message coming from a person of authority does
create reactance in an audience. Young adults like to consider themselves
“worthy of determining their own health outcomes,” and they receive numerous
messages “prescribing and prohibiting many of their prospective behaviors” <span style="mso-no-proof: yes;">(13)</span>. So, the doctor-patient conversation about
the benefits of HPV vaccination could have the opposite effect of that desired
by proponents of vaccination. Young men might seek to restore their “threatened
freedom” by refusing vaccination solely on the basis of the messenger.<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: Georgia;">Paul Silvia’s research on reducing resistance identifies
similarities between messenger and audience as a way to reduce or “deflect”
reactance <span style="mso-no-proof: yes;">(14)</span>. Silvia’s experiments
found that interpersonal similarity reduces resistance even in the context of a
threat to freedom. A threatening message given to his undergraduate research
participants by a similar communicator was still persuasive despite
jeopardizing freedom. In these experiments, similarity was as simple as a
shared birthday, first name, gender, year in school, or shared values reported
on a scale of importance <span style="mso-no-proof: yes;">(14)</span>. However,
the CDC does not take this importance of similarity into account in its
promotion of HPV vaccination for young men. </span></div>
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<span style="font-family: Georgia;">It is probably difficult for young men to establish
similarity with their physicians and, although there are pictures of young
people on information brochures, those young people are not the ones providing
the message. For example, one CDC HPV brochure contains five pictures of young
people (both men and women) with tattoos and dressed in sexy, age-appropriate clothes.
Most pictures portray couples in intimate positions. It is possible that young
men relate to the individuals in these pictures; however, none of the pictures
show peoples’ faces <span style="mso-no-proof: yes;">(15)</span>. This stylistic
choice might have been made for a reason, but it makes it difficult relate to
the people in the photographs. It also makes it especially challenging to
establish that these young people are the ones giving the message detailed in
the brochure. Therefore, including these pictures does little to reduce
psychological reactance.</span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">Suggested Intervention</span></b></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>I
suggest that the CDC invest in a targeted advertising campaign promoting HPV
vaccination in young males. Although there are literature and brochures
available for young men, there is no effective communication that frames the
topic favorably for this target audience. The recommendation for male HPV
vaccination is relatively new and is preceded by the recommendation for young
women as prevention of cervical cancer. So, understandably, there has not been
the same amount of time and research invested in promotion of vaccination for
young males. However, their vaccination is crucial in the development of herd
immunity to HPV strains that cause cancer and genital warts. The message needs
to reach young males outside the context of a health care setting. Although an
advertising campaign for HPV vaccination among women exists, it cannot be
tailored to “fit” the young male population. An entirely new advertising
campaign is required that makes use of extensive research of the target
audience, associating the message with a positive mood or feeling, and communication
through people who establish similarity with the target audience.<span style="mso-spacerun: yes;"> </span></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">Intervention 1: Research The Target
Audience</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span></span></b><span style="font-family: Georgia;">To develop an effective marketing strategy for HPV
vaccination among young men, the CDC needs to appeal to a stronger core value
than that of health. It is important to provide specific information about
disease and health, but investing in research for a marketing campaign could
make the target group much more receptive and reach those people who would have
had no interest in reading or talking about HPV. Investing in research about
the values of the target group would involve developing an understanding of the
target audience’s “needs, aspirations, values, and everyday lives” <span style="mso-no-proof: yes;">(9)</span>. Grier and Bryant suggest that such
research does not need to be expensive or complex. Consumer data may already
exist for that target audience. Also, it can be beneficial to involve consumers
(young men) as partners in the planning process. </span></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>A
great example of successful marketing research for a <span style="mso-spacerun: yes;"> </span>young adult audience is the “Truth” campaign that effectively
reduced youth tobacco use in Florida between 1998 and 2000 <span style="mso-no-proof: yes;">(16)</span>. This campaign had a lot of money
available to afford cutting edge marketing resources <span style="mso-no-proof: yes;">(17)</span>, but the same strategy can be successful in any public health
campaign. The marketing team for “Truth” spent a great deal of time on research
and conducted hundreds of interviews with members of their target audience <span style="mso-no-proof: yes;">(17)</span>. Thus, they were able to develop a
youth-guided marketing campaign with an effective “brand” for anti-tobacco. </span></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>One
very important aspect of marketing theory that “Truth” addressed is focusing
the message and not trying to apply it to too broad of an audience. It can be
tempting to use resources to try to develop a marketing campaign that reaches
the largest number of people, but this is not the intention of marketing. It is
important to establish the specific target group and let research on that group
dictate the direction of the marketing campaign. Therefore, an HPV vaccine
marketing campaign needs to be developed for young men independent of a
campaign for young women or parents. This may seem obvious, but having
different campaigns does not just mean different literature. It requires
targeted research and the creation of a marketing team with input from the
intended audience.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: Georgia; line-height: 200%; mso-bidi-font-family: Georgia; mso-bidi-font-size: 15.0pt;">In their study of motivations for exercising,
Segar et al. look at the connection between goals and behavior. Women in their
study were more likely to adhere to exercise goals related to daily quality of
life than healthy aging, despite reporting equal value attributed to each. Segar
et al. affirm, “immediate payoffs motivate behavior better than distant goals” <span style="mso-no-proof: yes;">(18)</span>.</span><span style="font-family: Georgia;">
So, an HPV vaccination marketing message needs to appeal to young men with a
core value that is stronger than health and promise to fulfill the immediate
goals associated with that core value. </span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">Intervention 2: Associate The Message
With A Positive Mood </span></b></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>To
effectively utilize communication theory for HPV vaccination, the CDC needs to
find a new context for the message. When, where and with what associations the
topic is addressed all need to be taken into account. Taking the message of HPV
vaccination for young men outside the doctor’s office would be the first step
in this intervention. Finding a setting in which it would reach young men while
they are in a favorable mood is the key. Not all of the information that is
covered in the CDC’s brochures needs to be included in the advertisement message.
It is most important that the audience is primed to consider the topic in a
favorable light. </span></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>Television
and radio advertising provide a great way to reach the target audience outside
the health care context. Advertising time slots during sporting events can take
advantage of a positive mood, especially for the target audience of young men.
Considerable funding behind the Florida “Truth” campaign allowed them to run
advertisements on channels and at times with high teen viewership like on MTV
and during broadcasting of the Superbowl <span style="mso-no-proof: yes;">(17)</span>.
But even without significant funding, one can develop an advertisement that
creates its own association with a positive mood. Monahan writes that heuristic
appeal can come from the use of a popular song or visual imagery, providing a
cue for positive feeling toward the message <span style="mso-no-proof: yes;">(11)</span>.
</span></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Gerald Gorn conducted experiments to determine the
relationship between hearing liked or disliked music and product preference <span style="mso-no-proof: yes;">(19)</span>. Apart from just music, his study question
is whether or not “background features” of advertisements affect attitudes. His
results indicate that the presence of “liked” music can cause people to choose
a certain product when there is very little product information provided <span style="mso-no-proof: yes;">(19)</span>. Gorn mentions that people are often
exposed to commercials when they are not considering buying the advertised product,
and it is in those situations that background features are most important. In
the case of HPV vaccination, young men are not considering the “product” of
vaccination, so product information is not as influential as background stimuli
that can arouse emotion. Very little specific information about HPV actually needs
to be in the advertisement because such information will be presented by a
physician once an individual has developed a positive attitude toward the
“product.” </span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">Intervention 3: Establish Similarity </span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: Georgia;">The<span style="mso-spacerun: yes;">
</span>“One Less” advertisement put out by Merck, the pharmaceutical company
that makes Gardasil, is a good example of establishing similarity between the
messengers and the target audience. Merck’s “One Less” campaign has designed
its website to include pictures of young men since Gardasil is now recommended for
them <span style="mso-no-proof: yes;">(20)</span>, but the advertising message is
still directed toward young women. The same advertising campaign cannot be
tailored toward young men because the message specifically empowers women to be
“one less” statistic of cervical cancer <span style="mso-no-proof: yes;">(21)</span>.
However, the use of similarity in this advertisement is a good example of a way
to reduce reactance. The advertisement starts out with a young girl
skateboarding. She says that she could be “one less” woman to learn that she
has cervical cancer. Other young women join in with the same statement while
they are playing basketball, horseback riding, playing drubs, and dancing <span style="mso-no-proof: yes;">(21)</span>. The people portrayed effectively identify
with strong, independent young women. The target audience of the advertisement
will likely find interpersonal similarity with these young women and identify
them as embodying ideals of their age group. </span></div>
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<span style="font-family: Georgia;">An HPV vaccine campaign for men could benefit from
a similar approach. The focus of an advertisement would be young men engaging
in activities to which their audience can relate while providing their own reasons
for receiving HPV vaccination. The primary goal in the development of the
advertisement would be to make the actors likable through similarity. Silvia writes
that similarity “creates liking” which is the “positive force towards
compliance” <span style="mso-no-proof: yes;">(14)</span>. Rather than coming from
a doctor or health care provider, the message would be from a more likable figure
who would not inspire the same reactance.<span style="mso-spacerun: yes;">
</span></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">Conclusions</span></b></div>
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<span style="font-family: Georgia;"><span style="mso-tab-count: 1;"> </span>There
are certainly challenges facing the CDC in any HPV vaccination campaign
targeting young men. As I mentioned before, the CDC does not currently have a
formal HPV vaccine campaign for men, nor does the pharmaceutical company that
produces Gardasil. However, the CDC does provide a good amount of information
(in the form of brochures and recommendations for physicians) intended to
motivate young men to get vaccinated. An advertising campaign by the CDC could
make young men more receptive to information about HPV vaccination. However, HPV
vaccination affects men differently than it does women; so, consumer research
and effective use of communication theory will be crucial to successfully
influence the vaccination decision of young males.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: Georgia;">References</span></b></div>
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<br /></div>
<div class="MsoBibliography">
<span style="font-family: Georgia;">1. <span style="mso-tab-count: 1;"> </span>Fernández ME, Allen JD,
Mistry R, Kahn JA. Integrating Clinical, Community, and Policy Perspectives on
HPV Vaccination. Annu Rev Public Health 2010 Apr 21; 31:235–52. </span></div>
<div class="MsoBibliography">
<span style="font-family: Georgia;">2. <span style="mso-tab-count: 1;"> </span>Giuliano AR. Human
papillomavirus vaccination in males. Gynecologic Oncology 2007 Nov; 107(2,
Supplement):S24–S26. </span></div>
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<span style="font-family: Georgia;">3. <span style="mso-tab-count: 1;"> </span>Villa LL. Prophylactic HPV
Vaccines: Reducing the Burden of HPV-Related Diseases. Vaccine 2006 Mar 30; 24,
Supplement 1(0):S23–S28. </span></div>
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Mollyhttp://www.blogger.com/profile/18395792142837014194noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-91653121136658006122013-01-01T11:15:00.001-08:002013-01-01T11:15:41.038-08:00Critique of an STD/HIV Prevention Intervention: Safe in the City – Kristin B.
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<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;">Introduction</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Sexually
transmitted diseases (STDs), including Human Immunodeficiency Virus (HIV), are
one of the biggest public health issues facing the United States today. Left
untreated, STDs can pose serious and oftentimes irreversible health threats, and
in the case of HIV, can lead to death. A 2011 Centers for Disease Control and
Prevention (CDC) report estimated that there are 19 million new STD infections in
the U.S. annually, of which half are among young people (1). STDs cost the
health care system over 17 billion dollars a year (1). In addition, a March
2012 CDC report estimated that 1.2 million people in the U.S. are living with
HIV and there are 50,000 new infections annually (2). Among these new
infections, African American and Latinos are disproportionately affected (2).
The same report also determined that one in five HIV-infected individuals is
unaware of their status (2). Because STDs and HIV are transmitted overwhelming
through sexual contact, getting tested and knowing one's status is imperative
in reducing the number of new STD/HIV infections. Research shows that knowledge
of one’s status increases the likelihood that infected individuals will
decrease risky sexual behaviors (3).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Abstaining
from oral, vaginal, and anal sex, practicing monogamy with uninfected partners,
reducing one’s number of sex partners, and using condoms correctly for every
sexual encounter can reduce one’s risk of contracting STDs/HIV (4). Because
using latex condoms is the most efficient way to reduce the risk of contracting
an STD/HIV among those who do not abstain from sexual activity (5), many
STD/HIV infection reduction interventions focus on giving people the knowledge
and skills to use condoms effectively. Risk factors for not having protected
sex include a lack of knowledge and perception of STD/HIV risk, negative
attitudes about using condoms, a lack of knowledge about using condoms
correctly, a lack of intentions to use condoms, a lack of self-efficacy and
skills to get tested, and a lack of self-efficacy and skills for practicing
safer sex, including acquiring condoms and negotiating their use. A majority of
STD/HIV prevention interventions target these risk factors.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;">Overview of Safe in the City</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Safe
in the City is a 23 minute video designed to reduce HIV and other STD
infections by increasing condom use. The video is shown in public STD clinic
waiting rooms and has no staff involvement and does not require any counseling
or group facilitation – the video is simply shown on loop to those in the
waiting room. The video’s goals are to increase STD/HIV knowledge, increase the
perception of risk of getting HIV or another STD, promote knowledge of correct
condom use and positive attitudes toward condom use, increase intentions to use
condoms, build self-efficacy and skills for getting tested and facilitating
partner testing, and build self-efficacy and skills for acquiring condoms,
negotiating the use of condoms with their partner, and increase actual condom
use (6). After watching the video, clients of the STD clinic are expected to use
condoms correctly and consistently.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>The
video is made up of five parts: three vignettes about negotiating condom use in
various relationships and two animated portions about different types of
condoms available and proper condom usage. As the video begins, the following
words appear on the screen: “Remember, not having sex is the most reliable way
to prevent getting an STD. Please talk to your healthcare provider for more
information or if you have any questions.” The first story begins with Paul
pressuring Jasmine to have sex without a condom, but Jasmine insists on using
one. Later, Paul hooks up with an ex-girlfriend, Theresa, but only uses a
condom for the end of the sexual encounter. Theresa calls Paul to tell him that
she went to a clinic and was diagnosed with an STD and encourages Paul to get
tested. Paul gets tested and decides to hold off on any further sex until his
test results are back (7). An animated portion about properly putting on and
removing a condom follows the story and emphasizes the fact that condoms should
be used consistently and correctly for them to be effective (8). The next story
shows Luis and Theresa beginning to get intimate and Theresa asking Luis if he
has a condom, which he does not. He gets offended and Theresa explains that
pulling out is not always effective and doesn’t protect against STDs, and that
condoms make her feel safe and free. The scene ends with Luis running to a
convenience store and returning to his apartment with a condom (9). The
following animated segment is about different types of condoms and emphasizes
the idea that there is a condom just right for everyone's needs (10). The final
story picks up after Ruben has sex with Tim, who notes afterward that he had a
condom with him but they got carried away and ended up not using it. Ruben
later has sex with Christina and she finds out that he gave her an STD. The
video ends with them going to the clinic together to get treatment for their
STD (11). </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;">Flaws of the Intervention</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Findings
from the CDC's 2008 evaluation of Safe in the City show that the intervention
did indeed significantly reduce new STD infections by 10% among patients
attending the clinics where the intervention was provided (12). However, this
reduction was seen only in males. Among females who viewed the video, there was
neither a beneficial nor harmful outcome found which indicates that the
intervention was ineffective among this population. Safe in the City, as the
current intervention now stands, is not only flawed for the purpose of
increasing condom use and reducing STD infections among females, but is also
flawed as a standalone intervention that does not fully take into account
social and behavioral science principles, theories, and research.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;">Critique #1 – Lack of
Group-Level Component</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Safe
in the City is an individual-level intervention that requires no contact or
discussion with healthcare providers. The video is played in STD clinic waiting
rooms where patients may choose to actively watch the video or not. In
addition, the video is just over 20 minutes long, so the viewer might not have
the chance to see the entire video or may only see the end of it. The viewer
knows that the people in the video are actors and what is happening on the
screen is not real even though it may depict real events. There is no
opportunity for discussion or questions, though the video passively lets the
viewer know that they should ask their healthcare provider if they have any
questions. A short video cannot possibly cover all scenarios that are likely to
come up, and because it is scripted, does not allow for spontaneous questions
to lead to discussion. Most importantly, the video does not allow the viewer to
practice the skills depicted.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Simply
watching a video intended to change behavior without being given the
opportunity to practice the skills demonstrated or even discuss what was viewed
is deemed less effective than pairing the video with another component (13,
14). In a study that examined the effectiveness of video-based patient
education interventions on promoting condom use among men and women in public
STD clinics in New York City, researchers looked at results from a control
group, a group that only viewed the video, and a group that viewed the video
and then participated in an interactive group session led by a trained
facilitator (13). Subjects who participated in the interactive group session
showed increased STD/HIV risk perceptions, greater self-efficacy, and higher
rates of condom acquisition than the control group or the video-only group,
however those in the video-only group demonstrated greater STD and condom
knowledge and more positive attitudes about condom use (13). Another study,
also conducted in public STD clinics in New York City, looked at the impact of
a video-based educational intervention on condom acquisition among African
American and Hispanic men and women (14). Findings show that compared to the
control group and video-only group, subjects who experienced the video in
conjunction with a group discussion were significantly more likely to acquire
condoms (14).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>An
important aspect of social cognitive theory, one of the theories Safe in the
City is based on, is observational learning or modeling. Observational
learning/modeling is the theory that people do what they see others do, not
what people tell them to do (15). However, observational learning/modeling is
not complete with just behavior imitation, it must also involve learning skills
and retaining those learned skills for future use (16). This connection is made
through aspects of the theory known as behavioral capability and self-efficacy,
which emphasize the execution of observed skills and address performance and
confidence barriers. Without also incorporating these other aspects, the social
cognitive theory will come up short when put into practical use. While the
stories portrayed in Safe in the City successfully show modeling by depicting
bad outcomes occurring when one or one's partner does not wear a condom, the
individual-level intervention does not take into account the importance of
developing skills and collaborating on strategies for safer sex behaviors,
which a group-level component could provide.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;">Critique #2 – Theoretical Basis
in Rationality</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Safe
in the City is theoretically based in the Information-Motivation-Behavioral
Skills (IMB) Model, Social Cognitive Theory, and the Theory of Planned
Behavior. The IMB Model holds that there are three fundamental determinants of
risk reduction: information, motivation, and behavioral skills. Information,
including facts about STD/HIV transmission and information regarding specific
methods to prevention, is seen as the precursor to risk reduction behavior,
then comes motivation to reduce risk, which entails attitudes toward
prevention, social norms, and intentions to practice preventive behaviors, and
finally behavioral skills are seen as needed in order to perform specific
preventive acts (17). However, because this particular intervention does not
develop behavioral skills, it is only based in the informational and motivational
aspects of the model.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Social
Cognitive Theory is built on the understanding that behavior change is based on
self-efficacy, goals, and outcome expectancies. It involves reciprocal
determinism (the interaction between the individual, the behavior, and the
environment), behavioral capability (the knowledge and skills to perform a
behavior), expectations (anticipated outcomes of a particular behavior),
self-efficacy (confidence in one's ability to take action), observational
learning or modeling (deciding to perform a behavior based on watching someone
else perform that behavior and seeing the outcome), and reinforcements
(responses to the behavior that increase or decrease the likelihood of
reoccurrence) (18).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>The
Theory of Planned Behavior states that a person's attitude toward a specific
behavior and that person's perception of the subjective norms (whether or not
the behavior is likely to be approved or disapproved by one's social groups)
associated with that specific behavior come together in an intention to perform
a behavior (18). This behavioral intention is based on one's perceived
behavioral control, which is made up of a person's self efficacy, or a belief
in the ability to actually perform a behavior and a belief in the amount of
power they have in actually performing the behavior (18).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>The
assumption behind Social Cognitive Theory and the Theory of Planned Behavior is
that people are rational decision-makers. However, these theories are flawed in
that they overlook emotional variables, particularly those associated with sex,
which tend to make individuals' behavior especially irrational. In Dan Ariely's
book <i style="mso-bidi-font-style: normal;">Predictably Irrational: The Hidden
Forces That Shape Our Decisions</i>, he discusses an experiment he conducted to
demonstrate the influence of arousal. Male heterosexual participants in his
study were asked to respond to questions while imagining how they would respond
while sexually aroused. The first set of questions revolved around sexual
preferences, the second revolved around the likelihood of engaging in sexually
immoral behaviors, and the third set revolved around the likelihood of engaging
in unprotected sex. Later on in the experiment, the participants were instructed
to view arousing pictures and to masturbate while answering the same sets of
questions as were originally asked. One of the findings of the study was that
individuals were 25% more likely to predict that they would not use a condom in
the aroused state than in the unaroused state (19). </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>The
theoretical basis of Safe in the City assumes that knowledge influences
attitudes and that attitudes then influence behavior, yet this is not how
actual behavior change seems to work. After watching Safe in the City,
individuals may be of the mindset that they will always use a condom, but
passion in the heat of the moment has been shown to say otherwise, particularly
if one does not have the communication skills necessary for negotiation. While
the IMB Model, Social Cognitive Theory, and the Theory of Planned Behavior may
work well as a foundation for public health interventions that train in these
types of skills, they do not sufficiently address how one can be expected to
negotiate behavior, such as condom use, in an irrational or emotional state
without training in a specific set of skills.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;">Critique #3 – Optimism Bias,
Illusion of Control, and Stigma Theory Left Unaddressed</span></b><span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Because
of the stigmatized nature of an STD/ HIV diagnosis, all public health
interventions that aim to reduce new infections will have some of the same fundamental
barriers. These barriers stem from Optimism Bias, the Illusion of Control, and the
Stigma Theories.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Optimism
Bias is a bias that causes a person to believe that they are less likely to
experience a negative event compared to others, yet more likely to experience a
positive event (20). In fact, people who regard a disease as extremely serious
are most likely to think that their likelihood of contracting that disease is
less than average (21). Optimism Bias is the belief that contracting an STD/HIV
could “never happen to me”, which leads people to engage in risky behaviors like
having unprotected sex. Safe in the City does not address Optimism Bias, so
even if an individual views the video, they may not think that the information
pertains to them. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>The
Illusion of Control is the tendency for people to overestimate their ability to
control events, for instance to feel that they control outcomes that they
actually have no influence over (22). Realistic control would be the use of
condoms, because using a condom does provide actual protection, whereas
illusory control would be asking about a partner's sexual history, where this
does not provide actual protection, particularly if one's partner has never
actually been tested (23). The Illusion of Control can be reinforced every time
an individual has unprotected sex but does not get an STD, leading that
individual to continue with that risky behavior (23). While realistic control
is addressed in Safe in the City through the promotion of consistent condom
use, all partners getting tested, and the omission of illusionary control, this
may not transfer to the viewer in the clinic who has avoided STDs despite
inconsistent protection. In addition, while the video does stress the
importance of using a condom every time, Safe in the City does not stress the
need to get tested after each unprotected sexual encounter and after each
change in partner, particularly if there is not an understanding of mutual
monogamy. Instead, the video assumes the viewer will never make a mistake and
does not include this possibility in the scenarios.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Stigma
Theory is when an individual has an attribute and society discredits and rejects
the individual because of that attribute (24). STDs, particularly HIV, are
attributes affected by Stigma Theory and result in an individual being
ostracized, rejected, avoided, and discriminated against by families,
healthcare professionals, communities, and governments; violence against one
who is perceived to have AIDS/HIV or who belongs to a high-risk group also
occurs (25). Because Safe in the City is currently only implemented in public
STD clinic waiting rooms, it does not address Stigma Theory adequately. The
venue should not be exclusive and instead should reach those who are afraid of
getting tested for fear of getting a positive result. In addition to Stigma Theory
related to testing, some people may fear that using condoms, whether or not one
is infected or not, may bring partner rejection (25). Safe in the City does not
address how to proceed in a scenario in which one person attempts to negotiate
condom use but has a partner that is resistant. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Safe
in the City, along with many other STD/HIV prevention interventions, does not
provide ways to combat Optimism Bias, Illusion of Control, and Stigma Theory. A
video may not be the best way to address these barriers since interaction with
the individual is needed in order to determine their exact level of risk. The
intervention’s venue is also problematic since those who are most at-risk for
infection may not be successfully reached.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;">Proposed Intervention</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Safe
in the City is not an entirely failed intervention. In fact, it is listed in
the CDC's Compendium of Evidence-Based HIV Behavioral Interventions and is
classified as a best-practice intervention due to positive evaluation findings
(26). As a brief, video-based, individual-level intervention, Safe in the City is
effective among males. As an intervention that is easy and inexpensive to
implement and that can reach large numbers of STD clinic patients of different
races/ethnicities and of different sexual orientations, it can be considered a
success. For clinics that want to provide a STD/HIV prevention component but do
not have the resources or funding for individual counseling or a group-level
program, Safe in the City might even be the best option to make a meaningful
impact. Moreover, research does show that implementing a lone video in a clinic
is better than solely implementing standard clinic procedures (13, 14).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>A
number of aspects of the intervention are good and should be incorporated into
the modified intervention. Psychological reactance is the theory that when an
individual is told that they cannot have something, there is more of a desire
to get that particular something (27). While oftentimes public health
interventions tell people what to do or not to do, Safe in the City instead
empowers people by giving them choices while still insisting on condom use.
There is an entire section of the video devoted to different styles of condoms
that one can choose from, even ultra-sensitive ones for those who complain that
they do not like the feeling of condoms. Communications theory and modeling
call for a likeable, familiar, and similar person to deliver the message. Safe
in the City successfully accomplishes this by using a young and
racially/ethnically and sexually diverse cast of characters. Reciprocity is the
idea that if someone does something for you, you feel like you want to do
something for them (28). In the case of Safe in the City, the video drills into
one's head that STD clinics have free condoms for the taking. Research has
shown that when free condoms are visibly provided, about 80% of people take
them, and of those that take them, almost 75% of people report using them (29).
Finally, the video shows different reasons for using condoms including STD/HIV
prevention, pregnancy prevention, and avoidance of long-term effects of STDs
such as infertility, and the importance of using a condom for an entire sexual
encounter from start to finish, waiting to know your status and your partner's
status before having sex, standing your ground on using a condom even in the
heat of the moment, and getting yourself and your partners tested (7, 9, 11).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>The
proposed intervention will still involve the Safe in the City video in its full
format, but it will also contain a group-level component led by a trained
facilitator. This new component will involve group discussion, a skills-building
session, STD/HIV and condom use information, and the distribution of free
condoms. The following proposed modifications to the intervention will address
the critiques detailed in the previous section in the hopes that with the new
group-level component, Safe in the City could be an even more effective
intervention in reducing rates of new STD/HIV infections. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;">Modification #1 – Addition of a
Small Group Component</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>The
largest proposed modification to the Safe in the City intervention entails
structural change. Instead of an entirely individually-based intervention, the
proposed intervention would be a single session, small group-level
intervention. This modification directly addresses the issue regarding the lack
of opportunity for developing and practicing skill building. Specific aspects
are pulled in part from a variety of similar video-based interventions that
have an added counseling or group-level component, including RESPECT, Sisters
Informing Sisters on Topics about AIDS (SISTA), and Video Opportunities for
Innovative Condom Education & Safer Sex (VOICES/VOCES) (30, 31, 32, 33). To
begin, small groups of about 4 to 8 individuals would be convened by gender and
race/ethnicity, led by a trained facilitator of the same gender and
race/ethnicity as the makeup of the group. The session would start with a
viewing of the Safe in the City video in its entirety. Once the video was
complete, the facilitator would begin the discussion by asking questions about
the situations and characters in the video and encouraging participants to
relate them to their own lives. The goal of this portion of the session is to
increase the perception of personal risk of STD/HIV infection among the
participants. Rather than providing general knowledge about STD/HIV, the
discussion would focus on the behaviors that put people at risk for infection.
The facilitator would also correct any misinformation about STD/HIV and condom
use that is discussed. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Following
this discussion would be a skills-building session to work on developing and
practicing skills needed for overcoming barriers to condom use. After the
skills-building session, the facilitator would educate participants about the
different types of condoms available for use. Before the group disbands, the
facilitator would actively distribute, rather than passively provide, different
types of condoms to participants based on what the participant identifies as
needing. Throughout the intervention the facilitator would be available for
questions and at the end would let participants know how to contact them if
questions or concerns should arise after the session. It should be noted that
depending on the needs of a particular group due to gender or culture, aspects
of the session could be altered.</span></div>
<div class="MsoCommentText" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-spacerun: yes;"> </span>An added group-level component allows
participants to learn something through group interaction that they cannot
learn from a video alone. Groups accomplish this by sharing common experiences,
exposing one another to positive peer influence, increasing motivation to
change, and providing support (34). The CenteringPregnancy program exemplifies
this in another area of public health, prenatal care. While prenatal care is
traditionally delivered individually, the CenteringPregnancy model is based on
the theory that groups are effective in providing support and helping people
reach goals and so is instead delivered in a group format by a healthcare
provider to women in similar stages of pregnancy (34, 35). Evaluations of
Centering Pregnancy show that compared to a one-on-one interaction, the group-level
program increases social support, perceived empowerment, and exposure to useful
skills and information (35). Adding this type of group-level component to Safe
in the City will allow participants to learn from one another through
discussion, social modeling and the aspects needed for modeling to be
successful, behavioral capability and self efficacy, and will thus strengthen
the existing intervention.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;">Modification #2 – Skills
Building with Motivational Enhancement and Theory of Gender and Power</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>The
second modification addresses the flaw in basing a risk reduction intervention
on theories that assume behaviors are rational, like Social Cognitive Theory
and the Theory of Planned Behavior, while the original intervention is not
built to give people the tools to make positive decisions in irrational states.
The incorporation of a skills-building session however, complete with group practice
and facilitator and group feedback on performance, allows a participant of the
new intervention the ability and confidence to negotiate condom use even in an
emotional state. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-indent: .5in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;">Under the guidance of the facilitator,
participants of the new intervention would role-play, practice, and discuss
communication skills like sexual assertiveness, which includes refusal skills,
or the ability to refuse unwanted sexual contact, and condom negotiation.
Training in these types of skills is effective in increasing the frequency of
condom-protected sexual activity (36, 37). The skills would first be modeled by
the facilitator and then practiced and discussed. The group would discuss
problems they have encountered in trying to adopt safer-sex behaviors and
develop and practice strategies for overcoming these problems. The IMB Model would
now be used in full as a theoretical basis. This skills-building component is
also founded in Motivational Enhancement, which promotes positive outcomes by
actively involving participants in the behavior change process and in
developing risk-reduction strategies that are suited to their own situations (38).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>While
this sexual assertiveness skills-building aspect of the modified intervention
would ideally address the fact that the original intervention is ineffective in
increasing condom use among females, the group sessions would also have a
component based on the Theory of Gender and Power. The Theory of Gender and
Power is a social structure theory that posits that there is a sexual division
of power that characterizes the gendered relationship of males and females, and
that this division of power may explain non-condom use among women (39, 40).
The modified intervention would address this power imbalance by correcting the
misconception that a female asking her partner to use a condom use may imply
infidelity or may compromise the relationship.</span> <span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;">SISTA, a peer-led HIV
prevention program for African American women founded in the Theory of Gender
and Power, has been shown effective in increasing consistent condom use, sexual
behavior, self-control, sexual communication, and sexual assertiveness skills
and in increasing partner adoption and support of consistent condom use (31). Borrowing
from SISTA, facilitators of the new intervention for women would also use
cultural- and gender-appropriate materials to encourage pride and enhance
self-worth and teach verbal and nonverbal communication skills intended to
reach partners hesitant to use condoms consistently or at all (31).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Finally,
by actively distributing condoms to the program participants and making sure
they are aware that condoms are always available for free at the clinic, the
message sent is that there is no reason to ever be without one. Because people
have a tendency to forgo condoms in the heat of the moment if they are not
readily available, making sure that condoms are indeed always available is a
good step towards combating people's would-be irrational behavior. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;">Modification #3 – Personal Risk
Assessments, Teachable Moments, Alternate Venues </span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>The
modified intervention would address Optimism Bias through the personal risk
assessments that occur after the viewing of the Safe in the City video. Relating
the scenarios displayed in the video to ones in the participants' own lives,
will make it clear that anyone can get an STD/HIV from unprotected sex, not
just those who are stereotyped as “dirty”. This message will increase
perception of risk of unprotected sex and reinforce the need for all
individuals to use condoms (41). For participants who appear to underestimate
their personal health risks, individual intensive counseling may be necessary
to overcome Optimism Bias.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>The
group-level component would also be able to address participants experiencing
illusory control through teachable moments brought about by the personal risk
assessment discussion. Teachable moments are situations that create an
opportunity to influence behavior change (30). One way of accomplishing this is
following the format used in a research study that used failure experiences as
a way to undermine perceived invulnerability to HIV and reduce Optimism Bias,
resulting in increased perceptions of personal risk for HIV and intentions to
use condoms (42). In the study, the facilitator asked participants to write
about a time when they had sex without a condom followed by a group discussion
about why condoms are a necessity, an exercise which forced participants to remind
themselves of a past failure while also simultaneously reminding themselves
that condoms are essential in protecting oneself (42). Participants then
individually judged whether individuals were HIV-positive or negative based on
pictures and brief biographical and sexual experience information. The majority
of participants performed at or below chance levels (42), also demonstrating failure.
</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>The
sexual assertiveness skills-building portion of the group session and the
component where the facilitator corrects misconceptions about what it means
when one partner asks their partner to use a condom is intended to address the Stigma
Theory critique. An additional way of addressing Stigma Theory is to hold the
intervention in venues other than public STD clinics where other at-risk individuals
can be found. These could include venues such as family planning centers,
community health centers, schools, businesses, churches, drug rehabilitation
clinics, and correctional facilities. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;">Conclusion</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Safe
in the City is an individual-level, brief, single-session, video-based
intervention designed to prevent new STD/HIV infections by encouraging
increased condom use among clients in STD clinic waiting rooms. Because clients
simply view the video, there is no development of skills necessary to
successfully negotiate condom use with sexual partners and no discussion of
common barriers to condom use or strategies to overcome these barriers. By
encompassing the video within a small group component, the modified intervention
would include gender- and culturally- appropriate segments on personal risk
assessment, sexual assertiveness skills-building, overcoming barriers to condom
use, accurate condom information, and condom distribution. These added segments
aim to address issues related to the theoretical foundation of the original
intervention, behavioral irrationality, Optimism Bias, the Illusion of Control,
and Stigma Theory in the hopes that such modifications would transform the
original intervention into a more effective intervention for increasing condom
use and reducing rates of new STD/HIV infections.</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman"; font-size: 12.0pt;">References</span></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
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<span style="font-family: "Times New Roman"; font-size: 12.0pt;">25. Center
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Mollyhttp://www.blogger.com/profile/18395792142837014194noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-45073169305324219292012-12-24T09:04:00.002-08:002012-12-24T09:04:49.173-08:00Breastfeeding Initiatives: Banning Formula is not the Answer – Kayley Pettoruto<br />
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Introduction</span></b><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Epidemiologic studies have proven the
numerous advantages of breastfeeding over using formula—including health,
nutritional, economic, social, immunologic, developmental, social and
environmental benefits (1). Breastfeeding reduces a mother’s risk of breast and
ovarian cancer and reduces a baby’s risk of ear, respiratory and
gastrointestinal infections, reduces rates of hospitalization, asthma, and
promotes maternal bonding and optimal growth (2).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Despite these known benefits,
breastfeeding rates after six –months and at one year of age are low, compared
to public health goals in the United States. The National Immunization Survey
of 2001-2002 estimates that more than 71.4% of children nationwide were
breastfed at some point; however, that rate drops to 16.1% by one year of age (3).
Unfortunately, these rates are lowest among individuals with the greatest risk
of poor maternal and child health outcomes: those women of low income, low
socioeconomic status, low educational attainment, and non-Hispanic black women
(3). With these disparities in mind, New York City developed a hospital-based
breastfeeding-only program, namely “Latch On”.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">This program is a hospital-based initiative that focuses on
reducing distribution of promotional infant formula and a public awareness
campaign, to inform women of the benefits of breastfeeding (2). This public
health awareness campaign takes form in posters in subways and hospitals (2). The
program in New York City also asks that hospitals put away formula, take down
formula advertisements, and advertise the health benefits of breastfeeding
throughout the hospitals (2). It requires that new mothers ask for formula from
the nurses instead of being given promotional material automatically. Nurses
are required to discuss the benefits of breastfeeding with new mothers. By reducing
formula distribution and increasing knowledge about the benefits of
breastfeeding, the “Latch On” program intends to increase exclusive
breastfeeding rates. (2). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Currently 28 hospitals in the area have signed on to
participate. The initiative focuses on two main health beliefs—women need
accurate information in order to make the right decisions about breastfeeding
and through reduction in distribution of promotional formula, breastfeeding
initiation and duration rates will improve (2).</span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">While the Latch On approach has many positive aspects to it,
which are backed by research and evaluation, the program has received a lot of
backlash from the public. </span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "Georgia","serif";">The Latch
On Initiative even had to publish a “myths and facts” memo in order to quell
some of the many myths that had arisen surrounding the program. Some of the
myths included in this publication were: “formula was being put under lock and
key”, “formula feeding will be forbidden in some fashion”, and probably most
importantly, “Latch on NYC is taking away and/or jeopardizing a woman’s right
to choose how to feed her baby” (2). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "Georgia","serif";"> In this critique, I will focus on three
aspects of the Latch On campaign that failed when considering social and
behavioral sciences. Firstly, the campaign assumes individual level factors are
sufficient to promote breastfeeding. Secondly, the Latch On campaign ineffectively
uses core values. Thirdly, the campaign does not use effective communications
strategies, including failure to avert psychological reactance.</span></div>
<div class="MsoNormal" style="line-height: 200%; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<b><span style="font-family: "Georgia","serif";">Critique 1: Individual Level Factors are
Insufficient<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Mayor Bloomberg’s Latch On Initiative assumes
that individual level factors are sufficient to promote change. This construct
led policymakers to create the Latch On Program, which provides information to
new mothers about the benefits of breastfeeding through posters, information
from hospital nurses and limits access to formula. However, the framework of
the social determinants of health explains how social and community influences,
living and working conditions, and general socioeconomic, cultural and
environmental conditions also influence health behaviors (4).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Interventions that focus entirely on
individual behavior change can be ineffective because they fail to consider the
cultural, sociopolitical and economic contexts of individual health experience
and behavior (5,6). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Even if women leave the hospital without
formula and a wealth of knowledge about the benefits of breastfeeding, individual
level interventions are not sufficient to promote change, as there are other
factors women face once they leave the hospital that may or may not allow them
to breastfeed. According to the literature, factors that influence the length
and duration of breastfeeding include employment status (7), social support,
self-efficacy, and breastfeeding experience (8). Assuming that informing women
that they should breastfeed and making formula harder to obtain in the hospital
setting does not in any way help women overcome these external factors. The
breastfeeding prevalence data reveals that these external factors are not being
considered. The major issue in the United States today is the continuation of
exclusive breastfeeding, not necessarily initiation. As the data shows, 71.4%
of children received breastfeeding initiation, which is a fairly substantial
percentile. The problem is the sustainability of breastfeeding—the breastfeeding
rate drops to 16.1% by one year of age (3). The American Academy of Pediatrics
highly recommends exclusive breastfeeding through the first six months and
continued breastfeeding through at least one year of age in order to ensure the
health benefits (1). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Ultimately, the flaw in this campaign is
assuming that individual level factors are exclusively influencing health
behavior—that is, women will breastfeed if they leave the hospital without
formula and with knowledge about the benefits. Breastfeeding is a very
difficult process and there are many barriers beyond simply those assessed in
this intervention.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";"> By
considering only individual level factors, the Latch On program ignores the
context beyond the hospital setting; they assume that women choose not to
breastfeed because they don’t know the benefits. Stress, lack of social support,
and work schedules are just some of the contextual factors that play a role in breastfeeding
decisions (7,8). Ultimately, all women need support beyond the day of birth to
ensure adequate breastfeeding practices. Simply de-promoting formula use and
increasing knowledge are not sufficient.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Critique #2: Ineffective
Use of Core Values<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The second critique of this campaign
is the use of health as the main core value. When developing a campaign, the core values of
the messages must be consistent with American values (9). Powerful American
values include individual freedom, freedom speech, and protection against
racial discrimination (9) and not health. Framing an issue accurately for
public approval is a very important component of public health campaigns (9).
In this particular campaign, the interventionists failed at framing Latch On
effectively to the public. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> A public health frame is strong if
it has a strong core position, utilizes metaphors, catch phrases, symbols, and
most importantly, a powerful core value (9). The tobacco industry is one such
example of a campaign that has been very successful due to the nature of its
core values. Despite the known negative health consequences of smoking, cigarette
campaigns have been successful because they appeal to freedom, autonomy, individual
rights, and economic opportunity (9). Tobacco control campaigns that have
utilized the core value of health have been less successful (9).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">To the left is a poster used in the
campaign (10). You can see here that the main core value used is health—breast
milk reduces a baby’s risk of ear infection, pneumonia, and diarrhea.
Throughout reading the promotional materials, I did not come across any
metaphors used in the campaign. The main symbol is the baby/infant, and the
catch phrases are “Latch On”, and “breast milk is best for you’re your baby”. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> In the press release for this
initiative, the State Health Commissioner, Nirav Shah, is quoted as saying,
“Mothers who choose to breastfeed their baby are making a healthy choice for
their child and themselves” (2). The Latch On initiative is focused solely on
health as a core value, which ultimately is ineffective with the public. </span><span style="color: #262626; font-family: "Georgia","serif"; mso-bidi-font-family: Georgia;">The
framing of this particular initiative created backlash because it did not
utilize core values that are important to Americans including freedom, justice,
and liberty (9).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="color: #262626; font-family: "Georgia","serif"; mso-bidi-font-family: Georgia;"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="color: #262626; font-family: "Georgia","serif"; mso-bidi-font-family: Georgia;">Critique 3: Failure of Health Communication Strategies <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="color: #262626; font-family: "Georgia","serif"; mso-bidi-font-family: Georgia;"> Latch
On also failed at utilizing effective communication strategies including
failure to consider psychological reactance theory and failure to utilize an
effective messenger. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="color: #262626; font-family: "Georgia","serif"; mso-bidi-font-family: Georgia;">This
particular initiative took away freedom by limiting new mother’s access to
formula. By putting away formula, and requiring that women request it from the
nurse, women felt that their individual freedoms were being limited. One particular
myth that spread rapidly was that the initiative was “</span><span style="font-family: "Georgia","serif";">jeopardizing a woman’s right to choose
how to feed her baby” (2). This type of reaction is a result of the
Psychological Reactance Theory, which states that any pervasive message may
cause an individual to feel that their personal freedom or personal choice has
been threatened (11,12). There are four main elements to psychological
reactance theory: freedom, threat to freedom, reactance and restoration of
freedom (11). In this case, the freedom is to receive formula in the hospital;
the threat is the removal of the formula; the reactance is the anger that results;
and the restoration of the freedom stage is when women go out and buy the
formula to reestablish their freedom.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">This type of reaction has also been
referred to as the Boomerang Effect (12). Warnings, among other types of public
health campaigns, sometimes produce opposite effects of those intended (12, 13).
One particular example of a public health campaign that produced boomerang, or
opposite effects, is the minimum age for alcohol beverages (12). Research has
revealed that increasing the legal age for drinking to 21 years of age may
actually have increased underage drinking (12).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">In public health, policymakers should
never limit individual freedoms if they want their interventions to be
successful (11).<b> </b>Taking away formula
only makes women want formula more, due to Psychological Reactance Theory. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">Psychological
reactance also may have occurred because of the lack of similarity of the
communicator to the targeted audience. Studies have shown that threats only
cause the boomerang effect when the communicator’s similarity was low or
unknown (14). When people are similar to the communicator, they agreed with the
message of the campaign, regardless of threat to freedom (14). Public health
campaigns can avoid reactance if they elect a communicator who is similar to
the targeted audience. The Latch On campaign does not employ these
communication principles. The messengers for this particular campaign are Mayor
Bloomberg, the Health Commissioners, and ultimately nurses and doctors. For
pregnant and nursing women, they need a spokesperson of whom is similar to
them—another mother or a peer. By using health officials and figureheads, the
Latch On program ideology was not relatable to their target audience. As a
result, their target audience—new mothers—rejected the program.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Introduction to New
Campaign<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> I propose a new intervention to
replace the Latch On campaign, which I believe will eradicate the three areas
where Latch On failed—lack of consideration of factors beyond the individual in
determining breastfeeding outcomes, ineffective use of core values, and lack of
health communication strategies. Instead of focusing on knowledge and formula
access, New York City public health officials should focus on antenatal
breastfeeding support. The data shows that the greatest area of need is
breastfeeding continuation, with only 16% of women breastfeeding their babies
through year one in the United States (3). I propose allocating funding to antenatal
breastfeeding peer education and group support in New York City hospitals. This
particular intervention will resolve the three failures of the original
campaign, by considering the context of breastfeeding, not just individual
level factors; by utilizing effective core values including individual freedom;
and avoiding psychological reactance through providing choices and a messenger
similar to the audience.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Support #1: Breastfeeding
Support, Improving the Context<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">Instead
of focusing on individual level knowledge and access to formula, the Latch On
Campaign should improve antenatal breastfeeding support, through both support
groups and peer education. Social support is highlighted as one of the most
significant predictive factors of breastfeeding initiation and lengthened
duration among low-income women (8)—not knowledge or access to formula, as the
Latch On Program advocates. In this study on low-income women, breastfeeding
experience, self-efficacy, support from the father and support from a grandmother
were all statistically significant correlates to lengthened breastfeeding
duration and better outcomes (8). Support is imperative to breastfeeding
success long term, not simply knowledge.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Social support is powerful in public
health. One particular prenatal care intervention, namely the Centering
Pregnancy program, is one such example that employs social support as a
mechanism to improve outcomes. For Centering Pregnancy, group prenatal care
resulted in lengthened gestation and increased birth weight (15).
Relationship-centered care empowers women to advocate for themselves and others
and gives them a social network of who can serve as a safety net and a sounding
board. The Centering Pregnancy prenatal
model of group-centered support groups can be applied to the antenatal period
as well. The United Nations Children Fund and the World Health Organization published
the 10 steps to successful breastfeeding (16, 19). The tenth step is “foster
the establishment of breastfeeding support groups and refer mothers to them on
discharge from the hospital or clinic” (16). Breastfeeding support groups are
an imperative piece to improving breastfeeding outcomes outside of the
hospital.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Breastfeeding peer counselors are another component of
antenatal support. Breastfeeding peer
counselors are defined as “</span><span style="color: #1e1c1d; font-family: "Georgia","serif"; mso-bidi-font-family: Times;">local community women who have
experienced breastfeeding success, have been trained in breastfeeding
management, and work with women of similar cultural, demographic, and socio-
economic characteristics to promote positive breastfeeding outcomes” (17).</span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Times;"> </span><span style="font-family: "Georgia","serif";">Training women to aid other women with
breastfeeding practices has been employed and effective in a variety of
developing countries, but few in the United States (17, 20, 21). A literature
review conducted by the National Institutes of Health revealed that
breastfeeding peer counselors improve breastfeeding initiation, duration, and
exclusivity and decreased rates of infant diarrhea (22). Studies have also
concluded that breastfeeding peer counselors are effective with low income,
minority women, who have some of the lowest rates of breastfeeding in the
United States (17).</span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Combining the principles of peer
education and group-centered support could help improve breastfeeding outcomes—especially
for women who might not have the best context—perhaps without a supportive
partner, family, safe neighborhood, among others. The creation of antenatal support
groups and peer counselors could help improve breastfeeding outcomes through
improving self-efficacy, knowledge, and social support for mothers. Women who
are supported in their breastfeeding process will more likely succeed in
persevering through the trials and tribulations of parenting and ultimately
have a better chance of breastfeeding through the first year of their child’s
life. Instead of taking away formula and focusing on knowledge, funding in New
York City should be allocated to antenatal breastfeeding support. Instead of putting away formula, nurses could
offer a breastfeeding peer educator and/or group-centered support for women in
each hospital in New York City. Immediately from the start, new mothers could
have a support system that is offered to them in the hospital immediately when
their baby is born. If framed and marketed effectively, this new program could
be very effective.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Support #2: Effective
Framing and Use of Core Values<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">Using
health as the main core value was entirely ineffective in the Latch On
Campaign. As a result, we need to re-frame and re-package the new breastfeeding
peer counseling campaign. Public health officials need to frame this campaign
as a women’s choice, not a loss of freedom. Freedom and liberty are powerful
core values in the United States (9), thus, any such campaign that takes away
freedoms (i.e. takes away formula), will be ineffective (11,14). In addition to
using powerful core value, public health officials need to employ effective
metaphors, symbols, and catch phrases in the new frame.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Core Values<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> Instead of framing health as the
core value, employing liberty and justice as core values could be effective.
Formula companies can be packaged as the enemy—their promotional strategies are
infringing upon a mother’s right to choose between breastfeeding and formula.
Because every hospital is covered in advertising and mothers are given formula
right from the start, women are not given the opportunity to choose whether they
want formula or not. Women have the right to reject the promotional strategies
of formula corporations, and choose whether they want to breastfeed or not. It
is one’s civil liberty to decide how they will feed their children and formula
companies, like tobacco companies, are targeting new mothers, without the well
being of their babies in mind. Women can make the choice to choose the peer
educator and group support over formula. The “the evil formula companies” frame
employs the core values of freedom and justice, which are more effective core
values than the heath frame used in the Latch On campaign.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Metaphors, Symbols, and
Catch Phrases<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";"> </span></b><span style="font-family: "Georgia","serif";">In
order to make this new frame truly effective, public health officials need to
create metaphors, symbols, and catch phrases to support the frame. Metaphors
and symbols should be recognizable and important to the American public in
order to be effective (9). Some potential catch phrases examples include:<o:p></o:p></span></div>
<div class="MsoNormal" style="text-indent: .5in;">
<i><span style="font-family: "Georgia","serif";"> “Putting
mom’s back in charge” <o:p></o:p></span></i></div>
<div class="MsoNormal" style="text-indent: .5in;">
<i><span style="font-family: "Georgia","serif";">“Taking the profit out of birth” <o:p></o:p></span></i></div>
<div class="MsoNormal" style="text-indent: .5in;">
<i><span style="font-family: "Georgia","serif";">“It is our civil right to protect our
babies” <o:p></o:p></span></i></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i><span style="font-family: "Georgia","serif";">“Take control of your baby’s outcomes.
Work with a breastfeeding peer educator”<o:p></o:p></span></i></div>
<div class="MsoNormal" style="margin-left: .5in;">
<i><span style="font-family: "Georgia","serif";">“She’s been through it before. She can
help you get through it, too.”<o:p></o:p></span></i></div>
<div class="MsoNormal" style="margin-left: .5in;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> Some important symbols to employ are
pictures of all kinds of women who serve as breastfeeding educators—of varying
ages, ethnicities and races--in order to appeal to the entire NYC population of
women. Posters should be available in multiple languages and focus on women’s
rights and self-empowerment. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> This campaign will be more
successful than Latch On because of the reframing, use of more effective core
values, and appeal to the audience at risk.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Support #3: Using Effective
Communications Strategies<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">The new campaign reduces psychological
reactance because women have options. They have the option to choose between
formula, or a peer educator and support groups. Giving women the option to
choose increases their freedom, instead of decreasing it. By giving women
options, psychological reactance is avoided. Women have the option to choose
formula, but they also have the option to work with a breastfeeding peer
educator and enroll in a breastfeeding support group. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Similarity of the messenger to the
audience is an important component of avoiding psychological reactance (14).
Breastfeeding peer educators work with women from their own community, who are
similar to them in </span><span style="color: #1e1c1d; font-family: "Georgia","serif"; mso-bidi-font-family: Times;">cultural, demographic, and socio-
economic characteristics (17). </span><span style="font-family: "Georgia","serif";">Because this program utilizes peers, who
are similar to the women they serve, psychological reactance is also avoided. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Another pitfall of the Latch On campaign
was using the Health Commissioner and Mayor as the spokespeople for the
campaign. Given the nature of psychological reactance, the spokesperson for the
new campaign should be a mother who breastfeeds, who is relatable to the
audience. Having a celebrity endorse a campaign makes it newsworthy and often
more effective (18). It could be potentially effective to use a celebrity
mother as the spokesperson for this new campaign in New York City.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Conclusion<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The Latch On campaign, although well
intentioned and backed with research, did not consider the predictable
irrationality of human behavior and social and behavioral sciences. The program
fails in three main ways. Firstly, breastfeeding outcomes are not attributed
solely to individual level factors. Stress, lack of social support, poverty,
working conditions all are factors that influence breastfeeding (8)—not simply
knowledge. Secondly, the program uses health as a core value, which is very
weak (9). Thirdly, the campaign produces psychological reactance, due to the
limiting of access to formula and the dissimilar spokespeople. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> A potentially effective intervention
for the low breastfeeding rates at 6 months and one year is breastfeeding peer
counselors and group support sessions. Funding should be allocated to training
breastfeeding peer counselors and organizing these group sessions. Nurses in
hospitals should offer this program to all new mothers in the obstetrics
department. This way, women can leave the hospital with a support system that
can help them breastfeed. This type of program is backed by a variety
research—peer educators and group support sessions are successful at improving
initiation and duration of breastfeeding outcomes (16, 17, 20, 21, 22). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">This new campaign corrects the errors
made by the Latch On Campaign, through the use of social and behavioral
sciences. Breastfeeding peer counselors and group support groups will resolve
the three failures of the original campaign, by considering the context of
breastfeeding, not just individual level factors; utilizing effective core
values including individual freedom; and avoiding psychological reactance
through providing options and a spokesperson who is similar to the targeted
audience. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
</div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-size: 16.0pt;">References<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph;">
<b><span style="font-family: "Georgia","serif";"> </span></b><b style="line-height: 200%; text-indent: 0.5in;"><span style="font-family: "Georgia","serif";"> </span></b></div>
<div class="ColorfulList-Accent11CxSpFirst" style="mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Calibri;">American
Academy of Pediatrics Policy Statement. Breastfeeding and the use of human
milk, section on breastfeeding. Pediatrics 2005; 115(2): 496-506.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Times;"> </span></i><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Times;">New York City Department of Health and Mental
Hygiene. Latch On New York City. </span><a href="http://www.nyc.gov/html/doh/html/ms/latchonnyc.shtml"><span style="color: windowtext; font-family: "Georgia","serif"; mso-bidi-font-family: Calibri; text-decoration: none; text-underline: none;">http://www.nyc.gov/html/doh/html/ms/latchonnyc.shtml</span></a><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Calibri;">.</span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Times;"><o:p></o:p></span></div>
<div class="ColorfulList-Accent11CxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Calibri;">Li R, Darling N, Maurice E, et al. Breastfeeding
rates in the United States by characteristics of the child, mother, or family.
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Times;">Dahlgren G.,
Whitehead M. Policies and Strategies
to Promote Social Equity in Health<i>. </i>Stockholm: Institute for
Futures Studies, 1991.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif";">Marks,
D. Health psychology in context. Journal of Health Psychology 1996; 1(1): 7-21.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial;">McKinlay, JB, Marceau, L.D. Upstream health public
policy: lessons from the battle of tobacco. International Journal of Health
Services 2000; 30(1): 49-69.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial;">Anderson-Kosmala, J. Breastfeeding works: the role
of employers in supporting women who who wish to breastfeed and work in four
organizations in England. <i>Oxford Journal
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Calibri;">Mitra AK,
Khoury AJ, et. all. Predictors of breastfeeding intention among low-income women.
Maternal and Child Health Journal 2004; 8(2): 65-70.</span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Times;"> </span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Calibri;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">9.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial;">Menashe, C.
& Siegel, M. The power of a frame: an analysis of newspaper coverage of
tobacco issues—United States, 1985-1996. <span style="color: #262626;">Journal of
Health Communication</span> 1998; 3(4):307-25.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">10.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Times;">Oh, I. </span><span style="color: #0e0e0e; font-family: "Georgia","serif"; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold;">Bloomberg's breastfeeding program, 'Latch On NYC,'
wants hospitals to change baby formula protocol. Huffington Post, 2012. </span><a href="http://www.huffingtonpost.com/2012/07/30/bloombergs-breast-feeding-latch-on-nyc-hospitals-hide-baby-formula_n_1718664.html"><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold;">http://www.huffingtonpost.com/2012/07/30/bloombergs-breast-feeding-latch-on-nyc-hospitals-hide-baby-formula_n_1718664.html</span></a><span style="color: #0e0e0e; font-family: "Georgia","serif"; mso-bidi-font-family: Arial; mso-bidi-font-weight: bold;">.</span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
<div class="ColorfulList-Accent11CxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">11.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial;">Dillard, JP & Shen, L. On the nature of
reactance and its role in health communication.” Communication Monographs 2007;
72(2): 144-168.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-bidi-font-style: italic; mso-fareast-font-family: Georgia;">12.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial; mso-bidi-font-style: italic;">Ringold, DJ. Boomerang
effects in response to public health interventions: some unintended consequences
in the alcoholic beverage market. Journal of Consumer Policy 2002; 25: 27-63.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">13.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Times;">Stewart, D.
W., & Martin, I. M. Intended and unintended consequences of warning
messages: A review and synthesis of empirical research. Journal of Public Policy and Marketing 1994; 13: 1–19.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">14.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial;">Silvia, P.
Deflecting reactance: the role of similarity in increasing compliance and
reducing resistance.” Basic and Applied Psychology 27(3): 277-84.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">15.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Calibri;">Zohar
M, Schindler Rising S, Ickovics J. Centering pregnancy group prenatal
care: promoting relationship-centered care. Journal of Obstetric, Gynecologic,
& Neonatal Nursing 2006; 35: 286-294.</span></div>
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<span style="font-family: Georgia, serif; line-height: 200%; text-indent: -0.25in;">16.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: Georgia, serif; line-height: 200%; text-indent: -0.25in;">Nickel, N., Labbok, M., Hudgens, M., et
all. The extent that noncompliance with the 10 steps to successful
breastfeeding influences breastfeeding duration. Journal of Human Lactation 2012;
XX(X): 1-12.</span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">17.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial;">Chapman, DJ, Morel, K, Burmudez-Millan, Young, S.
et all. Breastfeeding education and
support trial for overweight and obese women: A randomized trial. Pediatrics,
2012.<o:p></o:p></span></div>
<div class="ColorfulList-Accent11CxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">18.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Arial;">Aschermann-Witzel,
J., Perez-Cueto, F., et all. Lessons for public health campaigns from analyzing
commercial food marketing success factors: a case study. BMC Public Health 2012;
12:139.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">19.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Calibri;">Merewood A,
Heinig J. Efforts to promote breastfeeding in the United States: development of
a national breastfeeding awareness campaign. J Hum Lact 2004; 20(2): 1405.
<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">20.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Calibri;">Leit, AJ,
Puccini, RF, Atalah, AN, et all. Effectiveness of home-based peer counseling to
promote breastfeeding in the northeast of Brazil: a randomized control trial. Acta
Paedrics 2005; 94(6): 741-746.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">21.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Calibri;">Aidam, B.,
Perez-Escamillia, R., & Lartey, A. Lactation counseling increases exclusive
breast-feeding rates in Ghana. Community and International Nutrition 2004:
1691-1695.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Georgia; mso-fareast-font-family: Georgia;">22.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Georgia","serif"; mso-bidi-font-family: Calibri;">National
Institutes of Health. Breastfeeding peer counseling: From efficacy through
scale up. Journal of Human Lactation 2010; 26(3): 314-326.<o:p></o:p></span></div>
<br />
Mobolajihttp://www.blogger.com/profile/14048489686681786639noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-88548064115907997472012-12-24T08:58:00.000-08:002012-12-24T08:58:38.501-08:00Just Say No to Abstinence-Only Sex Education - Hasti Mehta<br />
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Times","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Teen sexual activity continues to remain a
prevalent problem for the United States (U.S). Although the proportion of high
school students who reported ever having sexual intercourse has remained steady
since 2001, it is still nearly half population (47%) (1). Approximately 47% of
adolescents aged 14-18 are sexually active, defined as having sex in the past
three months (1). Early sexual activity is associated with teen pregnancy,
increased risk of sexually transmitted infections (STIs) and a multitude of
other physical and mental problems. The U.S. still has the highest teen birth
rate amongst comparable countries even though teen pregnancy rates are at the
lowest levels since the National Center for Health Statistics (NCHS) began
tracking them in the 1940s (2,3). Despite these unnerving statistics, the
majority of states continue to implement abstinence-only education and the U.S.
continues to predominantly fund abstinence-only education. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><u><span style="font-family: "Times","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">Abstinence-Only Education <o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="line-height: 200%; mso-layout-grid-align: none; mso-pagination: none; tab-stops: 11.0pt .5in; text-autospace: none;">
<span style="color: #262626; font-family: "Times","serif"; mso-bidi-font-family: Arial;"> </span><span style="font-family: "Times","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">For a program to be considered an
abstinence-only education program, it must accomplish specific goals as put
forth by section 510 (b) of Title V of the Social Security Act (4).</span><i><span style="color: #262626; font-family: "Times","serif"; mso-bidi-font-family: Arial;"> </span></i><span style="color: #262626; font-family: "Times","serif"; mso-bidi-font-family: Arial;">The goal of
abstinence-only education is to create a social environment in which abstinence
from sexual activity before marriage is the norm. Abstinence-only sex education
also aims to teach students the importance of healthy, monogamous relationships
(namely marriage), the negative psychological impacts of sexual activity prior
to marriage, and the importance of being self-sufficient before engaging in
sexual activity. Overall, the program is designed as a way for youths to learn
how to make sound decisions regarding sexual activity and long-term
relationships. </span><span style="font-family: "Times","serif"; mso-bidi-font-family: Georgia;">This paper seeks to address what are believed to be the primary flaws
of the dominant, abstinence-only education program approach to sexual health
education; namely, 1) the lack of proper communication between educators and
students; 2) the role of individual level health belief models to account for
context; 3) the perceived lack of control caused by abstinence-only education
programs. Additionally, this paper will offer suggestions for how to improve
upon current public health practices, specifically addressing each of the three
criticisms outlined above.</span><b><span style="color: #262626; font-family: "Times","serif"; mso-bidi-font-family: Arial;"> <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<b><u><span style="font-family: Times, serif;">Critique 1: Lack of Relatable Educators<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"> A significant obstacle in the success of the abstinence-only
education programs is the difficulty that students have in connecting with the
individuals conveying the message. In 2005, 42 percent of teachers in the
United States were aged 50 or older compared to 11 percent of teachers who were
under the age of thirty (5). In 2011, 31 percent of teachers were aged 50 or
older compared to 22 percent of teachers who were under the age of thirty (5).
Although the average age of teachers has been on the decline, the problem on
connecting with the educator still remains. A message being delivered by
someone who is liked, similar, and familiar greatly increases the chance that
the message will be taken more positively (6).
Research has shown that a liked source can be more persuasive at times
when the message is difficult to process (7). This concept of “liking” is an
easy way for individuals to get others to comply with their requests (6). When
the person delivering the message is a friend or a known person, it induces
feelings of warmth and security and there is a smaller likelihood that the
individual will reject the request (8). Liking the person who delivers a
message increases the chances that those receiving the message will also agree
with the message (9). <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"> Similarity is another important factor that influences an
individual’s decisions. The effects of similarity, however superficial, can
create an instant bond between two people (10). When presenters are similar to
the audience, their credibility is increased and they have an easier time
connecting with the audience. Experiments conducted by Paul J. Silvia about the
effect of similarity and likeability on compliance and reducing resistance
found that when the presenter’s level of similarity was low or unknown, there
was a boomerang effect (9). However, when the presenter was highly similar to
the audience the audience agreed with the presenter regardless of the message
being delivered (9). The strength of similarity and its effects on persuasion
can easily be seen in an experiment conducted at a fundraiser on a college
campus where the contributions more than doubled when the phrase “I’m a student”
was added to the request (11). <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"> The last characteristic, familiarity, is also a large
influence on whether a message will be well accepted. Normally, individuals are
fond of things that are familiar to them (12). Prior experiments have found
that merely being exposed to the image of an individual in the past can
increase the likelihood that a person will remember the individual and be more
likely to be influenced by their statements (8). Although the abstinence-only message
being delivered in schools is targeted towards teens, it can be difficult for
them to be persuaded because they feel no connection with the teachers
delivering the message. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"> <i><o:p></o:p></i></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<b><u><span style="font-family: Times, serif;">Critique 2: Individual Level Health Models Failure to Account for
Context <o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"> The second significant obstacle in the success of
abstinence-only education programs is that they do not consider context. The
health belief model was developed to explain behavior at the individual level
(13). According to the health belief model, individual behavior is influenced
by four factors: perceived susceptibility, perceived severity, perceived
benefits of an action, and perceived barriers to taking that action (13). Based
on this model, an individual weighs the perceived benefits and the perceived
costs of an action and makes a rational decision based on the given facts. The
health belief model fails to factor in social or environmental influences. It
also assumes that all individuals are rational and nothing will influence their
decision once they have made it. This model treats individuals as though they
are living in a vacuum, not in the real world. While the health belief model
would work for one time quick decisions where the behavior will follow the
reasoned thought process, it is unlikely to work in situations where the action
must be sustained (14). Since the health belief model does not consider
context, it is unable to effectively influence behavior. Sexual</span><span style="font-family: "Times","serif"; mso-bidi-font-family: Arial;"> activity among
adolescents has frequently been characterized as unplanned and impulsive (15),
but these models are still used to insufficiently influence change amongst them.
<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: "Times","serif"; mso-bidi-font-family: Arial;"> Recent research has shown that there
is a definite difference in how individuals, specifically students, make
decisions when they are aroused and when they are not. Ariely and colleagues
conducted an experiment where they asked male undergraduate students to answer
questions in a “cold state” (where they were not aroused) and a “hot state”
(where they were aroused) (16). The research found that while in the “cold
state” the students were very rational, always took the moral high ground, and
predicted that they would use a condom during sexual activity (16). However,
when the students were in the “hot state”, they themselves did not know what
they would actually do and completely underestimated their actions (16). All
thoughts of prevention, rationality, and morality disappeared and they were 25
percent more likely in the aroused state than in the cold state to predict that
they would not use condoms (16). The research by Ariely et al. showed that the
students who could recite all the risks and negative consequences of sexual
activity in the cold state were simply irrational and unpredictable in the face
of passion. </span><span style="font-family: Times, serif;">Teens
know the risks that sexual activity can lead to while they are in school or at
home, but when it comes to an intimate setting, their perceived benefits and
risks can drastically change, thus leading to the very behavior the programs
are trying to prevent. </span><span style="font-family: "Times","serif"; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<b><u><span style="font-family: Times, serif;">Critique 3: Perceived Threat to Personal Freedom<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"> The third significant obstacle in the success of
abstinence-only education programs is that it specifically urges students to
abstain from sex entirely rather than teach them safe-sex alternatives (4). It
is common knowledge that freedom of behavior is an important part of human
life. In order to make decisions, people normally weigh their wants and needs
with the dangers and benefits and decide on ways to get what they want (17).
When a person’s behavioral freedom is reduced or threatened, the person will
begin to get agitated and look for ways to rebel (17). This need to recover
their lost freedom and ensure loss of further freedom is known as psychological
reactance (17). This is the problem plaguing the abstinence-only education programs.
Research conducted by Sharon Brehm has indicated that children as young as two
understand that their freedom is being threatened and will try to restore that
freedom (18). Brehm’s study concluded that this behavior demonstrates psychological
reactance because the children could not accept that they were not in control
and they had to assert their control even though it was not physically possible
(18). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-bottom: 12.0pt; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: Times, serif;"> Another
example of psychological reactance and its effects can be seen in the
experiment conducted on the effect on couples relationships based on negative
parental interference (19). The study found that the more the parents had a
negative impact, the more the couple stayed together (19). This experiment
proves that the more individuals are told not to do something, the more they
crave the opposite in order to assert their control. People are very intuitive
and can figure out when individuals who approach them do not agree with their
point of view. Kevin Hogan, author of “Covert Persuasion” states in his book
that “</span><span style="font-family: "Times","serif";">People are quickly
receptive to information and attitudes that agree with their point of view.
People will formulate arguments on the spot against any point of view that
disagrees with their currently held belief” (20). The concepts taught in
abstinence-only education programs are stated in a way that causes students to feel
as though their personal freedom of choice is being threatened.</span><span style="font-family: Times, serif;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<b><u><span style="font-family: Times, serif;">Proposed Intervention</span></u></b><b><span style="font-family: Times, serif;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"> As public health professionals continue to devise
different interventions to combat high teen pregnancy birth rates, it is
critical they realize the importance of implementing a program to which
students can relate. The proposed intervention will consist of three major
changes to the current model. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%; text-indent: .5in;">
<span style="font-family: Times, serif;">The first major change will
be a shift from teachers to peer educators as the main individuals who will
convey the message of abstinence-only education programs. Many studies have
proven the importance of having someone who is relatable when intending to
convey a message. In order to increase the chances of getting the message of
abstinence-only being the best way to prevent teen pregnancy across, peer
educators will be likeable, similar, and familiar (6,7). It will be important
to find students who are familiar with the student body and are well known. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%; text-indent: .5in;">
<span style="font-family: Times, serif;">The second change will
include implementing group level health models to introduce new behavior and
encourage change. Current individual level health models do not address
societal factors and the notion that individuals are inherently irrational when
making decisions (13,16). In order to reach the student body more widely, it is
important to implement alternative models that have the ability to affect
change in large groups of people and account for factors such as irrationality
and social norms (21). By implementing a group level health </span><span style="font-family: "Times","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">model it will be easier to change the
social norms and get a greater group of students to practice abstinence.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%; text-indent: .5in;">
<span style="font-family: "Times","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">The third change consists of changing
the way the abstinence-only model is currently framed
and turning it into a comprehensive sex education model to reach more students
and create a more effective program. With the current model threatening the
students’ control, it is important to develop a model that allows students to
understand that they have choices and it is up to them how they choose to be
safe when it comes to sexual activity. By creating a comprehensive sexual
health education program, the goal is to frame abstinence in a way that it
shows the students that they have more control when they abstain than when they
have safe sex. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<b><u><span style="font-family: Times, serif;">Solution 1: Shift from Teachers to Peer Educators <o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"> To be able to create an effective campaign that will be
able to spread the message of abstinence-only education programs it is
imperative to have likeable, similar, and familiar individuals presenting the
information to their peers. By placing peers who are well liked and familiar in
the role of educators, the students will be more likely to listen and accept
the message the students are putting forth. This concept of liking and its
positive effects in terms of influencing people was documented in Cialdini’s
book, in reference to the Tupperware party. He believes the Tupperware party is
the “quintessential American compliance setting” because it uses the idea of
liking to sell products (8). Simply because the request to buy the Tupperware does
not come from a stranger, the attendees are more likely to actually buy the products
(8). This proves that if the student educating his or her peers is well liked,
they will have the power to influence the thoughts of their peers. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"> Another characteristic that must be present in the peer
educators is that they must be similar to the group they are trying to teach. Similarities
do not have to be glaringly obvious, but something as trivial as having the
same style of clothing as their peers can place a positive spin on the message
being delivered (8). This theory was tested out at an antiwar campaign in the
1970s where one female volunteer was dressed as a “hippie” and the other was
dressed “straight” and it was found that each of the women attracted more
signatures for their petitions from similarly dressed individuals (22). This
example proves that dressing the same way and being able to blend in with the
crowd that you are trying to persuade can play a huge role in how the message
you deliver is perceived. Peer educators would be at much higher advantage than
teachers when informing students about abstinence-only education because they
are very similar to their peers. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"> The final characteristic that is beneficial in
efficiently persuading the students to understand the importance of abstinence
is to ensure the peer educator’s familiarity. From the first two requirements
we understand that the peer educator should be well-liked and similar to the
target audience. Guaranteeing that the peer educators are also familiar to a
majority of the study body is the last step. It would be beneficial to choose
an individual who is involved with student government or an accomplished
athlete that is well-known and liked by the students. An experiment conducted
during an Ohio election in which a man with little chance of winning changed
his last name to “Brown”, a family name of much of Ohio’s political tradition,
ended up victorious (8). From the previous examples it is evident that choosing
a well-liked, similar, and familiar student to educate his or her peers, the
acceptance of abstinence-only message amongst teens can go up significantly. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<b><u><span style="font-family: Times, serif;">Solution 2: Institute Group Level Alternative Models<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"> In order to combat the flaws the individual model, which
include not accounting for social norms, context, and irrational behavior, it
is recommended that an alternative model be used. The alternative model will
account for the group dynamic, unplanned behavior, visceral drives, and
irrational behavior (21). The idea of the “tipping point” as outlined by
Malcolm Gladwell would be effective in creating the intended effects. The
implementation of the group-level changes in a “hot state” rather than a “cold
state” would be another change that would bring about the intended effects of
abstinence-only education. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"> By creating
situations in which students are placed in a “hot state” of mind as mentioned
before, the message of abstinence may translate better when the students are in
a situation where they must make a sound decision (16). In order to make sure
that students are in a “hot state” of mind which can consist of fear, jealousy,
anger, or arousal, if would be important to invoke those feelings when the
message of abstinence-only education is being presented (16). In order to invoke
these feelings, several strategies can be used, including giving the students
reading exercises, having them watch videos, or having conversations that
invoke the feelings associated to the “hot state”. By giving the message to the
student when they are in the “hot state”, it is more likely that they will remember
the message when they are engaging in sexual activity. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%; text-indent: .5in;">
<span style="font-family: Times, serif;">Gladwell has written about
“tipping point”, which is the moment of critical mass, the inflection point,
the boiling point at which widespread change occurs (22) and this tipping point
is applicable to the diffusion of innovations theory. His book uses the example
of Hush Puppies, the well-known American shoe, which were dying out in early
1994 (22). The process by which they became a </span><span style="font-family: "Times","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">popular accessory again emphasizes the approach to be taken in
order to make abstinence-only more socially accepted.
In early 1994, Hush Puppies were dying out and the manufacturers were planning
on discontinuing the shoes, but they found that Hush Puppies were beginning to
become a fashion statement again in the clubs and bars in downtown Manhattan
(22). Soon fashion designers were asking the company to use the Hush Puppies in
fashion shoots and other high profile individuals were asking for a pair as
well (22). Soon after there was a huge increase in sales and the Hush Puppies once
again became a hot trend (22). This example demonstrates that there was a time
when only a few people wore the Hush Puppies, precisely because no one else was
wearing them, but after the shoe was picked up by two fashion designers, there
came a certain point where the shoes became a fashion statement unintentionally
(22). <a href="" name="_GoBack"></a>By applying the concept of the tipping point to
abstinence-only education, a few early adopters can fuel the trend, which will
eventually be adopted by the rest of their peers. In this way, abstinence will
become the norm rather than something students are resistant to. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"> <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<b><u><span style="font-family: Times, serif;">Solution 3: Emphasizes Freedom of Choice <o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="background: white; line-height: 200%; text-indent: .25in;">
<span style="font-family: Times, serif;">Abstinence-only programs
are very difficult to frame in a way that does not intrude on the students’
personal freedom of choice, thus the proposed intervention should include
resources for students who choose to engage in sexual activity to do so safely.
<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%; text-indent: .25in;">
<span style="font-family: Times, serif;">Applying advertising theory
to the abstinence program is another way to enact change in teens and frame the
idea in a way that is appealing to the intended audience. The three main </span><span style="font-family: "Times","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">components of advertising theory are
the promise, the support, and the core value (23). The idea of advertising
theory is to speak to the deepest aspirations that people possess and deliver a
message that addresses those aspirations. The promise will be adequately
supported by images, sounds, and stories that invoke certain core values that the intended audience holds dear to them (23). Advertising
theory emphasizes the desired behavioral change rather than the individual’s
current action (23). Advertising theory touches on the idea that people are
irrational and can be easily persuaded to change their opinion if the right
techniques are employed. In order to induce change by using advertising theory,
it is important to create a promise that the teen population can relate to and
may actually want. Once the promise is created, it would be important to
support the promise with related music and images that speak to teens. It is imperative
to ensure that the advertisement speaks to the core values that teens hold
dear, one of the main ones being freedom. By emphasizing the promise of freedom
of choice or freedom from burden at such a young age, advertising theory can be
effectively used to convey the message of abstinence-only to a larger audience.
<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%; text-indent: .25in;">
<span style="font-family: Times, serif;">The next piece would be to
market and brand the idea in a way that would be appealing to teens.
Appropriate use of marketing theory includes researching what people want and
applying those findings to create and package the message in a way that
fulfills the needs and wants of the target population (24). From the Florida
“truth” campaign it was found that students wanted “the facts” and then they wanted
to be left alone to make their own decisions (25). The “truth” campaign found
that if they wanted to be successful they would have to give alternate options
instead of just “don’t” (25). By defining freedom as one of the most prevalent
core values in teens, the abstinence-only education programs need to be
replaced by comprehensive safe-sex education programs that give teens the freedom
of choice and the chance to make an educated decision if they choose to engage
in sexual activity. In order to reach teens effectively, they need to receive
honest, effective sex education which helps them understand the options
available to them should they choose to engage in sexual activity, thus the
intervention should be amended to include a comprehensive sex education
component. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<b><u><span style="font-family: Times, serif;">Conclusion</span></u></b><span style="font-family: Times, serif;"><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;">In summary, although there
are good intentions behind the abstinence-only education programs, research has
shown that they are not effective at producing favorable results when it comes
to delaying early sexual activity and decreasing teen pregnancy rates. The most
obvious flaws include the lack of familiarity and similarity between the
educators and teens learning about abstinence, the lack of a group level intervention
that accounts for irrational behavior, and the threat to teens’ freedom of
choice at such a rebellious age. Through this intervention, the flaws of the
abstinence-only program can be seen and the proposed solutions of adding a
group-level, peer educated abstinence program with a comprehensive sex
education component can gain support.</span></div>
<div class="MsoNormal" style="background: white; line-height: 200%;">
<span style="font-family: Times, serif;"><br /></span></div>
<div align="center" class="MsoNormal" style="background: white; line-height: 200%; text-align: center;">
<span style="font-family: Times, serif; line-height: 200%;"><b>References</b></span></div>
<div align="center" class="MsoNormal" style="background: white; line-height: 200%; text-align: center;">
<br /></div>
<br />
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<br />
Mobolajihttp://www.blogger.com/profile/14048489686681786639noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-29202180608730644642012-12-24T08:49:00.000-08:002012-12-24T08:49:09.588-08:00Analysis and Critique of BPHC Helmet Safety Campaign – Yara Tayeh<br />
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<span style="font-family: "Georgia","serif";"> Nationally,
bicycle safety is a big concern and may be an even larger concern in the
Commonwealth of Massachusetts. According
to the Center for Disease control, the annual rate of bicycle-related emergency
visits </span><span style="font-family: "Georgia","serif"; mso-fareast-font-family: "Times New Roman";">is over 500,000 people in the US, and more than 700 people
die as a result of bicycle-related injuries (1). In Boston in particular, </span><span style="font-family: "Georgia","serif";">Commonwealth Avenue and Massachusetts
Avenue have the highest rate of bicycle accidents, according to three surveys
published by Boston Bikes in 2010 (2). </span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Boston
Bikes, a bicycle safety campaign and movement sponsored by Mayor Menino since
2007, reported in its key findings of a survey that citywide helmet usage was
up to 72%. This may seem like a high rate,
but the survey also reported that </span><span style="font-family: "Georgia","serif"; mso-fareast-font-family: "Times New Roman";">helmet use among EMS calls was only
45% (3). <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">Despite
these overwhelming statistics, it is evident that cyclists make up a large
portion of the population. </span><span style="font-family: "Georgia","serif"; mso-fareast-font-family: "Times New Roman";">According to the 2002 National
Survey of Pedestrian and Bicyclist Attitudes and Behaviors survey,
approximately 57 million people, 27.3 percent of the population age 16 or
older, rode a bicycle at least once during the summer of 2002 (4). So how can
we protect this large group of cyclists and not only encourage helmet wearing
but bicycle safety as a whole? <o:p></o:p></span></div>
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<span style="font-family: Georgia, serif;">Mayor
Menino has actively been promoting bicycle safety in Boston since 2007 but </span><span style="font-family: "Georgia","serif";">The Boston Public Health Commission very
recently launched a new campaign to promote bicycle safety in the city of
Boston in October of this year. The campaign introduces various advertisements across
high bicycle-traffic areas in Boston as well as stencils featured on bicycle
lanes on major streets in the city. The
advertisements scattered around Boston feature three images of bikers. In two out of the three advertisements, cyclists
<i>without helmets</i><b> </b>are depicted sustaining serious injuries. In the third
advertisement, a helmet-wearing female cyclist is portrayed as dirtied up but
virtually injury-free. The posters and stencils on city bike lanes share the
same or nearly identical messages stating that there are “No Excuses. Wear a
Helmet.” </span><span style="font-family: Georgia, serif; line-height: 200%; text-indent: 0.5in;">The
goal of the bicycle safety campaign is to promote and increase helmet use in
the city of Boston, with the central message that </span><span style="font-family: Georgia, serif; line-height: 200%; text-indent: 0.5in;">it is always safer to ride a bike with a helmet
than without a helmet (5)</span></div>
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<span style="font-family: Georgia, serif;">While
the Boston Public Health Commission has just recently released this campaign
for helmet safety—thus an insufficient amount of time has passed and proper
steps have not been taken in order to evaluate the program—there is evidence to
believe that the campaign will not be successful in increasing helmet use in
the greater Boston area. Several
problems emerge when analyzing this public health approach to helmet safety and
promotion. This paper will discuss three
central flaws in the helmet campaign’s design and will then proceed to explore
specific recommendations aimed at improving the approach to helmet safety. </span></div>
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<br /></div>
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<strong><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi;">First
Critique of Intervention: Health Belief Model is not appropriate for Helmet
Safety Campaign<o:p></o:p></span></strong></div>
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<span style="font-family: Georgia, serif;"><b> </b> The Boston Public Health
Commission’s campaign for bicycle and helmet safety follows the
well-established and one of the most widely used public health models, the
Health Belief Model (HBM), but even the most widely used model can be
inappropriate when looking at the context of the issue being addressed. The Health Belief Model asserts that health
behavior is motivated by the following six factors: 1) perceived susceptibility
to an issue, 2) perceived severity of an issue, 3) perceived benefits of an
action, 4) perceived barriers to taking that action, 5) the presence and
experience of a cue to action, and 6) the belief in one’s own self-efficacy
related to the behavior in question (6). Essentially, the HBM suggests that people
behave in a rational, predictable manner and that they carefully and
thoughtfully weigh susceptibility to, severity of, and barriers to an action against
the perceived benefits in order to logically make a decision. The HBM is a value expectancy model, which
refers to the assumption that people will behave in a certain way if they value
the outcome and if they believe that this particular behavior is likely to
results in that outcome (6).</span><strong><span style="font-family: Georgia, serif;"><o:p></o:p></span></strong></div>
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<span style="font-family: Georgia, serif;"><b> </b>Despite these logical assumptions,
it is clear that people do not behave as rationally and thoughtfully as
expected. According to several studies
including a study conducted by Clayton, Cantorrelo, and Johnstone, the Drug
Abuse Resistance Education program, which was largely modeled with an HBM
approach, was ineffective in reducing the rate of drug use and abuse in
elementary and middle school populations (7). Among other theories, D.A.R.E. program’s
entire basis revolved around student education about the severity and
susceptibility of drug use and abuse and the benefits of abstaining from this
unhealthy behavior, but the program was largely ineffective. Some studies have even observed an unintended
reverse effect; the establishment of the D.A.R.E program may actually have
increased the rate of drug use and abuse in evaluated populations and thus the
U.S. Department of Education has halted all federal sponsorships for D.A.R.E. programs
(8).</span><strong><span style="font-family: Georgia, serif;"><o:p></o:p></span></strong></div>
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<span style="font-family: Georgia, serif;"><b> </b>This failure in the HBM has been
observed in previous helmet safety campaigns, and the Boston Public Health
Commission’s recent campaign has failed to learn from previous shortfalls. Surveys
conducted by the Boston Bikes have determined that the target population—mostly
consisting of students at universities throughout the Boston area—simply do not
wear bicycle helmets </span><span style="font-family: Georgia, serif;">because
they are uncomfortable, too hot, or result in “helmet hair” (3). With
this invaluable data, the Boston Public Health Commission should not then turn
around and attempt to educate the public about bicycle safety and the
importance of helmets. Educating the
public about the perceived benefits of helmet use will certainly prove to be
ineffective. Bicycle and helmet safety
has been a core element in early health education in Massachusetts, but still
students choose not to wear helmets (9).
It is not a matter of self-efficacy—a person’s belief in his/her ability
to wear a helmet is not of concern here—but the perceived <i>susceptibility</i> of the individual is simply too low. Young adult populations have been educated
about the dangers of cycling without proper protective headgear, but the
perceived costs of wearing the helmet seem to outweigh the benefits through the
eyes of the trendy, young college student.
In human development, teenagehood and young adulthood are marked by what
is called the “Invincibility theory”, which is the belief that despite
perceived dangers, a life-threatening event simply will not occur to the
student as they perceive themselves to be invincible (10). Consequently, it is essential that the
Commission step outside of the limiting and inapplicable spectrum of the HBM,
dismiss the idea of bicycle education, and instead focus on the idea of
immediately changing the behavior, which may potentially instill a change of
attitude later on. <b><o:p></o:p></b></span></div>
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<span style="font-family: Georgia, serif;">The
Diffusion of Innovations theory and the idea of a “tipping point” suggests that
past a certain rate of adoption of a particular behavior, the rate of adoption
will escalate dramatically (11). The
premises and assertions of this theory may be more useful for the helmet safety
campaign. It is important to convince
the population of interest to change the behavior first—in this case the
behavior being helmet use—and with that behavior change the adoption of a
health-oriented mentality will come. This
new theory will be discussed further on. </span><strong><span style="font-family: "Georgia","serif"; font-weight: normal; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-bidi-theme-font: minor-bidi;"><o:p></o:p></span></strong></div>
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<span style="font-family: Georgia, serif;"><br /></span></div>
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<b><span style="font-family: "Georgia","serif";">Second Critique of Intervention: Forceful
messages have reverse effects, especially on youth <o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";">An
important psychological theory that must be considered when developing public
health intervention is the Theory of Psychological Reactance. According to this theory developed by Jack
Brehm, when behavioral freedoms are taken away, people will respond in the
opposite manner. Brehm writes:<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">“…people become
motivationally aroused by a threat to or elimination of a behavioral freedom.
This motivational state is what is called psychological reactance. It impels
the individual to restore the particular freedom that was threatened or taken
away. It does not impel the individual to acquire just any freedom--only the
one threatened or taken away will do” (12). <br />
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<span style="font-family: "Georgia","serif";">When a public health campaign
begins telling people what to do in a forcible manner, it is likely that the
public will respond to this threat to freedom with the opposite behavior. An example of this dilemma arises in the
abstinence-only campaign implemented in several cities and states across the
United States. According to a report
published by the Legal Momentum advocacy group and sponsored by Harvard School
of Public Health, not only are abstinence-only campaigns wrongly created under
the pretext of conservative ideologies and political motivations, they have
been proven to be rather ineffective in preventing sexually transmitted
diseases and pregnancies (13). The
report states that <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">“</span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman";">[w]hen youth schooled by
abstinence-only programs do become sexually active, the programs’ anti-condom
messages may actually discourage them from practicing safe sex, making the
negative information the programs offer about contraception and disease
prevention particularly dangerous. Such messages deny young people the
opportunity to receive vital education to protect their health and well-being
and, in particular, impede girls’ ability to avoid unwanted pregnancy and STIs
to which they are more biologically susceptible</span><span style="font-family: "Georgia","serif";">” (13). <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Georgia","serif";">Furthermore, the American
Public Health association cites that </span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Longitudinal
studies find that although abstinence pledgers, when compared to non-pledgers,
were more likely to delay initiation of intercourse, they were less likely to
use condoms and other contraception after initiation; at six-year follow-up,
pledgers experienced similar rates of STIs when compared to non-pledgers (14).<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">In addition,
the efficacy of mandatory helmet laws is under speculation because what may
have been perceived as increased helmet use among the population may actually
have been due to the fact that a large group of cyclists simply stopped biking
altogether as a result of the law.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">Like many
of these aforementioned interventions, the Boston Public Health Commission’s
helmet safety campaign fails to take into account the Theory of Psychological
Reactance. Instead, it relies on strong,
forceful language like the slogan “No excuses. Wear a helmet” to promote
healthy behavior. This is likely to be a
significant shortcoming of the campaign in the future. Rather than taking away freedom from the group,
the intervention should focus on <i>giving </i>the
population something that they desire.
Shifting directions and thinking less about campaigning and more about
advertising may be just what this campaign needs (and this will be discussed
further along in the paper).<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"><br /></span></div>
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<b><span style="font-family: "Georgia","serif";">Final
Critique of Intervention: Inappropriate use of marketing images<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";">The
helmet safety campaign puts too grand of an emphasis on fear. Catch phrases like “No excuses” and displaying
images of bloodied and severely injured peers only strives to scare the population.
Instilling fear in this target population does not seem like it will be a very
effective mechanism for promoting a healthy behavior. A study was published in the Journal of
Psychology and Health that explored the use of fear arousal in health
education. It found no solid evidence
that fear as a central message in campaigns and health education is an
effective means to promote behavior change (15). The study states that “</span><span class="singlehighlightclass"><span style="font-family: "Georgia","serif"; mso-fareast-font-family: "Times New Roman";">fear</span></span><span style="font-family: "Georgia","serif"; mso-fareast-font-family: "Times New Roman";">
control processes may interfere with precautionary motivation, recommends
cautious and limited <span class="singlehighlightclass">use</span> of <span class="singlehighlightclass">fear</span> appeals in <span class="singlehighlightclass">health</span> promotion. It seems likely that <span class="singlehighlightclass">fear</span> arousal is less important in motivating
precautionary action than perceptions of action effectiveness and
self-efficacy” (15). The authors of the
study recommend cautious use of fear appeals for health educational campaigns,
suggesting that campaigns may profit more from highlighting the personal
relevance of threats to health and the feasibility of preventative action
rather than “frightening people about the severity of outcomes following risk
behavior by showing images of death and injury” (15). <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">By
contrast, a meta-analysis performed by the Department of Communication at
Michigan State University that reviewed the use of fear appeals in public
health campaigns found intriguing results (16). </span><span style="font-family: "Georgia","serif"; mso-fareast-font-family: "Times New Roman";">The meta-analysis suggests that
strong fear appeals produce high levels of perceived severity and susceptibility,
which confirms the efficacy of the Health Belief Model for certain public
health campaigns. It appears that strong fear appeals followed by high-efficacy
messages are most successful in producing behavior change, whereas strong fear
appeals with low-efficacy messages are met with higher levels of defensive
responses (16). In what realm does the Boston
Public Health Commission’s helmet safety campaign lay? While wearing a helmet requires little
effort, perhaps this meta-analysis did not take into account the age group and
the behavior in question. It is likely
that the target population is immune to strong appeals to fear because of the
aforementioned Invincibility theory. Because
the population of interest has such little perception of susceptibility, then a
strong fear appeal will only lead to defensive reactions and overcompensated
behaviors.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">Rather
than relying on fear appeals, the Boston Public Health Commission should focus
on marketing and appealing to the <i>aspirations</i>
of youth. Marketing theory has been very effective in all different fields,
including business, product promotion, and public health, which will be further
discussed below.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"><br /></span></div>
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<b><span style="font-family: "Georgia","serif";">A
New Proposal: Redefining helmet safety in Massachusetts<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";">Although
the helmet safety campaign sponsored by the Boston Public Health Commission
uses traditional designs to promote healthy behavior, there is evidence to
suggest that this campaign will not be entirely successful in increasing helmet
use in Boston, Massachusetts. The
following sections will propose an alternative approach to this helmet
campaign, building off of and improving upon the design of the current
campaign.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">I propose
three modifications to the campaign: 1) focus on immediate behavior change
rather than trying to educate the public by providing discounted helmets to the
public, 2) instead of taking the freedom away from cyclists by forcing them to
obey the law with “No excuses”, <i>promise</i>
<i>freedom</i> to the cyclists and <i>give</i> them something instead, and lastly
3) employ marketing techniques to inspire helmet use and change the face of the
posters scattered around Boston. Let us
begin by individually examining each of these modifications and try to
understand the social and behavioral theories that support these changes to the
campaign.<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"><br /></span></div>
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<b><span style="font-family: "Georgia","serif";">First
Defense of New Intervention: Change behavior, change a mind<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";">The
helmet safety campaign is largely based off of the Health Belief Model, where
educating the public about the severity and susceptibility of bicycle accidents
in order to promote helmet use is significantly stressed. But we have seen how in more than one case,
the Health Belief Model just does not seem to work out as well as expected,
especially when dealing with youth who do not feel especially susceptible to
the dangers of the road. The Diffusion
of Innovations Theory explains the pattern and rate of behavior adoption in
society, which is usually portrayed by a sigmoidal curve (17). Along the curve range people we call
Innovators, then Early Adopters, then the Early Majority, the Late Majority,
and finally at the very end of the curve are the Laggards (in order of early to
late adopters of the behavior of interest).
In a study conducted by James Dearing, Edward Maibach, and David Buller,
the Diffusion of Innovations theoretical approach was explored in promoting
physical activity (18). Among other results,
the study found that in order to be effective, interventions should </span><span style="font-family: "Georgia","serif"; mso-fareast-font-family: "Times New Roman";">focus
on tailoring messages according to each individual’s degree of readiness (where
he/she is on the sigmoidal curve) and employ change agents to interact with
potential adopters (18). <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";">In his
book, <i>The Tipping Point</i>, Malcolm
Gladwell writes about the phenomenon called the “tipping point”, which is the
idea that explains change as not a gradual occurrence but something that
happens at one dramatic moment of time; little changes can have big effects (11). So how can we combine both the Diffusion of
Innovations Theory and this “tipping point” concept to promote helmet use?<o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif"; mso-fareast-font-family: "Times New Roman";">The Boston Public Health Commission should
focus on providing discounted helmets to the target population, and past a certain
point of behavior adoption, the use of helmets should escalate dramatically. When
just a small subset of people potentially adopts helmet safety, they, in turn,
will influence the vast majority of other potential adopters to use a helmet while
cycling.</span><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"> The Boston Public Health
Commission’s agenda has included providing $5 bicycle helmets to cyclists in
the past, but students do not want cheap and unstylish</span><span style="font-family: "Georgia","serif"; mso-fareast-font-family: "Times New Roman";">
headgear (5). </span><span style="font-family: "Georgia","serif";">These helmets should be stylish and have
a slightly aerodynamic shape so as to be more aesthetically appealing. It is important that the helmets are fun and
sleek, but still of the highest and safest quality. The helmets can even be
designed to have built in compartments made of breathable material—perhaps
built in headphones—that does not jeopardize the safety of the rider. If the Boston Public Health Commission
focuses on making the helmets more fashionable and appealing, then perhaps more
people will begin wearing the helmets.
Another strategy could be to pay public health professionals to cycle
around Boston while sporting these fashionable helmets. The more these helmets are sighted, the more
likely observers will be to begin wearing helmets until the number of peoples
wearing the helmets will pass the “tipping point” and escalate dramatically. <o:p></o:p></span></div>
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<span style="font-family: "Georgia","serif";"><br /></span></div>
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<b><span style="font-family: "Georgia","serif";">Second Defense of New Intervention: Advertising
for freedom<o:p></o:p></span></b></div>
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<span style="font-family: "Georgia","serif";">The
Advertising Theory can take the idea of providing discounted helmets one step
further. Not only should these helmets be
stylish, they should display one single word on them—a word that the bicyclists
themselves can choose. For example, a
bicyclist can either custom-make the helmet by selecting a word that holds
great meaning for him/her (such as “hope” or “freedom” or “courage” or the name
of a significant other or perhaps a loved one who has passed) or he/she can
choose from a range of helmets with a range of statements. Imagine how these helmets can immediately
transform from unstylish and annoying to equipment that symbolizes the ideals
and system of beliefs of the wearer. The
helmets can become symbols of youth, independence, originality, and most of all
freedom. Students will want to wear
their helmets in order to proclaim to the world what they stand for and compare
their symbols with others. Imagine if one
cyclist reads the word on another’s helmet and this ends up striking up a
wonderful conversation between two strangers.
The helmets can come to symbolize and expand the social lives of those
who wear them. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";">Advertising
Theory focuses on meeting the needs and desires of the intended audience, promising
the audience that they will be or feel a certain way if they adopt this
particular product or behavior (19). These
helmets potentially make promises of freedom, uniqueness, and expression to
consumers. Relying more on Advertising
Theory quickly bypasses any sort of psychological reactance that may occur as a
result of strong, forceful messages (“No excuses. Wear a Helmet”) and instead
empowers bicyclists to take control of their own lives. This change in campaign design may
significantly improve rates of helmet usage in Boston.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<b><span style="font-family: "Georgia","serif";">Final Defense of New Intervention: Appealing to aspirations<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";">Lastly,
let us take a look at Social Marketing Theory and see how it can apply to and
support the modified helmet safety campaign.
Social Marketing Theory is based on the idea that the behavioral and
social change of interest should be reframed and repackaged in such a way so as
to make it more appealing and more tailored to the target beneficiaries (20). Public health professionals must focus on
tailoring the message according to the needs and values of the audience, as
well as appealing to the population’s preferred channels of communication (20). <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";">Social
Marketing Theory has been found to be the most effective model used to
influence behavior change, specifically in regards to sexual health (21). The Hombres Sanos, a social marketing
campaign aimed at the promotion of condom use and HIV testing for Latino men
and women, was well-received and showed promising results. This campaign employed social marketing
techniques—which involved consumer-centered, culturally sensitive
communication, branding and catchy slogans, as well as visual media such as
appealing and humorous posters—in order to promote condom use and HIV testing (20). The campaign really focused on the
population’s interests and aspirations, molding its message and tone to fit the
needs and values of Latino men and women. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-indent: .5in; text-justify: inter-ideograph;">
<span style="font-family: "Georgia","serif";">So
how can we employ social marketing techniques in order to increase helmet
safety in Boston? The helmet safety campaign should appeal to the <i>aspirations</i> of the youth that are not
wearing helmets via various media used by youth. What do young, college-level adults aspire
for? What do cyclists aspire for? Let us return to the idea of freedom and fun
introduced earlier in this paper. College
students usually strive for independence, fashion, and a good time, and we know
that helmets do not necessarily evoke any of these values. How can we transform perceptions of bicycle
helmets? Building upon the proposals
mentioned earlier, public health professionals should focus on advertising for
the new, trendy bicycle helmets using empowering and stylish posters scattered
around Boston as well as utilize social media as a means of communication. These posters and advertisements should be
catchy and appeal to the motivations of freedom and independence, branding
these helmets as tools for expression. All materials for the campaign should be
consistently branded under the concepts of independence, strength, and
empowerment. The helmet brand could be
called ‘Xpression’, which emphasizes that these helmets are not just for safety
but mainly for the <i>freedom of expression</i>. Envision an electric poster that shows the
silhouette of a man or woman on a bike with the words “strength” or “fierce” or
the catch phrases “I am my own person” or “keep smiling” imprinted on his/her
helmet. The poster will display a single
phrase on it “Xpression: what defines you?”
This poster would strike the average college student more than an image
of a young adult male covered in blood after a bicycle accident.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-align: justify; text-justify: inter-ideograph;">
<a href="" name="_GoBack"></a><span style="font-family: "Georgia","serif";"> Overall, the Boston Public Health
Commission’s helmet safety campaign can be improved by using and modeling after
theories such as the Diffusion of Innovations Theory, Advertising Theory, and
Social Marketing Theory. “No Excuses.
Wear a helmet” just does not sit well on the tongue, but a campaign that
revolves around empowering youth while still remaining fashionable and easily
adoptable may just be what Boston has been waiting for all this time.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="MsoNormal" style="text-align: center;">
<b><span style="font-family: "Georgia","serif";">REFERENCES</span></b><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-justify: inter-ideograph;">
<b><span style="font-family: "Georgia","serif";"><br /></span></b></div>
<div style="text-indent: .5in;">
<span style="font-family: "Georgia","serif"; font-size: 12.0pt;">(1)
Center for Disease Control and Prevention. <i>Bicycle
Related Injuries</i>. Atlanta, GA: Home and Recreational Safety, 2009. http://www.cdc.gov/homeandrecreationalsafety/bikeinjuries.html<br />
(2) The Daily Free Press. <i>Bike initiatives aim to increase cyclist’s
safety</i>. Boston, September 2012. http://dailyfreepress.com/2012/09/20/bike-initiatives-aim-to-increase-cyclists-safety/<br />
(3) City of Boston. <i>Bike Statistics</i>. Boston, MA: Parks and
Recreation Department, 2010. http://www.cityofboston.gov/bikes/statistics.asp<br />
(4) Pedestrian and Bicycle
Information Center. <i>General Bicycling
Statistics. </i>North Carolina: University of North Carolina Highway Safety
Research Center. http://www.bicyclinginfo.org/facts/statistics.cfm<br />
(5) Boston Public Health
Commision. <i>Helmet Safety Campaign</i>. Boston,
MA: Injury Prevention, 2012. http://www.bphc.org/programs/cib/healthyhomescommunitysupports/injuryprevention/Pages/HelmetSafety.aspx<br />
(6) Individual health
behavior theories (chapter 4). In: Edberg M. <i>Essentials of Health Behavior: Social and Behavioral Theory in Public
Health.</i> Sudbury, MA: Jones and Bartlett Publishers, 2007, pp. 35-49.<br />
(7) </span><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Clayton RR, Cattarello AM, Johnstone BM. The effectiveness
of Drug Abuse Resistance Education (project DARE): 5-year follow-up results. <i>Preventative Medicine</i>, 1996; 3: 307-318.<br />
(8) Hanson, D.J. Alcohol
Abuse Prevention. <i>Drug Abuse Resistance
Education: The Effectiveness of DARE</i>. Potsdam, NY, 2007. </span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;"> </span><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">http://www.alcoholfacts.org/DARE.html<br />
(9). Mass Ride. <i>Safe Routes to School Funding in
Massachusetts</i>. Massachusetts: Safe Routes to School National Partnership,
2012. http://www.saferoutespartnership.org/state/srts-in-your-state/massachusetts.
<br />
(10) Jack, M.S. Personal
fable: a potential explanation for risk-taking behavior in adolescents. <i>Journal of Pediatric Nursing, </i>1989;
5:334-338.<br />
(11) Introduction. In:
Gladwell M. <i>The Tipping Point: How Little
Things Can Make a Big Difference</i>. Boston: Little, Brown and Company, 2000,
pp.3-14.<br />
(12) Brehm, J.W. Psychological
Reactance: Theory and Applications. <i>Advances
in Consumer Research</i>, 1989; 16, 72-75.<br />
(13) Legal Momentum:
Advancing Women’s Rights. <i>Sex, Lies,
& Stereotypes: How Abstinence-Only Programs Harm Women and Girls</i>. New
York: Committee on Oversight and Government Reform, 2008.<br />
(14) American Public Health
Association. <i>Abstinence and U.S.
Abstinence-Only Education Policies: Ethical and Human Rights Concerns</i>. Washington,
DC: Advocacy and Policy, 2006.<br />
(15) Ruiter, R., Abraham, C.,
Kok, G. Scary warnings and rational precautions: A review of the psychology of
fear appeals. <i>Psychology and Health</i>,
2001; 16:6.<br />
(16) Witte, K. and Allen, M.
A Meta-Analysis of Fear Appeals: Implications for Effective Public Health
Campaigns. <i>Health Education and Behavior</i>,
2000; 27:591.<br />
(17) Dearing, J. Applying
Diffusion of Innovation Theory to Intervention Development. <i>Research on Social Work Practice</i>, 2009:
19:503.<br />
(18) Dearing, J., Maibach, E.
and Buller, D. A Convergent Diffusion and Social Marketing Approach for
Disseminating Proven Approaches to Physical Activity Promotion. <i>American Journal of Preventative Medicine</i>,
2006; 31:4.<br />
(19) Grier, S. and Bryant, C.
Social marketing in public health. <i>Annual
Review of Public Health</i>, 2005; 26:319-339.<br />
(20) Andreasen, A. <i>Marketing
Social Change: Changing Behavior to Promote Health, Social Development, and the
Environment</i>. Jossey-Bass,
1995.<br />
</span><span style="font-family: "Georgia","serif"; font-size: 12.0pt;">(21) Cardeno, A. et al.
Marketing HIV Prevention for Heterosexually Identified Latino Men Who Have Sex
with Men and Women: The Hombres Sanos Campaign. <i>Journal of Health Communication: Health Perspectives</i>, 2012; 17:6.</span><span style="font-family: "Georgia","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
Mobolajihttp://www.blogger.com/profile/14048489686681786639noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-74225515273646930272012-12-24T08:39:00.001-08:002012-12-24T08:39:47.956-08:00Distracted Driving: The Plight of Teenagers and Texting<br />
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Distracted driving has become a serious
issue in this country; vehicular accidents can easily occur when drivers are
doing something other than focusing on driving. With the rapidly rising
popularity of cellular phones, their use in the car has increased as well. Talking
on the phone while driving is problematic, however, texting while driving is
even more problematic as that requires the driver to use his or her fingers
while driving, as opposed to simply holding the phone to his or her ear. In
2010, 2.052 trillion text messages were sent and received by cellular phone
users (1). Texting has been the cause of many injuries and fatalities due to vehicular
accidents. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";"> Teenagers
communicate on their smart phones mostly by texting, and the rate of texting is
highest amongst teenagers. Further, the rate of texting while in a vehicle is
also highest amongst teenagers. Drivers aged 16 to 24 were most likely to use a
handheld electronic device as was reported in a 2008 National Highway Traffic
Safety Administration report (2). In a study using college students, 91% of participants
reported texting while driving (3). Young drivers are new drivers and
accordingly inexperienced and more likely to cause vehicular accidents,
especially if they are distracted while driving. Motor vehicle accidents are
the leading cause of death among adolescents and young adults (4). Thus the
risk of vehicular accidents caused by distraction is greatest amongst
teenagers. A Florida study on 16 – 24 year old drivers found that 87.2% stated
that they use cellular phones while driving and 70.4% use hand-held phones (5).
The largest proportion of distracted drivers is under the age of 20; 11% of
fatal crashes involving drivers in this age group were distracted (6). Action
should be taken to curb distracted driving as a whole, with a special focus on
texting and driving, especially among teenagers. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Distracted.gov<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> There are several existing public
and private campaigns that aim not only to educate drivers about distracted
driving but also to decrease its pervasiveness. Chief among these campaigns is Distracted.gov,
the Federal government’s official website for distracted driving. The website
includes educational information, ways to become involved, and things to do to
help keep American roads safe. The website seems to do a good job of compiling
and showcasing information about distracted driving, however, there are changes
that could be made to improve certain aspects of the website geared towards
teenagers to help them comply with the laws that govern cellular phone use
while driving. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">The website is designed to serve parents,
teens, educators, and employers, and it is thus heavy with statistics and
scientific information. On its main menu, it offers options to peruse
categories such as statistics, research, and state laws. Teenagers have become
accustomed to receiving information in short (and often entertaining) bursts
and at a fast pace. Those teenagers who find their way to Distracted.gov would
likely become bored with the presented material, losing focus, and consequently
disengaging. The website does have a section with videos, something younger
individuals are more likely to view. There is also a section titled “Glee
Campaign” (7) which describes a partnership with the television show <i>Glee</i>. <i>Glee</i> is very popular with teenaged viewers. Aside from a distracted
driving PSA video, this section of the website contains mostly additional
statistics. There are web banners and infographics, but they are comprised of
quotes such as “<span style="text-transform: uppercase;">A texting driver is 23
times more likely to get into a crash than a non-texting driver</span>” (7).
The message -- which signifies someone yelling as it is all capitalized -- is
very direct, but it borders on abrasive and may only incite fear in its readers.
There is nothing in the <i>Glee</i> section
showing cast members of the program. This is a missed opportunity to use
celebrities as spokespeople to convey messages about distracted driving. It has
been demonstrated that the success of changing the behavior of groups is tied
to the behavioral model used, and that adding or changing the use of a model
can improve outcomes. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Critique 1: Eliciting
Psychological Reactance<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The Psychological Reactance Theory, developed
by Sharon Brehm, explains what happens when there is a perceived loss of
control due to being told what one can or cannot do. As a rule, people like to
feel in control and perceived loss of control can create serious effects. Control
is a drive like hunger and thirst, and being in control lights up the pleasure
centers in the brain. These same pleasure centers also light up when people
feed their addictions. Humans are thus biologically programmed to do the
opposite of what they were told not to do in order to regain control. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Many public health and safety campaigns
make the mistake of triggering reactance by telling the population what they
should be doing. In general, teenagers do not like being told what to do, and
greatly desire their freedom. The teenage years are spent working on gaining
independence from parents and other authority figures. Distracted.gov uses
slogans such as “Stop the Texts, Stop the Wrecks” (8) in an attempt to reduce
teens’ combining texting with driving. Therefore, telling teenagers to stop
texting (because it is unsafe) creates a greater desire for them to do so, over
and above their simple desire to communicate. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Further, in a posted message, Secretary
of Transportation Ray LaHood states that, “There's one message we hope everyone
receives loud and clear: the safest way to get from one place to another is to
hang up and drive. Powering down your cell phone when you're behind the wheel
can save lives - maybe even your own” (9). These messages, while certainly
valid, incite reactance because they do nothing other than tell young people to
stop texting and driving. Additionally, studies have shown that the more
explicit the message, the more reactance it will evoke (10). The Transportation
Department’s messages are extremely explicit; consequently, the level of
reactance in teens is high. Ultimately, the messaging backfires on its goal and
may actually encourage texting. The key to reducing reactance is the frame used
to convey the message; the frame should appeal to and include the audiences’
core values. A negative frame, often used in public health, is not as
successful as positive frames used in marketing and advertising. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Critique 2: The Weakness of
the Use of the Health Belief Model<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The Health Belief Model, a
traditional theory developed to predict health-related behaviors (11), states
that behavioral decisions are made at the individual level, weighing perceived
costs and benefits. The individual incorporates perceived susceptibility and
severity into the perceived benefits. While the Health Belief Model is often
used in public health, it does not do a good job of addressing the necessity to
change behavior prevalent in epidemics (and distracted driving is becoming
epidemic) because of its underlying assumption that people behave rationally.
The model also assumes that once people make a decision to change their
behavior, that change will take place, making no distinction between theory and
practice. This is not the case because human decision-making typically involves
irrational behavior (12). Traditional behavioral models were developed in the
1960s, and were effective for one-time health-related decisions such as
immunization, but have been ineffective regarding addiction and long-term
changes (13). Texting has become an addiction, especially for young adults. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Teenagers may be concerned about
vehicular accidents and fatalities but simply inundating them with statistics
and the consequences of texting and driving does not necessarily mean they will
act differently the next time they receive a text message while operating a
vehicle. Assuming teenagers will change their distracted driving behavior
because they have the knowledge of its dangers is similar to assuming teens
will stop or (better yet) never start smoking. Adolescents’ decision-making regarding
smoking is based on emotions not rational thinking (14). Teens have always
participated in risky behavior and simply providing them with a plethora of
information regarding the risks will, unfortunately, be ineffective in
accomplishing the goal of behavioral change.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The Health Belief Model uses the assumption
that behavior is changed on an individual level. However, many teenagers are
socially oriented, wanting to spend all of their time with their friends.
Teenagers adopt ways of dressing, speaking, and behaving by copying each other,
especially if a behavior is perceived as cool. Distracted.gov does make the
attempt to address teens on a group level (rather than simply as individuals)
by offering information for organizing school presentations and hosting other
distracted driving events. However, downloadable information and posters to be
used during these events include negative and scary messages, and more
statistics. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> Another assumption that is made by
using the Health Behavior Model is that teenagers will weigh the costs and
benefits of abstaining from texting and driving. Again, this is a flawed
approach; if teenagers weighed the benefits of discontinuing risky behavior we
would no longer have adolescent smoking, drinking, engaging in sexual activity,
and the ensuing unplanned pregnancies. Unfortunately, using the Health Belief Model
does not address the need to account for teenagers’ persistent irrational and
group-influenced decision making. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Critique 3: Lack of
Celebrity Peers and Role Models <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> Distracted.gov includes, among many
other things, videos, which have become very popular especially with younger
viewers. As the cliché states, “a picture is worth a thousand words” (15).
Videos are far more user-friendly and easier to grasp than reading text. The
majority of these videos are tragic and heart-breaking stories about lives lost
to distracted drivers. Family members and friends describe the victims and also
talk about how their lives were sadly taken. The videos include victims of all
ages, races, and geographical locations. There is also a range of ages among
the friends and family members speaking in the videos. There are many parents
speaking about the loss of a son or daughter. Teenagers do speak about the loss
of a friend or family member, however while they may be similar to the target
audience in age, they are not familiar to their audience. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> There are few other images of people
on the website. Of these, approximately 75% are of government or law
enforcement personnel. For example, there is a large image of the Secretary of Transportation
on his message page. There is also an image of the Secretary shaking the hands
of law enforcement agents at an event. A third image shows the Secretary
speaking from a podium with officials standing behind him on the stage. It is
clear that these images are present to not only identify the Secretary, but
also show the department’s activities, however additional opportunistic images
have been omitted. An image showing the Secretary at an anti-distracted driving
event for teens, interacting with them, would have been a great choice to add
to the image library. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> In addition to the lack of
celebrities and role models on the website, the images of other teens involved
in activities they enjoy are also lacking. The main menu of the website
includes a section specifically for teens, but there are no fun group images
showing teens at an event in this section. It is clear that the topic of
distracted driving accidents and fatalities is heavy, serious, and no laughing
matter, but inundating teenagers with that kind of atmosphere will not be
effective. Websites such as the84.org and thetruth.com, both anti-youth smoking
movements, have images and videos throughout the website showcasing smiling and
engaged teens at events. These menu categories on the websites include games,
sports, music, merchandise, and art. These are concepts that interest teens, unlike
facts and statistics, although those are also included on these websites. One
image on the thetruth.com’s sports section shows teens on the beach at a
surfing event in Hawaii. The caption reads “(T)ruth ripping it up. We’re
hanging loose and taking in the Vans Triple Crown event in Hawaii” (16). By
incorporating videos of things teenagers love on their website, sporting activities
for example, the campaign is able to find a way to get teens to come back to
the website. Adolescent viewers will return to the site to see if videos and<a href="" name="_GoBack"></a> images of additional sporting events are posted. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> As previously mentioned, the
Department of Transportation has partnered with <i>Glee</i> and lists information regarding this collaboration on
Distracted.gov. This is another missed opportunity as there are no images or
videos of the cast members. The PSA in this section calls itself the “Glee
Distracted Driving PSA” (7) but other than the <i>Glee</i> logo in the bottom right-hand corner of the video, there is only
one other mention of <i>Glee</i> on the
webpage. A brief paragraph describing the campaign states “Thanks to the cast
of Glee for their continued efforts to raise awareness about this issue” (7). Based
on what is listed on the website, the particulars of the affiliation with the
television program feel sparse. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Additional Features
on Distracted.Gov Could Increase Teen Compliance</span></b><b><span style="font-family: "Georgia","serif";"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The website Distacted.gov is put
together well and offers an abundance of information geared toward distracted
driving education and ways to reduce its prevalence and consequences. However,
additions or improvements can be made to the website so that it may work better
in interesting teenagers. Appealing to teenagers’ core beliefs of freedom and
independence, affecting their predictably irrational behaviors, and attracting
them with their idols are all ways that the campaign can improve its efficacy. Capturing
teenagers’ interest and engaging them in the discussion of the dangers of
texting and driving is an important step in increasing teens’ use of
Distracted.gov and their connection to distracted driving prevention. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The website should revise its teen-oriented
section by framing it to appeal to their core beliefs of freedom and
independence. Videos, games, and images attractive to teenagers should be used,
similar to the design of the website of the84.org (17). The84.org is a
Massachusetts based movement working to decrease youth smoking. The website is
fun, playful, and captivating to young adults. There are contests, challenges, and
fun activities for teens to become involved.
<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Modification 1: Freedom and
Independence, Not Safety and Health<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> Appealing to teenagers’ core beliefs
will reduce the risk that psychological reactance is in part a cause of their
continued texting while driving (18). Freedom and independence, not safety and
health, are core beliefs of teenagers. The site should explain to teenagers
that technology has taken away their freedom. All of the messages they send
electronically and post online can be tracked. Nothing is ever deleted when one
presses the delete button. Overuse of technology also takes away from face to
face time that could be spent with friends and participating in fun activities.
If the question is posed to teens, it is likely they would prefer to be at the
mall with their friends rather than sitting alone in a room texting. We are
also losing the freedom to not be inundated with messages, advertisements, and
electronic jargon. Teens have so many connections on Facebook, Twitter, and YouTube,
which cause them to be constantly overwhelmed by unnecessary notifications and
communications. By producing messages that convey the potential loss of freedom
caused by technology, youths may view texting and driving as the nemesis not
the desire. Non-reactance messages need to be implicit as opposed to explicit.
Conveying the ideas in a way that is subtle will be more effective than
bombarding them with direct messages. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> The key to avoiding reactance is in
how the issue is framed. Frames that work well appeal to the core values and
beliefs of its audience (19). The truth campaign, which aims to stop youth
smoking, changed its frame by replacing health with freedom and rebelling
against tobacco companies. On the main page of its website, it states, “Heck,
we love everybody. Our philosophy isn't antismoker or pro-smoker. It's not even
about smoking. It's about the tobacco industry manipulating their products…”
(16). This message is not a direct fear-inciting one that attempts to scare
people into changing behaviors. It redirects blame from being placed on the
smoker to the tobacco companies. Distracted driving campaigns should change the
theme of their messages; blame should not be placed on young drivers texting,
but on technology for taking control of our lives. Teenagers will respond to a
theme of regaining control of their lives, as it stands for the freedom and
independence they crave. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Modification 2: Decisions
Are Not Made Rationally or Independently<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> Alternative behavioral theories,
unlike traditional theories, address the fact that people behave irrationally
in their decision-making regarding health issues. Fundamentally, alternative
models address groups rather than individuals. Two of the underlying premises
of alternative models are: that a group dynamic exists and thus behavior should
be predicted at the group level; and, behavior is dynamic and unplanned. Further,
traditional models focus on changing attitudes first and behavior second.
Alternative models have been more successful by focusing on changing behavior
first and assuming that a change in attitude will follow. Based on these
fundamental themes, alternative theories could be more effective in capturing
the attention of teenagers and subsequently, reducing their distracted driving.
<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> Advertising Theory takes these
themes into account and understands that change takes place on a group level
and also that behavior is dynamic. The original Florida truth campaign (different
from the website thetruth.com), an anti-smoking campaign geared toward teens,
used these concepts to produce successful outcomes (20). Advertising Theory
promises to fulfill the viewer’s deepest aspirations and supports this promise with
emotionally provoking images, stories, and music. The promise and its supporting themes are
tied together by the core values of the target audience. Tobacco control advertisements
have used Advertising Theory; one ad shows tobacco executives around a table
laughing and makes no mention of health. The message is that smokers are being
manipulated by the industry and will regain their control (an aspiration of
teens) if they stop smoking. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Distracted.gov should use Advertising
Theory as a basis for its website or at the very least, for the teen-oriented
pages. For example, videos, posters, and brochures should be designed to appeal
to teens’ desire for freedom and independence and their desire to be with their
friends. The promise of the message is that teens will feel like a part of the
movement to stop distracted driving; they will feel like they belong to the
group. The website’s features should be branded in a way that engages the teens
and provides uniformity throughout all of the material. As a group, teens will
feel empowered to make the decision to stop texting and driving. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Modification 3: Familiar
Messengers</span></b><span style="font-family: "Georgia","serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> According to the principles of
Communications Theory, in order for a message to be persuasive, the person
chosen to deliver the message should be likable, familiar, and similar (21).
For this reason, familiar speakers such as teen celebrities and iconic role
models such as famous athletes should be used in videos to speak to the
American teenagers. Advertising Theory uses this tactic. Many successful
companies use icons as spokespeople in their advertisements; Gatorade is using
Peyton Manning to endorse their products, while CoverGirl uses Taylor Swift.
Teenagers look up to the iconic celebrities they follow, trying to emulate
them. These famous personalities are revered by many in our society, especially
impressionable adolescents. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">Teenagers look up to and listen to similarly-aged
celebrities and iconic role models such as famous athletes (22). Distracted.gov
should add video advertisements with these icons as spokespeople. In these ads,
celebrities will explain how they do not use their cellular phones while
driving. The celebrities will also explain how they tell distracted drivers to
stop using their phones, when they are the passengers. Teenagers viewing these
commercials will more highly value the messages when they are delivered by
similar and familiar individuals. For example, a compilation commercial modeled
on Rock the Vote could be used (23). Rock the Vote is a movement that aims to
engage youth in political awareness and build involvement. It has registered
more than 5 million young people to vote (24). Rock the Vote produced ad spots
that showcased approximately 15 celebrities per advertisement, such as Miley
Cyrus, Miranda Cosgrove, and cast members from <i>Modern Family</i> to encourage political engagement. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";">In the proposed distracted driving
prevention advertisements, celebrities such as Justin Bieber, Taylor Swift, and
members of the band One Direction would speak directly into the camera, each
for a few seconds. They would all deliver similar messages, such as “ I always
leave my phone on the back seat and wait until I get home to text my BFF back”.
Additionally, the partnership with <i>Glee</i>
should be expanded. The cast of <i>Glee</i>
should also have a video with short spots of each of them explaining to camera
that they do not drive distracted. Images of the cast members should be posted
on the webpage promoting non-distracted driving in the aforementioned ways of gaining
control and freedom by putting aside their smart phones. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; text-indent: .5in;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<b><span style="font-family: "Georgia","serif";">Conclusion <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"> Usage of cellular phones will likely
only increase as technology becomes an even greater part of our lives, and it
becomes even more of a social norm to use electronic gadgets throughout all
activities and at all times of day (25). With our increasingly busy lives, the use
of a phone in a vehicle may always be an enticing prospect. Many individuals attempt
to multi-task by returning texts and phone calls while commuting to work or for
errands. Teenagers, used to using their phones incessantly, will likely be among
the drivers that reach for their phones out of instinct. It may take many years
for a significant decrease in distracted driving to be visible. For this
reason, it is imperative to ensure that all audiences are targeted
appropriately and effectively in order to eliminate the ubiquity of distracted
driving.</span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="line-height: 200%;">
<span style="font-family: "Georgia","serif";"><br /></span></div>
<div class="MsoNormal" style="text-align: center;">
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<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
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http://the84.org/</span><br /><span style="font-family: Georgia, serif; text-indent: -0.25in;">18.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><span style="font-family: Georgia, serif; text-indent: -0.25in;">Lee G et al. The roles of self-concept
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</span></span></span><span style="font-family: Georgia, serif; text-indent: -0.25in;">Rock
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<!--[if !supportLists]--><br />
Mobolajihttp://www.blogger.com/profile/14048489686681786639noreply@blogger.com0tag:blogger.com,1999:blog-1572776051032236617.post-12243061049745460442012-12-24T08:32:00.000-08:002012-12-24T08:33:35.383-08:00The Government’s Anti-Bullying Campaign Is Failing and The Children Are Paying For It - Edriss Yassine<br />
<div class="MsoNormal" style="line-height: 200%;">
Bullying has become a huge part of
American society and is harming the health of our children. The National
Institutes of Health defines bullying as the act of repeatedly trying to harm
someone who is perceived to be weaker either by direct attacks, such as hitting
or taunting, or indirectly, such as spreading rumors (1). Every 7 minutes a child is bullied on a
school playground, every months 3 million students are absent from school
because they feel unsafe and an estimated 18 million children will be bullied
in the United States this year alone (2). There are four main types of bullying: verbal
bullying, name-calling or teasing, relational bullying, spreading rumors or
social isolation, physical bullying, hitting or being pushed, and cyber
bullying though social media and the internet (3). In order to try to stop
these harmful events, the United States government has poured millions of
dollars into its anti-bullying campaign called stopbullying.gov but has not
accomplished the goal it has set out to do. On its website, the campaign gives
an overview of the bullying crisis, how to look for it, and most importantly,
how to try to prevent it. However, the advice and techniques suggested by the
campaign are flawed and are not working because bullying is still a huge issue
today. The stopbullying.gov campaign
emphasizes three main points to stop bullying. First, they suggest that parents
should act as role models to their children and set a good example for their
children to follow. They hope that the children will mimic their parents and
bullying will stop. Second, they suggest that parents and teachers set a bully
report system and simply tell them to stop it when they see it. Lastly, they
suggest that parents, teachers and the community try to change the bully’s
attitude by using peer groups and interventions. The three main points that the
campaign emphasizes in order to stop bullying are failing because they employ
the individual level behavior change models called the Social Learning Theory,
the Theory of Reasoned Action and the Transtheoretical Model. These theories are flawed and tend not to
work because they try to predict behavior on an individual level and assume
that people are rational, however we know that is not the case and that we
behave in fundamentally irrational ways as presented in the book <i>Predictably Irrational </i>(4). This paper will explain why the
stopbullying.gov campaign is not working and propose new suggestions on how to
improve the campaign using group level behavior change models such as the
Social Expectations Theory, the Psychological Reactance Theory and the
Diffusion of Innovations Theory and the power of social media, television and
celebrities.</div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b>Parents Are Not As Good Of Role Models As They Think<o:p></o:p></b></div>
<div class="MsoNormal" style="line-height: 200%;">
The
first suggestion to stop bullying by the stopbullying.gov campaign states that
if parents get more involved in their children’s lives and act as role models
by teaching them how to be nice to others and show compassion, then their
children will mimic them and do the same, helping eliminate bullying. This
rational is based on the individual behavior change model known as The Social
Learning Theory. The SLT was developed in 1977 by Albert Bandura and is based
on the concept of modeling and states that individuals will model what they see
others doing (5). The campaign is under
the impression that this individual model will work because parents are good
role models to their children and they will teach them important core values
when it comes to showing compassion to others. However, psychologist Richard
Weissbourd tells us that parents who are obsessed with their children’s
happiness usually ignore important values like goodness, empathy, appreciation
and caring (6). Therefore, if parents
are ignoring to teach their children the critical core values needed to show
compassion to others and help stop bullying, their children cannot mimic them
and bullying will continue. Furthermore, a study conducted by researchers at
the University of California San Diego in the Journal of Moral Education show
that parents constantly lie to their children while teaching them that lying is
unacceptable (7). This further supports the claim that parents are not good
role models to their children because they are hypocritical and most of the time
the children know about it. If the SLT is followed and the children learn and
mimic their parents, then the children will not learn good core values that
will help stop bullying, instead they will learn their parents’ bad habits. Due
to the campaign’s flawed assumptions that parents are good role models so
children will mimic their good behaviors and will show compassion toward others
and the fact that the SLT is weak because it is an individual level behavior
model, the first suggestion by the campaign will not work to change the bully’s
behavior. </div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal">
<b>Reporting Systems and
Telling Kids to Just Stop It Will Not Change Their Behavior<o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
The
second suggestion to stop bullying by the stopbullying.gov campaign states that
if parents and teachers create a bully reporting system and tell the bullies to
just stop it when they see bullying happening will create an atmosphere where
bullying will stop due to the adult telling them to. This rationale is flawed and
will not work because it is based on the individual level behavior model known
as The Theory of Reasoned Action. The TRA was developed in the late 1970’s by
Ajzen and Fishbein and states that behavior can be predicted because it is a
balance between outcome expectancies and social norms. Once the balance is tipped
one way or the other and it leads to intention, behavior will always happen (8,9). The campaign does not take into consideration
certain things that heavily influence the TRA like the child’s need to fit in, peer
pressure, social norms and the fact that children tend to act as groups and not
individuals, which influence the outcome expectancies and the social norms in
the TRA scale. Psychotherapist Dr.
Russell Hyken shows that as early as kindergarten, children understand the
concept of social norms and begin to form cliques and also because of
expectations and peer pressure, they begin to exclude certain people from their
groups (10). Furthermore, once the
children belong to a clique, they are protected from the torment of others and
they will do anything to stay in the clique, even if it means not reporting one
of their friends for fear of retaliation or the fear of being bullied
themselves. Andrew Matthews, a successful author and public speaker on
attitude, success, happiness and prosperity, states that for every ten children
who are being bullied, only one tells their parents (11). With statistics like
these, the bully reporting system proposed will not work because not enough
kids will be reporting bullying in order to make a difference. Also, telling a bully to just stop will not
elicit an effect especially in front of their friends because they will act out
against it to stay popular. Because the TRA is an individual model and children
tend to stick together as groups, the use of this model will not work to stop
bullying because one must try to change the group as a whole and not just the
individual. </div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b>Bullies Are Not Like Drug Addicts<o:p></o:p></b></div>
<div class="MsoNormal" style="line-height: 200%;">
The
third suggestion to stop bullying proposed by the stopbullying.gov campaign
states that the bully’s mind can be changed with the use of peer groups and interventions.
This rationale is flawed and will not work because it is based on the
individual level behavior model known as the Transtheoretical Model. The
Transtheoretical Model was developed in the early 1990’s by Prochaska and
DiClemente and states that a health behavior is adopted through stages that
people go through one step at a time. Those stages are pre-contemplation,
contemplation, preparation, action and maintenance (12). Using the TTM, A
person starts from the beginning and goes through each stage, one at a time,
until they reach the end. Because this model is predominantly used to treat
drug addiction, I believe that this approach singles out the bullies and treats
them like drug addicts. The effects of
isolating someone out may be drastic and potentially harmful. According to the
Mayo Clinic, isolation may worsen the situation and make the person feel
attacked, more isolated and resistant to treatment (13). Furthermore, another downside to the
Transtheoretical Model is that if people slip and fall off, they may not just
fall one step, they may fall all the way back down to the beginning. This is
dangerous because sources have showed that relapse is common with TTM and
should be expected (14). When a bully
relapses, they may be even more aggressive than the first time in order to take
out their aggressions and the victims will get the blunt of the force. Due to
these reasons, this type of intervention will not work to change the behavior
of bullies.</div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b>Intervention With The Use of Social Media, Television and Celebrities<o:p></o:p></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<b> </b>The current
intervention put forth by the United States government in their
stopbullying.gov campaign is failing and in order to save children from the
future torment of bullying and in order to make their lives better, a new intervention
must be put in place. My proposed intervention to replace the current one is
the launch of a new campaign that focuses on bullying through the use of group
level alternative models, social media and television using celebrities.
According to the Nielsen Co., the largest television rating and research
company in the world, an average person spends 20% of their day watching
television (15). If you do the math, in
a 24-hour day, a person watches television for 4.8 hours of it and that is a
lot. Furthermore, according to an article in the Bloomberg Report, Americans
spend an average of 6.5 hours a day online, mainly on social networks (16). Thirdly,
the influential power of celebrities cannot be underestimated. Usually, when a
celebrity backs something, the population follows. For example, in a recent
article, Forbes talked about the power of persuasion that celebrity comic Conan
O’Brien has over the public. Conan announced his national tour via Twitter with
a single tweet and within 2 hours, the 32 city, national tour was completely
sold out (17). Therefore, by using these
enormously popular media outlets and celebrities, we can move away from
changing the individual directly to changing the individual though changing the
masses. The three new interventions will incorporate the group level alternate
models of behavior of the Social Expectations Theory, the Psychological
Reactance Theory, and the Diffusion of Innovations Theory by having children
mimic the popular children at school instead of their parents, using
psychological reactance to get kids to report bullies by reducing peer pressure
and changing social norms, and finally, using the influential power of the
masses to change the bully’s mind instead of singling them out. The first
campaign that we will launch will be called “New Friend For The Day”, followed
by the use of psychological reactance and lastly, a campaign called “No More
Pain”. </div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b>Popular Kids Stop Bullying By Example, Not Parents<o:p></o:p></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<b> </b>The government’s
first way to stop bullying, by having parents set a good example and kids
mimicking them is not working. As an alternative, my first proposed
intervention that will work in the prevention of bullying uses a group level
alternative model called the Social Expectations Theory and the use of social
media by the more popular kids in school. The SET was developed by Perkins and
Berkowitz in the late 1980’s and states that we can create massive change by
changing social norms (18). Changing the
behavior of the masses by changing the social norms is much more powerful than
having the children try to mimic their parents who are not good role models in
the first place. In this intervention, we will launch a “New Friend For The Day”
campaign on Facebook and target it toward the popular kids at school like the
athletes. The goal of this campaign will be to have the popular athletes
befriend a bullied kid in order to change the stigma that these bullied kids
are different and by hanging out with them for a day, that these kids will
become friends with them for a longer period of time. On this Facebook page the
popular kids can share their stories of what they learned after befriending one
of these kids. We can have people like the captains of the football and
basketball team start posting to this site and then eventually when others read
the stories of these kids, they will be inspired to do the same. This will
eventually change the masses and therefore change the mindset of the bullies by
changing the social norm. We can see that popular kids befriending bullied kids
stops bullying by looking at the example at Queen Creek High School that
occurred a couple of months ago. At this high school there was a young girl
with a brain disorder who was tormented at school everyday and always went home
crying. The quarterback of the Queen Creek football team befriended her after
seeing what these bullies were doing and she has not been bullied ever since
(19). The whole football team eats lunch
with her and keeps an eye on her while she is at school. She was quoted in the
news by saying “They’re not mean to me anymore, because all my boys love me”
(19). The high school football team changed the minds of the masses and the
bullies by changing the social norm and making it acceptable to have friends
with disabilities. Since it worked in situations like Queen Creek High School,
it will work at an even larger scale using a highly frequented site like
Facebook and the “New Friend For The Day” campaign. </div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b>Report Bullies By Telling Kids Not To Do Anything<o:p></o:p></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<b> </b>The government’s
second way to stop bullying by creating a bully report system and telling kids
to just stop it is not working. As an alternative intervention, I propose that
we use the Psychological Reactance Theory teamed up with television and celebrities
to tell kids to not do anything when they see bullying happening. The PRT was developed by J.W Brehm in 1966 and
states that when peoples’ sense of control is taken away from them, they are
programmed to get that control back (20). For example, when people are told
what to do, they perceive it as their freedom being taken away, so in order to
regain their freedom, they do the opposite of what they are told. We can see the use of psychological reactance in
the commercial for the 2008 elections in order to try to get people to vote. In
this commercial, famous celebrities continuously tell people that they should
not vote for various reasons (21). However, this commercial used psychological
reactance to help do the complete opposite and helped influence the public to
vote and voter turnout was pretty high for the elections. We can use the same
concept in our campaign by using famous musicians and actors that children look
up to. These commercials can be aired during the shows that’s kids watch the
most in order to make sure that they see them and we will have the actors and
musicians tell the kids not to do anything and not to report it when they see
bullying happening no matter how badly the bullied kids are being hurt. This, in
turn, will invoke psychological reactance because they are being told what not
to do and they will do the opposite and start reporting bullying and will help
teachers and parents resolve the bullying issue. Because their freedom is being taken away, their
minds will not focus on their cliques and fitting in, instead they will be
trying to get their freedom back no matter what the consequences. We can see
the results of trying to get ones freedom back at any cost in an article by
Doob and Zabrack (22). In their experiment, the people whom were sent a
questionnaire along with $20 and were forcibly told to finish the questionnaire
did just the exact opposite and returned a blank questionnaire and the $20. Those
who were kindly asked to fill it out without any money offered, did so without
question. Therefore, if these people returned free money that they could have
kept just because of psychological reactance, then the children will not think
about the consequences of reporting a bully as long as they get their freedom
back. By using psychological reactance
instead of the originally proposed intervention using the TRA, We will be able
to implement an intervention that will really work and take the kids’ mind’s
off of what will happen if they report bullying. </div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b>Change Bullies By Changing The Masses<o:p></o:p></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<b> </b>The government’s
third way of dealing with the bully situation by using peer groups and
interventions is not working because it is singling out the bullies and
treating them like drug addicts. As an alternative intervention, I propose that
we use the Diffusion of Innovations theory along with more social media and
television ads using celebrities in order to change the stigma about bullying. The
Diffusion of Innovations theory was proposed by Rogers in 1962 and states that
you don’t have to worry about changing an individual, instead if you can reach
a critical mass, the masses will tip and change the group as a whole (23). The
theory uses the key concepts of knowledge, persuasion, decision, implementation
and confirmation. Although it was originally used for situations like
vaccinations, it can also be applied to bullying. The campaign will be called
“No More Pain” and will air in prime time on television and use social media to
spread the word about the pain that bullying is causing and to help change the
stigma about bullying. According to the Anti-Bullying blog, there are a lot of
famous and influential people who were bullied as children (24). The campaign
will use these famous actors and musicians that the kids look up to and aspire
to be and they can spread the message about working together to change the
stigma about bullying. We will also have these actors who were bullied during
childhood share their stories in order to give the bullied kids hope that they
can be successful despite bullying. According to the theory, as the
celebrities’ message sinks in and the public’s opinion slowly starts to change,
it will reach a tipping point and then dramatically increase and change the
mindset of the group as a whole and not have to worry about the individual. We
can see an example of this in the mental health campaign called “Bring Change 2
Mind” (25). This campaign is using
famous celebrities in advertisements to help change the stigma of mental
illness. Their use of commercials has helped to start a dramatic change in the
public opinion about mental illness and it is working effectively. If this
campaign is using this technique to help bring change and it is effective, then
the same can be said about using it for our bullying campaign. This
intervention has a tremendous advantage over the original one in that it has no
risk of bullies falling off the plan and reverting back to their old ways
because it eliminates the step-by-step process of the Transtheoretical Model. Furthermore,
it does not single out anyone and will not make them feel defensive in anyway
and help prevent retaliation. </div>
<div class="MsoNormal" style="line-height: 200%;">
<br /></div>
<div class="MsoNormal" style="line-height: 200%;">
<b>Conclusion<o:p></o:p></b></div>
<div class="MsoNormal" style="line-height: 200%;">
<b> </b>The government’s
stopbullying.gov campaign is not effective and is failing. It proposes that
bullying be stopped by children mimicking bad role models, face the potential
consequences of reporting bullying individually and trying to change bully’s
minds by singling them out and treating them like drug addicts. It is because
of their use of individual behavior models such as the Social Learning Theory,
the Theory of Reasoned Action and the Transtheoretical Model that their
resolutions are not effective. Overall these models are weak and will not help
bring change because they assume that behavior is rational and reasoned and
that they can change the individual. Instead, a new program should be
implemented that uses group level alternative models that will work, for
example, the Social Expectations Theory, the Psychological Reactance Theory and
the Diffusion of Innovations Theory. These models are strong and more effective
than the individual models because they take into consideration that people are
not rational and behavior is better changed using groups instead of
individuals. The alternative propositions like the “New Friend For The Day”
campaign, telling kids not to do anything and the “No More Pain” campaign will
use the power of social media, television and celebrities to influence and
change the stigma of bullying as a mass instead of individually. The
influential power of famous celebrities cannot be taken lightly. Due to people
spending so much time a day sitting in front of their televisions or on the
internet, they are more familiar with celebrities and what is going on with them
than any other thing going on in the world currently. Therefore, harnessing
that power and using it for the greater good is the way to go. I believe that
if the original propositions are laid to rest and the new proposed ideas are
implemented, then bullying will significantly decrease and the lives of
millions of children will be much better than they are now and the world will
be a better place because of it. </div>
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<div style="text-align: center;">
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<span style="text-indent: -0.25in;">22.</span><span style="font-size: 7pt; text-indent: -0.25in;"> </span><span style="text-indent: -0.25in;">"WARNING:
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<br />
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</span><span style="text-indent: -0.25in;">Rogers, Everett Mitchell. </span><i style="text-indent: -0.25in;">Diffusion
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<span style="text-indent: -0.25in;">25.</span><span style="font-size: 7pt; text-indent: -0.25in;"> </span><span style="text-indent: -0.25in;">"Celebrities
Who Were Bullied As Kids." </span><i style="text-indent: -0.25in;">The Anti-Bullying Blog</i><span style="text-indent: -0.25in;">. N.p., 06 Jan.
2010. Web. 13 Dec. 2012. </span><a href="http://antibullyingblog.blogspot.com/2011/11/celebrities-who-were-bullied-as-kids.html" style="text-indent: -0.25in;">http://antibullyingblog.blogspot.com/2011/11/celebrities-who-were-bullied-as-kids.html</a><br />
<br />
<span style="text-indent: -0.25in;">26.</span><span style="font-size: 7pt; text-indent: -0.25in;"> </span><span style="text-indent: -0.25in;"> </span><span style="text-indent: -0.25in;">"Take the Bring Change 2 Mind
Pledge." </span><i style="text-indent: -0.25in;">Bring Change 2 Mind</i><span style="text-indent: -0.25in;">. N.p., n.d. Web. 13 Dec. 2012.
http://bringchange2mind.org/</span><br />
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<br />Mobolajihttp://www.blogger.com/profile/14048489686681786639noreply@blogger.com0