When Less is More: A Critique of Cigarette Health Warning Labels – Vania Lin

Background Information

            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.  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.  One of the stated goals of this change was to “empower youth to say no to tobacco” (1).  Court proceedings in the case of R.J. Reynolds Tobacco Co. v. U.S. Food and Drug Administration, the lawsuit tobacco companies brought forth against the FDA, have delayed the implementation of the new warnings (1).  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).

Overview of the Critique

            The effectiveness of the new graphic labels in preventing smoking initiation in adolescents is questionable.  In particular, the warnings neglect to address the effects of branding on adolescent smoking and the formation of social identity.  The labels also overvalue the importance of health to adolescents.  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.  Lastly, the labels will likely trigger psychological reactance, which would incite rebellion against the warnings and may even provoke smoking initiation.

The Implications of Branding

            The graphic warning labels fail to address the importance of branding in adolescent smoking and social identity.  The new labels may be more prominent, but they do nothing to eradicate the associations that tobacco companies have designed cigarette packaging to convey.  Adolescence is characterized by experimentation and the formation of identity; it is the time in life when people are most likely to start smoking.  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).  Tobacco companies, armed with this knowledge, aim to attract people to smoking at a young age.  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).  This finding highlights the connection between marketing of cigarettes by tobacco companies and adolescent smoking.

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).  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.  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.  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.  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).  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.

Overvaluation of the Importance of Health

            The graphic warning labels centered on the harmful health effects of smoking overestimate the importance of health to youths.  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.  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.  Smokers also perceived greater benefits of smoking relative to the risks of smoking (7).

Lee, Buchanan-Oliver, and Johnstone (2003) further explored the relationships between adolescent characteristics and values and smoking.  They found that the sense of being invulnerable persisted in adolescents despite their knowledge of the health effects of smoking.  The authors characterized this aspect of adolescence as the “personal fable”: adolescents have a hard time separating personal beliefs from universal principles.  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.  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.  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.  As one participant succinctly put it, “You do things because they are bad for you.  ‘Cause you do things to take a risk” (8).  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.

The Effects of Psychological Reactance

            The graphic labels will likely trigger psychological reactance in adolescents and exacerbate the problem of adolescent smoking.  The theory of psychological reactance asserts that people believe that they are free to make their own choices and shape their own behavior.  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.  One way to do so is to rebel against the force (9).

Dillard and Shen (2005) described the three aspects of a message that contribute to psychological reactance: dominance, explicitness, and reason.  Dominance is the degree to which the message imparts the belief that the source can control its audience.  Explicitness is the extent to which the message conveys the source’s purpose.  Reason is the justification the message provides to convince the audience to adopt the source’s view.  In general, dominance in a message incites anger and psychological reactance, while reason decreases psychological reactance.  The effect of explicitness varies and depends on context, but usually works in favor of persuasion and generates positive emotions (10).

            The elements of the new graphic warnings will likely incite psychological reactance in adolescents.  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.  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.  Their explicitness makes clear that the government is trying to influence the adolescents’ behavior through the warnings.  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.

Erceg-Hurn and Steed (2011) showed that graphic labels triggered heightened psychological reactance.  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.  The tested labels contained messages such as “Smoking Kills.” and “Smoking Causes Mouth and Throat Cancer”; photographs accompanied the graphic labels.  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.  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).  These results can reasonably be generalized to adolescents—adolescents, with their tendency to rebel, may experience even greater levels of psychological reactance than adults.

Furthermore, Miller, Burgoon, Grandpre, and Alvaro (2006) determined that psychological reactance was a major risk factor for smoking behavior.  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.  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.  Poor communication with parents was also a predictor of smoking behavior, though to a lesser extent.  In addition, psychological reactance was a significant risk factor even among adolescents who did not smoke and had not previously experimented with smoking (11).  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.

Proposed Alternative Intervention

            An effective alternative approach may be to utilize plain packaging and warning messages focused on independence and self-affirmation rather than on health.  In plain packaging, the color, size, material, and the opening method of cigarette packs are standardized.  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.  No other writing, excluding health warnings, or visual images are allowed (12).  Plain packaging would thus effectively eliminate the associations created through branding.

The warnings would focus on the aspects of independence and control rather than on health and would draw upon the theory of self-affirmation.  The messages would be phrased in the form of questions.  The goal is to prompt adolescents to question the effect that smoking has on their freedom and control without triggering psychological reactance.

The Power of Plain Packaging

            Replacing the current multitude of cigarette packaging designs with a single, standardized plain design eliminates the venue for branding.  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.  Plain packaging blocks this route by standardizing all pack designs.  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.  Wakefield, Germain, and Durkin (2008) demonstrated that plain packaging successfully removed brand associations.  In the study, smokers rated the attractiveness of cigarette packs that are shown both in their original packaging and in progressively plainer packaging.  Participants also rated the smokers of these cigarettes on various qualities, including stylishness, class, and confidence.  Lastly, participants rated how satisfying smoking the cigarettes from each pack would be.  Wakefield et al. found that smokers rated original packaging as most attractive, with the ratings dropping as the packaging became progressively plainer.  Participants gave smokers of plain packs lower ratings on positive qualities (e.g., less stylish, less sociable, less mature) than smokers of original packs.  They also responded that smoking cigarettes from plain packs would be less satisfying and that the tobacco would be of poorer quality (13).  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.

A Shift in the Focus of Warnings

            Warnings on the cigarette packs focusing on independence and control would likely have a greater impact on youths than those focusing on health.  Adolescents value independence and autonomy highly, while health is not as valued in part because of the sense of infallibility.  Messages that focus on health would likely trigger the adolescents’ cognitive “personal fable” defense.  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).  In contrast, messages that frame smoking as threats to their independence and control bring the warnings much closer to the adolescents’ lives.  Take for example the following message: “You are independent and in control: why let nicotine addiction change this?”  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.  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.  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.

The Usage of Self-Affirmation and Questions

            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.  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.  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).  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.  Affirm the individual’s point of view” (15).  Harris and Napper (2005) examined the responses of young women to messages describing the link between alcohol and breast cancer.  Participants in the self-affirmation condition were asked to  write about the most important value in their life, the reason for its importance, and how they incorporated the value in their daily lives.  Participants in the control group were asked to write about why the least important value in their lives might be important to others.  All the participants were exposed to information regarding alcohol and breast cancer afterwards.  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).

In a similar vein of investigation, Armitage, Harris, Hepton, and Napper (2008) demonstrated the use of self-affirmation in a study involving adult smokers.  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).  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).  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.  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).

These findings demonstrate the effectiveness of self-affirmation in decreasing defensiveness and promoting changes in health-related behavior.  The study conducted by Armitage et al. is particularly relevant, as it addresses the issue of smoking cessation.  In preventing smoking initiation in adolescents, self-affirmation can similarly be used to decrease defensiveness, specifically psychological reactance, when delivering warnings on cigarette packs.  The previously used example message “You are independent and in control: why let nicotine addiction change this?” embodies this principle.  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.  This reduces the defensiveness that is elicited by the second part of the message “why let nicotine addiction change this?”  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.  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.

Phrasing the warnings on the cigarette packs as questions would reduce psychological reactance as well.  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.  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.  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.  Here, lower perceived risk would indicate a higher level of defensiveness.  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.  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.  As such, warnings phrased as questions may be the best method of delivering antismoking messages (17).

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.  The question format avoids a tone of dominance.  Instead of delivering an authoritative statement, the message poses a question to adolescents and invites them to consider the issue.  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.  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.  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.

Conclusion

            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.  Messages should furthermore embody self-affirming qualities and be presented in the format of questions.  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.  Together, these measures maximize the effectiveness of cigarette warnings and their impact on adolescents.

REFERENCES

1.    U.S. Food and Drug Administration. Cigarette Health Warnings - Overview: Cigarette Health Warnings. Silver Spring, MD: U.S. Food and Drug Administration. http://www.fda.gov/TobaccoProducts/Labeling/Labeling/CigaretteWarningLabels/ucm259214.htm.

2.   Associated Press. Appeals court denies rehearing on decision blocking graphic health warnings on cigarette packs. Washington Post. http://articles.washingtonpost.com/2012-12-05/business/35625639_1_cigarette-packs-new-warnings-cigarette-smoke.

3.   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. JAMA: The Journal of the American Medical Association 1990; 264(12):1550–1555.

4.   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. Tobacco Control 2004; 13(3):315–318.

5.    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. International Journal of Nonprofit and Voluntary Sector Marketing 2008; 13(3):275–285.

6.   Scheffels J. A difference that makes a difference: young adult smokers’ accounts of cigarette brands and package design. Tobacco Control 2008; 17(2):118–122.

7.   Virgili M, Owen N, & Severson HH. Adolescents’ smoking behavior and risk perceptions. Journal of Substance Abuse 1991; 3(3):315–324.

8.   Lee CK-C, Buchanan-Oliver M, & Johnstone M-L. New Zealand adolescents’ perception of smoking and social policy implications. Social Marketing 2003; 11(1):45–59.

9.   Erceg-Hurn DM, & Steed LG. Does exposure to cigarette health warnings elicit psychological reactance in smokers? Journal of Applied Social Psychology 2011; 41(1):219–237.

10.                  Dillard JP, & Shen L. On the nature of reactance and its role in persuasive health communication. Communication Monographs 2005; 72(2):144–168.

11.Miller CH, Burgoon M, Grandpre JR, & Alvaro EM. Identifying principal risk factors for the initiation of adolescent smoking behaviors: the significance of psychological reactance. Health Communication 2006; 19(3):241–252.

12.                  Freeman B, Chapman S, & Rimmer M. The case for the plain packaging of tobacco products. Addiction 2008; 103(4):580–590.

13.                  Wakefield MA, Germain D, & Durkin SJ. How does increasingly plainer cigarette packaging influence adult smokers’ perceptions about brand image? An experimental study. Tobacco Control 2008; 17(6):416–421.

14.                  Harris PR, & Napper L. Self-affirmation and the biased processing of threatening health-risk information. Personality and Social Psychology Bulletin 2005; 31(9):1250–1263.

15.Hogan K, & Speakman J. Covert Persuasion: Psychological Tactics and Tricks to Win the Game. Hoboken, NJ: Wiley, 2006.

16.                  Armitage CJ, Harris PR, Hepton G, & Napper L. Self-affirmation increases acceptance of health-risk information among UK adult smokers with low socioeconomic status. Psychology of Addictive Behaviors 2008; 22(1):88–95.

17.                  Glock S, Müller BC, & Ritter S. Warning labels formulated as questions positively influence smoking-related risk perception. Journal of Health Psychology 2012; 0(0):1-11.

Just Say No to Abstinence-Only Sex Education - Hasti Mehta

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.

Abstinence-Only Education

    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). 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. 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.

Critique 1: Lack of Relatable Educators

            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).

            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).

            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.

           

Critique 2: Individual Level Health Models Failure to Account for Context

            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 activity among adolescents has frequently been characterized as unplanned and impulsive (15), but these models are still used to insufficiently influence change amongst them.

            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. 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.

Critique 3: Perceived Threat to Personal Freedom

            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).

            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 “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.

Proposed Intervention

            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.

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.

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 model it will be easier to change the social norms and get a greater group of students to practice abstinence.

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.

Solution 1: Shift from Teachers to Peer Educators

            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.

            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.

            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.  

Solution 2: Institute Group Level Alternative Models

            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.

             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.

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 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). 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.

             

Solution 3: Emphasizes Freedom of Choice  

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.

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 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.

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.

Conclusion

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.

References

1. The National Campaign to Prevent Teen and Unplanned Pregnancy (2012, July). Teen Sexual Behavior and Contraceptive Use: Data from the Youth Risk Behavior Survey, 2011. The National Campaign to Prevent Teen and Unplanned Pregnancy. Retrieved December 8, 2012, from http://www.thenationalcampaign.org/resources/pdf/FastFacts_YRBS2011.pdf
2. The National Campaign to Prevent Teen and Unplanned Pregnancy (2012, October). Summary of 2011 Preliminary Birth Data from the National Center for Health Statistics (NCHS). The National Campaign to Prevent Teen and Unplanned Pregnancy. Retrieved December 8, 2012, from http://(2) www.thenationalcampaign.org/resources/pdf/FastFacts_NCHSBirthData2011.pdf
3. The National Campaign to Prevent Teen and Unplanned Pregnancy (2012, March). Teen Birth Rates: How Does the United States Compare? The National Campaign to Prevent Teen and Unplanned Pregnancy. Retrieved December 8, 2012, from http://www.thenationalcampaign.org/resources/pdf/FastFacts_InternationalComparisons.pdf
4. Advocates for Youth (n.d.). 8-Point Definition of Abstinence-Only Education. Advocates for Youth. Retrieved December 8, 2012, from http://www.advocatesforyouth.org/topics-issues/abstinenceonly/132?task=view
5. Emily Feistritzer, C., Griffin, S., & Linnajarvi, A. (2011). Profile of Teachers in the U.S. 2011. National Center for Education Information. Retrieved December 8, 2012, from http://www.ncei.com/Profile_Teachers_US_2011.pdf
6. MajorLeagueBusiness (2011, September 20). Robert Cialdini - The 6 Principles of Influence [Video File]. Retrieved from http://www.youtube.com/watch?v=_4ZcStMsss8
7. Knowles, E. S., & Linn, J. A. (2004). 9: Narrative Persuasion and Overcoming Resistance. In Resistance and Persuasion (p. 179). Mahwah, N.J: Lawrence Erlbaum Associates.
8. Cialdini, R. B. (2007). Liking: The Friendly Thief. In Influence: The psychology of persuasion. New York, NY: Collins.
9. Silvia, P. J. (2005). Deflecting reactance: The role of similarity in increasing compliance and reducing resistance. Basic and Applied Social Psychology, 27, 277-284. Retrieved from http://libres.uncg.edu/ir/uncg/f/P_Silvia_Deflecting_2005.pdf.
10. Cialdini, R. B., & Goldstein, N. J. (2002). The Science and Practice of Persuasion. Cornell Hotel and Restaurant Administration Quarterly, 43(2), 40-50. Retrieved from http://www.influenceatwork.com/wp-content/uploads/2012/02/Cornell-HotelRestAdminQrtly.pdf.
11. Aune, K. R., & Basil, M. D. (1994). A Relational Obligations Approach to the Foot-in-the-mouth Effect. Journal of Applied Social Psychology, 24(6), 554-556. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1559-1816.1994.tb00598.x/abstract.
12. Bornstein, R. F. (1989). Exposure and affect: Overview and meta-analysis of research, 1968-1987 . Psychological Bulletin, 106(2), 265-289. Retrieved from http://libra.msra.cn/Publication/36895350/exposure-and-affect-overview-and-meta-analysis-of-research-1968-1987.
13. Edberg, M. C. (2007). Individual health behavior theories. In Essentials of health behavior: Social and behavioral theory in public health (1st ed., pp. 35-49). Sudbury, Mass: Jones and Bartlett.
14. Siegel, Michael. “Health Belief Model.” SB721. Boston University, Boston. 11 Oct. 2012. Lecture.
15. Moore, K. A., Miller, B. C., Glei, D., & Morrison, D. R. (1995, June). Adolescent Sex, Contraception, and Childbearing: A Review of Recent Data. Child Trends. Retrieved December 9, 2012, from http://www.childtrends.org/Files/Child_Trends-1995_01_01_ES_AdolSexContracept.pdf
16. Ariely, D. (2008). The Influence of Arousal. In Predictably irrational: The hidden forces that shape our decisions. New York, N.Y: HarperCollins Publishers.
17. Burke, W. W., Lake, D. G., & Paine, J. W. (2009). A Theory of Psychological Reactance. In Organization change: A comprehensive reader. San Francisco, CA: Jossey-Bass.
18. Brehm, S. S., & Weinraub, M. (1977). Physical barriers and psychological reactance: 2-yr-olds' responses to threats to freedom. Journal of Personality and Social Psychology, 35(11), 830-836. doi:10.1037/0022-3514.35.11.830.
19. Driscoll, R., Davis, K. E., & Lipetz, M. E. (1972). Parental interference and romantic love: The Romeo and Juliet effect. Journal of Personality and Social Psychology, 24(1), 1-10. Retrieved from http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=1973-04399-001.
20. Hogan, K., & Speakman, J. (2006). Covert Persuasion Begins in the Mind. In Covert persuasion: Psychological tactics and tricks to win the game (p. 6). Hoboken, N.J: John Wiley & Sons.
21. Siegel, Michael. “5 Premises of the Alternative Model.” SB721. Boston University, Boston.  25 Oct. 2012. Lecture.
22. Gladwell, M. (2000). Introduction. In The tipping point: How little things can make a big difference (pp. 3-14). Boston, MA: Little, Brown.
23. Siegel, Michael. “Advertising Theory.” SB721. Boston University, Boston. 1 Nov. 2012. Lecture.
24. Siegel, Michael. “Marketing Paradigm.” SB721. Boston University, Boston. 29 Nov. 2012. Lecture.
25. Hicks, J. J. (2001). The strategy behind Florida's “truth” campaign. Tobacco Control, 10(1), 3-5. Retrieved from http://tobaccocontrol.bmj.com/content/10/1/3.full.

D.A.R.E. To Take A New Direction – Alan Breaud

Drug abuse in the United States continues to be an issue that is being inappropriately addressed.  According to the National Institute on Drug Abuse, the most recent statistics show that close to 22.6 million Americans abused a psychotherapeutic medication or used an illicit drug in 2010 (1).  It is also pointed out, unfortunately, that this drug usage typically begins when people are in their teenage years (under 18 years old) and hits its peak in their late teen years or early twenties (1).  Given that the most prevalent use of these drugs is highest among this particular age group, it would seem logical to develop effective drug resistance programs that target pre-teens.

            One method of addressing this issue has become popular over the past few decades in the form of the D.A.R.E. program.  This program seeks to educate kids on the harmful effects of illegal drugs, tobacco, and abuse of prescription drugs and alcohol.  D.A.R.E., or Drug Abuse Resistance Education, began in 1983 as a result of a collaborative effort between the Los Angeles Unified School District and the Los Angeles Police Department (2).  It is a program that is highly endorsed by law enforcement nationwide, in addition to the U.S. Department of Justice, the Department of Defense and the Department of State (3)(4).  However, the program comes with a heavy cost.  Ten years after its inception in 1983, it was reported that the cost of the program, as a whole, across the country was around $750 million by 1993 (2).  

D.A.R.E. is a school-based education system with a curriculum taught almost entirely by police officers   Their mission, according to the official website, “is to provide children with the information and skills they need to live drug-and-violence free lives” (3).  They delve a little more into this by explaining how important it is to “equip kids with the tools that will enable them to avoid negative influence” and instead focus on their individual talents and gifts (3). 

            While this seems to be excellent intervention geared toward keeping kids off of drugs, research in the field of health communication tends to point to a different conclusion.  Many researchers have found that the D.A.R.E. program is hardly effective at all, despite the overwhelming support it receives from law enforcement nationwide (2).  Results looking at the short-term effects of the program show that the D.A.R.E program had no effect on illegal drug use, alcohol abuse, or even selling and dealing drugs (2).  Long-term studies echo these same results.  A longitudinal study of the program’s effectiveness reported limited success of the program and determined that the curriculum’s effects decay significantly over time (6) .  In the American Journal of Public Health, Drs. Steven West and Keri O’Neal of the Virginia Commonwealth University state very blatantly that “Project D.A.R.E. is ineffective” (7).    

            Because drug abuse is climbing among teenagers and young adults alike, the D.A.R.E. program needs to be completely revamped in order to provide an effective and lasting message that reaches its estimated 300,000 classrooms (3), possibly even by removing the classroom element altogether.  In its current format, the program is almost like an intellectual exercise.  The D.A.R.E. officers are instructed to provide a strict curriculum that includes in-class exercises and homework (4).

The purpose of this paper is to look at several problems in the design of the D.A.R.E. program that are undermining its effectiveness.  First, the framing used by D.A.R.E. will be analyzed, followed by the issues of contributing to misperceptions of social norms and creating psychological reactance that can potentially be causing prevention efforts to backfire.  Then, the paper will look at a new intervention effort and how it will address these problems in order to have a much more effective campaign.

Critique #1 - Improper Framing of the Issue

            One key issue that plagues the D.A.R.E. program is its improper framing of the issues the campaign is trying to address.  Framing refers to the way in which a message is “packaged” (5).  It is more than just a way of arguing a point.  It employs images, symbols, catch phrases, and a strong core position that complements the key core value the communicator is wishing to get across (5).  The key goal of framing, from a health perspective, is to provide a message that encourages one type of behavior over another (8).  In a health context, messages are typically framed to present gains or losses (8).  However, gain frames have been seen to be much more effective in preventative behavior (8). 

            The problem with the D.A.R.E. campaign is that it appeals to the core value of health and make use of loss frames.  They simply relate the risk factors associated with different products and trust that kids and adolescents are going to make the right choice, given that information.  This same idea, for example, is used to try and get people to stop drinking soda.  Everyone knows from his or her doctor or the news that sodas are bad for you because they contain too much sugar and provide empty calories.  However, soda remains widely available because people still like to drink it.  Vending machines are ubiquitous, and soda can be purchased at practically any restaurant and convenience store.  Appealing to the core value of health is just not enough to prevent people from drinking soda.     

The messages coming from D.A.R.E. are always ones of how dangerous various illicit substances are for one’s body.  For example, on the drug information section of their website, all the drug information comes with a “dangers and effects” section that relate the negative consequences of use (3).  While this information is important, it is simply presenting the negatives associated with use, while giving no information on the benefits of non-use.  As Jeffery Hicks points out, youth already know the dangers associated with drugs, alcohol, tobacco, etc. (9).  They want to be left to their own faculties to make a decision for themselves. 

Positive frames, or information presented in a positive light, have a more substantial impact on preventive health behavior (10) compared to negative frames.  For example, a message of self-esteem that was packaged in a positive way has been shown to increase intentions to exercise more often.  When information is given in a positive manner, this gives individuals a more risk averse option and gain-oriented choice (11).  Therefore, while the D.A.R.E. campaign is interested in preventative behavior, they are using the incorrect tone of frames to achieve that goal.    

Critique #2 - Kids Will Try What Their Friends Are Trying

            One of the key problems at the heart of the D.A.R.E. program is that it is conveying a message that illegal drug usage is highly prevalent throughout the school system.  The instruction in the curriculum informs students what to say when offered drugs from their peers and how to avoid negative peer pressure.  Consequently, this turns the issue into a scenario of not if children will be offered illegal drugs, but when it will happen.  This type of language leads to the idea that drugs are much more common than they may actually be.  In fact, several papers have looked at how teenagers and young adults are significantly overestimating the amount of substance abuse that their peers are engaging in.  One study out of Addictive Behaviors journal looked at how college students often overestimate their peers’ drinking habits by as much as 76% (12), a trend that was also seen in middle school and high school students (13).  These inaccurate perceptions can also be extended to tobacco and illicit drug use.  Researchers found that on 100 college campuses, perceived drug and tobacco use was highly exaggerated compared to actual self-reported use (14).  

Unfortunately, since D.A.R.E. is continuously relating a message that drugs are a highly prevalent problem within the school system and social setting, their curriculum may be inadvertently creating a problem that causes more drug use rather than preventing it.  Research out of the School of Public Health at the University of Michigan found that peer usage of alcohol and drugs is positively associated with individual usage of these substances (12).  Studies looking into social norms have shown repeatedly that even perceived prevalence of substance use is an excellent predictor of an individual’s likelihood of experimenting or using that same substance (16) (17).  Likewise, researchers out of the University of Washington, Seattle found that perceptions of friends’ use and descriptive norms regarding marijuana were “most strongly associated with marijuana use” (18).  Therefore, direct exposure is not needed to have a substantial influence.    

            So, beyond seeing friends or peers using marijuana or alcohol, even the perception that a large number of members in a school or social network are using illicit substances can lead to individual usage. Unfortunately, as previously seen, overestimation of drug and substance use is quite substantial.  Therefore, if kids have a skewed idea of the actual amount of drug use their peers are engaging in, then statistically they are going to be more likely to try these substances.  A look into the D.A.R.E. resources and curriculum shows that this skewed idea is exactly what is being relayed to kids and their parents.  According to the D.A.R.E. program’s own website, among other messages, they say “fifty percent of young people have used an illegal drug by the time they leave high school” and there are “over 50 factors that might put someone at risk for drug use” (19).  In terms of alcohol, they claim that 90% of kids graduating from high school have experimented with alcohol (19).  If these kids that are exposed to the D.A.R.E. program are seeing these statistics, they are receiving the message that the prevalence of drug and alcohol use is incredibly high, causing these substances to be perceived as a social norm.  And, as stated earlier, social norms are one of the best predictors of drug and alcohol consumption.   

Critique #3 – There is Possible Reaction to Threats to Freedom

            The D.A.R.E. program curriculum teaches kids skills to avoid the peer pressure of using drugs, alcohol, and even the dangers of involvement in gangs.  According to Jack Brehm, continuously telling an individual not to engage in a particular behavior only encourages that individual to attach a greater importance to that given behavior (20).  When a free behavior, such as the ability to use drugs or smoke tobacco, is taken away or threatened, especially in a situation where an outsider eliminates the choice instead of the individual, then that behavior instead becomes more desirable (20).  The elimination of a perceived freedom creates a state of “psychological reactance,” a psychological state where an individual seeks to re-establish the eliminated freedom (20).  A police officer standing in front of a classroom full of children or young adults who is reiterating the idea over and over again not to engage in marijuana or alcohol use may actually be giving that behavior a greater value in his or her audiences’ minds.  Taking away the freedom to make that choice to engage in the behavior of using a drug or drinking alcohol, for example, can contribute to an individual wanting to, as Dr. Brehms’ theory contests, re-establish the ability to make that choice.    

Research in the Journal for Social Psychology indicates that this psychological reactance tends to be greater in younger subjects compared to older ones (21).  The authors of this theory even noticed this phenomenon in children as young as two years old (22).  The rationale is that the younger population tends to view more situations and behaviors as freedom-threatening (21).  Additionally, these young people also tend to question more, including adult authority (23).  This is problematic for the D.A.R.E. campaign, given that it is taught in a classroom atmosphere by a police officer in uniform to young children.  These officers are trained to teach children how to completely avoid drugs and alcohol.  Additionally, as part of the program, D.A.R.E. highly encourages parents to get involved by setting “no-use” rules regarding alcohol and tobacco and set strict rules regarding their children’s social activities (19).  Unfortunately, research regarding reactance theory would indicate that emphasizing a message of not engaging in a particular behavior to a young audience could actually be counter-productive to the D.A.R.E. mission. 

New Intervention - The D.A.R.E. 75 program: A New Start Tackling One Issue          

In order to address the issues surrounding the effectiveness of the D.A.R.E. campaign, I would propose a new strategy that involves focusing not so much on the individual harms and direct consequences of drugs, alcohol, etc., but rather a design that includes individual as well as group-level factors that appeal to the emotional side of the individual and tries to create a social change rather than an individual one.  This type of approach should be modeled after the Florida “Truth” campaign, which has seen success in getting youth in that state to quit smoking (9).  “Truth” was an anti-tobacco marketing campaign that resulted from a tobacco industry settlement and began in 1998 (9).  The Truth campaign was successfully able to re-frame tobacco use as an issue of the tobacco industry putting limits on kids’ freedom and independence (9).  According to Jeffery Hicks, youth already knew the harmful effects of tobacco.  What youth wanted is to be left to make their own decision after being given the facts (9). 

These implications can be translated to D.A.R.E. in a new, re-vamped media campaign called the D.A.R.E. 75 campaign that re-frames the use of illicit substances as putting restrictions on freedom, as opposed to providing more freedom.  The “75” is a response to a National Survey on Drug Use and Health report that found 25% of kids aged 12 to 20 years old reported drinking alcohol in 2011 (24).  The 75 focuses on the 75% of kids not using alcohol, which can hopefully begin to create a social norm that alcohol prevalence is not what many may think it is.

            This new approach would tailor the D.A.R.E. campaign to look at the use of alcohol only, as opposed to taking up a cause against a variety of harmful substances or behaviors such as drugs, gang violence, tobacco or any other issues.  This would allow D.A.R.E. to focus all their energy on effectively reducing the number of youth who currently use or are thinking about using alcohol in the future.  Part of the Truth campaign success is their ability to focus all their energy simply on reducing tobacco use prevalence in youth (9).  Their interests were not spread out across an array of different causes.       

            Comparable to the Truth campaign, this new approach would be a mass advertising campaign that depicts the alcoholic beverage industry as one that thrives and makes enormous profits off of youth continuing to buy their product.  It would make use of TV slots, billboards, and social media.  This message is intended to relate the idea that alcohol beverage companies are in the business of increasing profit margins.  They thrive on the ability to make a profit off of their customers.  For example, a billboard could be used that shows money going from a young teenager’s pocket to the pockets of well-dressed executives sitting around a conference room with a big “Budweiser” or “Miller-Lite” plaque above their head, indicating they work at that respective company.   

            This approach can address all three issues previously laid out.  It changes the whole issue of alcohol use as not one about how alcohol has detrimental effects on the growing brain, or showing alcohol-related fatalities, but about how the alcohol-producing companies are strictly in the business of providing an alluring product that will undoubtedly bring in a large profit margin.  Thus, the main frame coming across to the youth audience has completely changed to one of empowerment of their individual freedom, while hopefully creating some psychological reactance against the alcohol companies instead of the communicator of the health message.

Defense of Intervention #1 - A Change in Frame

The new campaign would shift the core value of health that D.A.R.E. traditionally uses to the core value of freedom.  As previously seen, the frame is the way information is packaged to convey an underlining meaning of what the message is all about (5).  In the new approach, the core value is taking a dramatic shift from one of health to one of individual freedom (from the alcoholic beverage industry).  As Dr. Siegel points out, the tobacco industry has been really effective in creating a message to the public that has a frame that appeals to individual freedom, an intuitively American core value (5).  This new approach takes that core value over to the D.A.R.E. 75 campaign so they can craft their own message around it, as seen in the Truth campaign.  This new campaign can make use of images depicting rich executives and how they may see youth as just another customer, not a friend or someone they have any invested interest in beyond making money.  In addition, a series of catch phrases, such as “pocket to pocket” or “my good time is not worth giving them my dime,” can be used to support the frame of individual autonomy from the alcohol companies. 

            The key, then, is to provide an emotional appeal to youth so they will refuse to submit to peer pressure and so they will turn away from the harmful effects of alcohol at such a young age.  Kids know they are not supposed to use alcohol.  They have all the information about it, but again, they want to be left to their own faculties as to whether or not to make decisions based on that information (9). Here, the goal of the frame is to tap into youth’s desire to have control, a gain-frame that potentially can appeal more to them and be more effective (8).  Kids are constantly being told what to and what not to do and this is providing that ability to make their own choice, even if the message is making an attempt to sway that decision.            

Defense of Intervention #2 - It’s not as Popular As You Might Think

            The name of the new campaign would be entitled the D.A.R.E. 75 campaign.  Again, this is a play on the statistic that in 2011 it is estimated that 25% of adolescents were using alcohol (24).  As shown previously, social norms can play a significant role in predicting whether or not an individual will choose to adopt a behavior.  In fact, one study looking at college students found social norms to be the biggest predictor of alcohol use (16).  For some reason, young people have a very skewed idea of the actual drinking habits of their friends and peers (17).  Dr. H. Wesley Perkins of Hobart and William Smith Colleges points out how misperceptions can have a strong influence on an individual to drink heavily (12).  He goes on to explain how showing actual drinking rates and numbers are likely to lessen misperceptions help those abstaining from drinking or engaging in healthy drinking habits feel better about their decision (12). 

            Therefore, the key idea in the name is to turn around the misperception of actual drinking rates.  If social norms are a significant predictor of use, then this should be the first key issue to address in the new program.  Kids at a young age are always eager to fit in somewhere.  If the prevailing belief is that all the kids in school are experimenting with alcohol, then research has shown that this belief is very likely to encourage an individual who is contemplating using alcohol.  With this in mind, D.A.R.E. 75 seeks to relate the fact to youth that 75% of adolescents are not using alcohol.  This will hopefully, as Dr. Perkins points out, help those in that tricky youth decision whether to drink or not, feel more at ease in choosing the route of not to drink.

Defense of Intervention #3 - Providing Freedom to Make Their Own Decisions

Driving home the message of the dangers of an illicit substance and telling children not to do something counter-intuitively can create an allure of that substance through psychological reactance (9).  For example, telling a child not to watch a certain range of channels on a television can create an enormous amount of curiosity that can drive that child to see exactly what is on those channels that the adults do not want him or her to see.  This approach of explicitly telling kids exactly what they can and cannot do puts restriction on their freedom.  And as previously found, Hammock and Brehm show that reactance leads to an attempt to re-establish that eliminated freedom (20).  Therefore, a campaign that seeks to show the use of illicit substances putting limits on freedom, as opposed to providing more freedom, should greatly reduce the amount of reactance from the message. 

    According to Jefferey Hicks, what’s important in a message is the tone of what you are trying to get across.  Youth do not want to be preached to with a series of “do’s” and “do nots” (9).  As one could see, a police officer in uniform standing in front of a classroom or auditorium full of young people could easily give off that paternalistic and preaching tone.  Hicks found that youth were using tobacco as a tool of rebellion because they were continuously being told not to do it (9).  The Truth campaign was successfully able to use that tool of rebellion against the big tobacco industry.  The D.A.R.E. campaign needs to show a message that relates drugs, alcohol, or tobacco to be substances that limit their freedom in life.   

            In addition to creating a better tone for the overall messages related by D.A.R.E., Paul Silvia points out that similarity is a good tool to “deflect” reactance (25).  He found through a series of experiments that similarity can have multiple effects that increase effectiveness of the communication of a message, including reducing the negative force towards reactance and increasing positive force by increasing the likeability of the communicator (25).

            This all relates back to D.A.R.E.’s use of a police officer to provide information to young people.  Police officers are people who represent law and authority.  They have very little in common with a classroom full of kids.  Therefore, kids see this situation as an authority figure telling them what not to do.  The communicator needs to be youth providing information to youth.  These communicators also need to be people that youth can relate to and who are going through the same set of social situations and life decisions.  This can immediately provide a more similar communicator that can be more relatable to youth.  Using young people to provide the message of standing up against the alcohol companies has the potential to significantly deflect any reactance to the message.          

Conclusion - A New Step Forward

            The D.A.R.E. 75 campaign can be a significant improvement upon the existing D.A.R.E. model.  While the current program does an excellent job at providing information on a variety of different substances and behaviors, that is simply all it may be doing.  Because of programs such as D.A.R.E, young people are very aware of the dangers of drugs or alcohol, but have not given them the right push to act accordingly.  The D.A.R.E. 75 campaign addresses these issues that have been potential barriers to effectively communicating with the younger generation.  It is a definite improvement and step in the right direction for the D.A.R.E. program.    

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