Analysis and Critique of BPHC Helmet Safety Campaign – Yara Tayeh

        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 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, Commonwealth Avenue and Massachusetts Avenue have the highest rate of bicycle accidents, according to three surveys published by Boston Bikes in 2010 (2). 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 helmet use among EMS calls was only 45% (3). 

Despite these overwhelming statistics, it is evident that cyclists make up a large portion of the population. 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?

Mayor Menino has actively been promoting bicycle safety in Boston since 2007 but 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 without helmets 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.” The goal of the bicycle safety campaign is to promote and increase helmet use in the city of Boston, with the central message that it is always safer to ride a bike with a helmet than without a helmet (5)

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. 

First Critique of Intervention: Health Belief Model is not appropriate for Helmet Safety Campaign

            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).

            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).

            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 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 susceptibility 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. 

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.

Second Critique of Intervention: Forceful messages have reverse effects, especially on youth

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:

“…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).

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

“[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” (13).  

Furthermore, the American Public Health association cites that 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).

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.

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 giving 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).

Final Critique of Intervention: Inappropriate use of marketing images

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 “fear control processes may interfere with precautionary motivation, recommends cautious and limited use of fear appeals in health promotion. It seems likely that fear 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).

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).  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.

Rather than relying on fear appeals, the Boston Public Health Commission should focus on marketing and appealing to the aspirations 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.

A New Proposal: Redefining helmet safety in Massachusetts

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.

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”, promise freedom to the cyclists and give 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.

First Defense of New Intervention: Change behavior, change a mind

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 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).  

In his book, The Tipping Point, 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?

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.

            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 headgear (5).  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.

Second Defense of New Intervention: Advertising for freedom

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.

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.

Final Defense of New Intervention:  Appealing to aspirations

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). 

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.

So how can we employ social marketing techniques in order to increase helmet safety in Boston? The helmet safety campaign should appeal to the aspirations 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 freedom of expression.  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.

            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.

REFERENCES

(1) Center for Disease Control and Prevention. Bicycle Related Injuries. Atlanta, GA: Home and Recreational Safety, 2009. http://www.cdc.gov/homeandrecreationalsafety/bikeinjuries.html
            (2) The Daily Free Press. Bike initiatives aim to increase cyclist’s safety. Boston, September 2012. http://dailyfreepress.com/2012/09/20/bike-initiatives-aim-to-increase-cyclists-safety/
            (3) City of Boston. Bike Statistics. Boston, MA: Parks and Recreation Department, 2010. http://www.cityofboston.gov/bikes/statistics.asp
            (4) Pedestrian and Bicycle Information Center. General Bicycling Statistics. North Carolina: University of North Carolina Highway Safety Research Center. http://www.bicyclinginfo.org/facts/statistics.cfm
            (5) Boston Public Health Commision. Helmet Safety Campaign. Boston, MA: Injury Prevention, 2012. http://www.bphc.org/programs/cib/healthyhomescommunitysupports/injuryprevention/Pages/HelmetSafety.aspx
            (6) 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.
            (7) Clayton RR, Cattarello AM, Johnstone BM. The effectiveness of Drug Abuse Resistance Education (project DARE): 5-year follow-up results. Preventative Medicine, 1996; 3: 307-318.
            (8) Hanson, D.J. Alcohol Abuse Prevention. Drug Abuse Resistance Education: The Effectiveness of DARE. Potsdam, NY, 2007.  http://www.alcoholfacts.org/DARE.html
            (9). Mass Ride. Safe Routes to School Funding in Massachusetts. Massachusetts: Safe Routes to School National Partnership, 2012. http://www.saferoutespartnership.org/state/srts-in-your-state/massachusetts.
            (10) Jack, M.S. Personal fable: a potential explanation for risk-taking behavior in adolescents. Journal of Pediatric Nursing, 1989; 5:334-338.
            (11) Introduction. In: Gladwell M. The Tipping Point: How Little Things Can Make a Big Difference. Boston: Little, Brown and Company, 2000, pp.3-14.
            (12) Brehm, J.W. Psychological Reactance: Theory and Applications. Advances in Consumer Research, 1989; 16, 72-75.
            (13) Legal Momentum: Advancing Women’s Rights. Sex, Lies, & Stereotypes: How Abstinence-Only Programs Harm Women and Girls. New York: Committee on Oversight and Government Reform, 2008.
            (14) American Public Health Association. Abstinence and U.S. Abstinence-Only Education Policies: Ethical and Human Rights Concerns. Washington, DC: Advocacy and Policy, 2006.
            (15) Ruiter, R., Abraham, C., Kok, G. Scary warnings and rational precautions: A review of the psychology of fear appeals. Psychology and Health, 2001; 16:6.
            (16) Witte, K. and Allen, M. A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns. Health Education and Behavior, 2000; 27:591.
            (17) Dearing, J. Applying Diffusion of Innovation Theory to Intervention Development. Research on Social Work Practice, 2009: 19:503.
            (18) Dearing, J., Maibach, E. and Buller, D. A Convergent Diffusion and Social Marketing Approach for Disseminating Proven Approaches to Physical Activity Promotion. American Journal of Preventative Medicine, 2006; 31:4.
            (19) Grier, S. and Bryant, C. Social marketing in public health. Annual Review of Public Health, 2005; 26:319-339.
            (20) Andreasen, A. Marketing Social Change: Changing Behavior to Promote Health, Social Development, and the Environment. Jossey-Bass, 1995.
            (21) Cardeno, A. et al. Marketing HIV Prevention for Heterosexually Identified Latino Men Who Have Sex with Men and Women: The Hombres Sanos Campaign. Journal of Health Communication: Health Perspectives, 2012; 17:6.

Distracted Driving: The Plight of Teenagers and Texting

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.

            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.

Distracted.gov

            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.

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 Glee. Glee 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 “A texting driver is 23 times more likely to get into a crash than a non-texting driver” (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 Glee 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. 

Critique 1: Eliciting Psychological Reactance

            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.

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.

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.  

Critique 2: The Weakness of the Use of the Health Belief Model

            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.

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.

            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.  

            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.   

Critique 3: Lack of Celebrity Peers and Role Models

            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.  

            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.

            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 images of additional sporting events are posted. 

            As previously mentioned, the Department of Transportation has partnered with Glee 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 Glee logo in the bottom right-hand corner of the video, there is only one other mention of Glee 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. 

Additional Features on Distracted.Gov Could Increase Teen Compliance

            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.  

            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.   

Modification 1: Freedom and Independence, Not Safety and Health

            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.

            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.

Modification 2: Decisions Are Not Made Rationally or Independently

            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.

            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.

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.

Modification 3: Familiar Messengers

            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.

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 Modern Family to encourage political engagement.

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 Glee should be expanded. The cast of Glee 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.   

Conclusion

            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.

REFERENCES

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An Analysis and Proposed Intervention for the USDA’s MyPlate Campaign towards Adolescents-Danny Neilson

Introduction

In modern America, approximately 65% of Americans can be classified as either overweight or obese (1). Furthermore, the incidences of diet-related health problems such as heart disease, diabetes and cancer are at an all time high. In America, it has been shown that 4 out of the 10 leading causes of death can be attributed to poor dietary behaviors (2). However, the incidence of obesity is not equally distributed among different genders and ethnic groups (1). In addition to different prevailing opinions among males, females and different ethnic demographics towards diet and nutrition, one can correctly assume that children and adolescents have their own unique approach to nutrition and its role in role in daily life. Studies of International Adolescent Nutrition reveal that there appears to be an increasing prevalence of obesity worldwide, possibly explained by increased dietary lipid intake and decreased physical activity, especially in urban settings (3).

Overwhelming evidence suggests that increased fruit and vegetable consumption leads to decreased risks of obesity, cardiovascular disease, cancer and stroke (4). Past US pubic health programs, such as Five a Day and the Food Pyramid, have aimed at increasing fruit and vegetable consumption. Like traditional public health interventions, past USDA public health interventions have relied on the Health Belief Model as the basis for behavior change. The Health Belief Model asserts that an analysis of Perceived Benefits and Perceived Costs leads to Intention, which then leads to Behavior (5). Despite the failings of USDA’s Five a Day campaign and the recently replaced Food Pyramid, the USDA’s new model for promoting healthier dietary choices, MyPlate, relies primarily on the principles of the Health Belief Model to instill behavioral changes.

The MyPlate campaign is mainly centered around the MyPlate icon and the USDA’s website choosemyplate.gov, which provides detailed nutritional information and an omnipresent MyPlate logo. On the website, the MyPlate logo is described as “a simple, yet powerful, visual cue to prompt consumers to think about their food choices across food groups and to build a healthy plate at meal times” (6). The MyPlate home page offers nutritional advice regarding what to eat, how much to eat and details regarding which foods should be limited (7). Furthermore, the home page details sample menus, recipes, daily food plans, nutrition tips and plans for eating on a budget (7). The consumer’s section of the MyPlate website offers specific nutritional advice for Dieters, Pregnant and Breastfeeding Women, Children from 6-11 years and Preschoolers of the ages 2-5. A notable emission from the consumer section of the MyPlate website is a sub-group specifically tailored to the needs and attitudes of adolescents. The website also offers a SuperTracker, to help Americans plan, track and analyze their diet and physical activity (7). A significant difference between the new MyPlate icon and the more recent MyPyramid is the elimination of the sub-group previously known as “discretionary calories”, which includes sweets, refined grains and soda. Interestingly, a 2005 study of American male and female adolescents found that discretionary calories make up approximately 46% of total caloric intake in the average adolescent diet (8). According to the FAQ section of the MyPlate website, these foods are not expected to be completely eliminated from the diet but were not included so as not to promote the consumption of unhealthy foods (7).

Despite the upgrades in the MyPlate campaign, the continuing flaws of the USDA’s nutrition education program will fail to promote lasting dietary changes, particularly for adolescent consumers. The most glaring of these flaws are a failure to account for Psychological Reactance, weak and one-dimensional marketing and advertising efforts, and the assumption that dietary choices are rational, education-based decisions that take place at the individual level. The proposed intervention will detail a plan of action that eliminates Psychological Reactance through an improved understanding of Communications Theory, bolsters marketing through a superior implementation of Advertising Theory and Marketing Theory and directly influences dietary behavior at the group, as opposed to individual, level.

Critique 1: MyPlate’s campaign generates Psychological Reactance and is not persuasive

Psychological Reactance Theory, developed by Brehm, Brehm and Wicklund, asserts that any persuasive message may arouse feelings of resistance, leading the listener to reject the desired behavior and do the opposite of what is suggested (9). From infancy, this behavior is evident. A study of psychological reactance in infants found that when presented with two objects, one behind a barrier and the other freely accessible, 2 year old boys resoundingly preferred the object behind the barrier (10). Unfortunately, the MyPlate campaign does not account for Psychological Reactance in its message. The logo of the MyPlate campaign, a circle split into four quadrants with a small circle outside the plate for the dairy group, literally confines American’s eating choices. The MyPlate logo and the nutrition information provided on the choosemyplate.gov website are threatening because they threaten one of the freedoms that Americans value most highly, the ability to choose the foods and quantities that they desire. While this is not the intention of the MyPlate campaign (7), the logo and information provided to American consumers reduces the dietary choices that consumers can make by blocking off food choices into specific categories and giving calorie boundaries. Furthermore, adolescents are proven to consume a high percentage of total calories from discretionary calories and also consume insufficient amounts of fruits and vegetables (8). In the same way that a smoker reacts adversely when threatened with the loss of ability to smoke, teens feel that their control and freedom is threatened when such a large amount of their diet is put on the chopping block.

Despite its good intentions, the MyPlate logo and corresponding nutritional advice decreases the control of adolescent consumers. Like past studies exploring potential loss of freedom, low personal control is similarly correlated with passivity and poor morale (11). The corresponding feelings of decreased control and explicit messaging resulting from the MyPlate logo and website are likely to generate high levels of Psychological Reactance.

Another factor that MyPlate does not account for is Communications Theory, which states that messages are more persuasive if the source delivering them is likeable, similar, familiar, and carries positive associations. Similarity increases liking and decreases resistance by making a message less threatening (12). This aspect of Communications Theory is not implemented well in the MyPlate campaign because the information on the site is provided by a faceless, voiceless source. According to the MyPlate website, all of the online materials provided, including the Daily Food Plan, Food Tracker and Food Planner were developed by a team of nutritionists, dietitians, economists, and policy experts at the USDA (7). As a result, teen consumers are not able to relate to the message being provided due to the disparity among the group providing the message and the one receiving. The MyPlate website does not provide a visible teen role model or spokesperson for adolescents to look up to, thereby inhibiting feelings of Similarity. Like the principle of Similarity, Communications Theory also suggests that Likeability makes a message more persuasive. Attraction to the communicator is a well-known force towards compliance (12). While the “voice” behind the MyPlate campaign is not necessarily unlikeable, there is nothing about the MyPlate logo or the information provided on the website that will arouse feelings of warmth and likeability towards the message being provided because it is delivered by anonymous nutrition professionals. Furthermore, familiar messages are viewed as more valid than unfamiliar messages (13). Depending on the upbringing and nutritional knowledge of the adolescent, the information provided on the MyPlate website may or may not be viewed as Familiar. In comparison to the tens of thousands of commercials and other messages that teens receive each year, many of which pertain to dietary choices, the MyPlate logo and the nutritional recommendations provided by the website are extremely unfamiliar. Lastly, Communications Theory asserts that messages will be more persuasive if they carry positive associations. Food chains, such as McDonald’s or Burger King, are quite aware of this and the distribution of toys to children in conjunction with unhealthy food and beverages has been implicated as a barrier to children meeting nutritional standards (14). The MyPlate message is not delivered in a state of enjoyment as toys are with fast-food meals, thereby limiting the campaign’s ability to achieve positive associations with teen consumers.

Critique 2: MyPlate fails in its Marketing and Advertising efforts

Despite the difficulty it takes to produce a successful public health social marketing campaign, past interventions have been effective in preventing and controlling tobacco use, increasing physical activity, improving nutrition and increasing condom use (15). One of these obstacles is the decreased visibility of public health messages in comparison to non health-promoting messages. Children view approximately 40,000 television commercials each year and marketers are increasingly exploring how to reach children through Ipods, gaming platforms, cell phones and other digital devices (16). Unfortunately, the minds behind the MyPlate campaign have not fully utilized the multitude of technological options available at their disposal. The USDA’s main efforts are centered on the MyPlate logo and the information on the choosemyplate.gov website.

The MyPlate website and logo do not demonstrate an understanding of Advertising Theory. Advertising Theory posits that effective advertising presents a promise, support (in the form of words, images, music, etc) and fulfills the aspirations of the targeted audience. On the MyPlate website, the “Consumers” section visible at the bottom of the home page does not contain a section dedicated specifically towards adolescents (7). There are sections available for Preschoolers (2-5 years), and Children (6-11 years) but not for individuals of 12 years or greater who are not yet adults. This omission is particularly significant given that studies indicate that attention is greater for tailored as compared to non-tailored health communications (17). While adolescents can use MyPlate’s resources to calculate their individual nutritional needs, the lack of information and catering towards the unique preferences and attitudes of adolescents means that attention will be low for adolescents viewing the MyPlate website. Furthermore, the central “promise” of the MyPlate logo and the MyPlate website is one of health, which is one of the least effective core values in teen marketing campaigns (18). Additionally, the main “support” of the MyPlate campaign is provided through written advice and images. Media researchers have hypothesized that computer-mediated messages are less effective than other forms of communication such as radio, video and interpersonal communication because they lack non-verbal cues, reducing the “richness” of the message (19). Since MyPlate’s campaign is decidedly computer-mediated, an opportunity to advertise more effectively through audio, visual and interpersonal communication is lost.

Despite the difficulty of designing a nationwide nutrition program for men and women of all ages, there is precedent showing that marketing campaigns can promote change for diversified social groups.  Research into the marketing practices of Absolut Vodka reveals that brand meanings change across social, cultural and national boundaries, a trend facilitated by successful marketers (20). On a related note, research into media messages promoting health and nutrition reveals that communication messages directed towards a particular audience have been proven to be the most effective in achieving change (21). While a logo or symbol may be an effective means of communicating nutritional advice, it must appeal to the core values and beliefs of the group of people it intends to influence. By directing its message more directly towards adolescents, MyPlate would be able to achieve much more significant changes in teenage dietary behavior.

Campaigns are most effective when companies and agencies market what people want, not what the group wants to sell. This way of thinking, known as Marketing Theory, can be immensely successful when implemented correctly, as shown by the results of Florida’s “truth” campaign. The core values of Florida’s “truth” campaign originated from the feedback of a 500 person youth summit and youth review board assembled to gain insight into the values that teens most identify with (18). By determining the values that teens most valued, in this case, rebellion, the “truth” campaign was equipped from the start to package a public health message that promotes a core value that adolescents cherish. This shift in thinking away from established social marketing practices is touted as the key step in the success of the “truth” campaign (18). Not only does the MyPlate campaign not appeal to a key core value for adolescents, the emission of a section of their website devoted specifically to teens means that they will not be motivated to change their dietary practices for the better.

Lastly, an understanding of the “authority effect” can help explain why MyPlate is likely to fail in its efforts to improve the eating habits of adolescents. The “authority effect” is a commonly used social influence principle used in advertising which asserts that information being delivered from an individual high in authority increases the likelihood of compliance for a given behavior (22). However, in a study of consumer behaviors for young adults in the US, teens had more receptive attitudes when the spokesperson for an ad was low as opposed to high in authority (22). With this knowledge, it is apparent that the “support” as explained by Advertising Theory would be most effective if delivered from a peer low in authority instead of the team of nutritional experts assembled by the USDA to give the MyPlate message.

            Critique 3: MyPlate assumes that dietary choices are made at the individual level through a rational, cost-benefit analysis

The Center for Nutrition Policy and Promotion, a sub-group of the USDA responsible for the creation of MyPlate describes its primary objectives as “advancing and promoting dietary guidance for all Americans and conducting applied research and analyses in nutrition and consumer economics” (7). As evidenced by the MyPlate logo and the nutritional advice provided on the MyPlate website, these objectives are mainly pursued through a reliance on the Health Belief Model. Despite the assumptions inherent in MyPlate’s usage of the Health Belief Model to explain behavior change, group level factors exert a tremendous amount of impact on dietary decisions, especially for US teens, individuals who are at a delicate stage of life where personal identity and the opinions of others are magnified in importance. A nationwide study for a sample of 1319 Americans examining the dietary quality and body mass of adults found that knowledge of basic nutrition facts, diet-health awareness and the ability to self-assess nutrient intake did not have a strong influence on dietary quality or body mass (23). Factors such as lifestyle characteristics, cultural habits, community infrastructure, and the politics of food production and retailing are hypothesized to outweigh nutrition knowledge when it comes to dietary quality and body mass for US adults (23). On a similar note, a study examining the eating habits of Dutch Adults found that elevated socioeconomic position is correlated with higher levels of fruit and vegetable intake (24). These group-level factors are not addressed in the MyPlate logo and are not visible in the nutritional advice provided on the website.

By failing to account for the limitations of the Health Belief model, principally the barriers that prevent intentions from becoming established behaviors, the MyPlate message has limited applicability to the decision-making process of US adolescents at meal time. In a study of Costa Rican adolescents, barriers to healthful eating were found to be lack of availability of healthful foods in the school environment, poor family diet, and the peer-group notion for both males and females that healthful eating for males is effeminate (25). Factors perceived as motivators included availability of high-quality, healthy foods, healthy family eating practices and healthy peer group eating (25). MyPlate’s campaign does not address these group-level variables, limiting its effectiveness.

Furthermore, there are environmental obstacles beyond the scope of the individual to creating healthy food environments for US adolescents. Changes can be made to garner more healthful food options in school cafeterias, but these programs cannot be sustained monetarily without a significant shift in student’s food preferences towards healthier options (26). Studies have found that “competitive”, non health promoting foods are widely available to students and have been linked to high intakes of calories, soft drinks, total fat, saturated fat and a lower intake of fruits and vegetables (26). Additionally, lack of school-wide communication between food service staff, health educators and teachers makes it difficult to implement school wide nutrition education programs (26). The MyPlate campaign demonstrates limited resources pertaining to developing more effective communication among the food service providers at US schools and does nothing to address the fact that many schools do not have the funds to implement optimal environments for making healthy food choices.

Articulation of Proposed Intervention:

The chief goals of the following proposed nutritional intervention for US adolescents are to eliminate Psychological Reactance, successfully implement the Theories of Communications, Advertising, and Marketing and to directly influence behavior beyond the individual level. This will begin with two 30 second commercials that will air during the 2013 Super Bowl. At the end of both commercials, the new slogan for the USDA’s dietary intervention program will be unveiled. Spelled out with the shapes of fruits and vegetables, this message will read, “Freedom to Achieve Your Dreams”.

Attempts to eliminate Psychological Reactance will be centered around delivering implicit messages that do not threaten freedom or control. These implicit messages will be based upon Communications Theory, which states that in order for messages to be maximally effective, they must be delivered from a source that is Similar, Familiar, Likeable and carries Positive Associations. In order to appeal equally to both male and female adolescents, two spokespeople of both genders will be chosen to represent MyPlate, Olympic gymnast Aly Raisman, 18 year old Captain and gold medal winner for the US Women’s Gymnastic Team at the 2012 Olympic Games, and Josh Hutcherson, 20 year old and one of the leading actors in the immensely popular movie, “The Hunger Games”.

Advertising and Marketing efforts will be based upon appealing to the core value of freedom, and not Health. This coincides with Marketing Theory, which shows that public health campaigns are most effective when agencies market the core value(s) that people want (18), in this case for teenagers, freedom, as opposed to what the USDA wants to sell, in this case Health. To maximize advertising efforts, both commercials will contain a Promise, Support and demonstrate that eating healthfully fulfills the aspirations of US teenagers. Unlike the MyPlate website, which does not contain a section devoted specifically to adolescents, this campaign specifically targets teens, which has been shown to increase the effectiveness of public health campaigns (21).

Lastly, this intervention will take into account the irrational behavior of US teenagers and eliminate the usage of the Health Belief Model. Instead the campaign will focus on the implementation of alternative models of behavior change. With Raisman and Hutcherson serving as role models, the commercials will promote a “tipping point” for individuals to adopt healthier eating practices, a characteristic outlined in Diffusion of Innovation Theory (27). Furthermore, since both individuals are highly popular and in the news due to their recent captivating performances, this campaign will successfully utilize the components of Agenda-Setting Theory, which essentially states that messages are more effective when their message coincides with what is being covered by the media.

Defense of Intervention Section 1:

The MyPlate campaign is built upon the presentation of explicit, rather than implicit messages. A study of anti-smoking public service announcements reveals that public health messages are most effective and generate far less Psychological Reactance when they are delivered implicitly, rather than explicitly (28). Psychological Reactance occurs for teens viewing the MyPlate logo and reading nutritional advice on the choosemyplate.gov website because the information provided details specific actions that consumers should take rather than relying on implicit messaging techniques such as metaphors.

Rather than delivering explicit nutritional advice, the two commercials will focus on decreasing reactance through implicit, non-threatening messages. First of all, this will start through the new slogan of the campaign, “Freedom to Achieve Your Dreams” spelled out with fruits and vegetables. This message will not generate Psychological Reactance because it does not pose a threat to freedom by delivering explicit advice. These commercials will contain no dialogue, instead relying on images, motivating music and story-telling to motivate teens to change their dietary behaviors. Although the specifics of the commercials will be slightly different so as to show the unique story of both teens, the message for both will be the same, eating a healthy diet provides the impetus to live freely and achieve one’s dreams. For Aly’s spot, the images depicted will show a sped-up version of her life, from birth, through childhood, adolescence and ultimately culminating with footage of her Olympic Gold medal performance. This commercial will intersperse footage of Aly in her daily life with images of her eating healthy foods, such as fruits and vegetables and overcoming the grueling demands of her training as a result. For Josh, the commercial will depict a re-enactment of critical scenes from “The Hunger Games” interspersed with images of him eating nutritious foods which gave him energy, allowing him to display his tremendous strength to the sponsors of the competition. The commercial will also depict scenes in which his character, Peeta, was able to stave off death through the nourishment of the healthy foods he ate leading up to and during the competition.

These two spokespeople will allow for a great display of Communications Theory when executed to the fullest. Since both characters are adolescents, they will invoke feelings of Similarity from the audience, as opposed to the faceless, nameless creators of the MyPlate campaign. Furthermore, to capitalize on the need for Likeability as explained by Communications Theory, both characters are attractive and athletic, two characteristics which serve as strong motivators for teens when it comes to nutrition (3). Next, both individuals are familiar to American teens, as they have appeared in the Olympic Games and a block-buster movie, respectively. These two will have success in serving as public advocates because familiarity increases the chances of proposed behaviors being adopted (13). Like fast-food chains which capitalize on the fact that children are in a state of enjoyment when eating at their restaurants by handing out toys, these commercials will be especially effective because they will be viewed during a time in which enjoyment is high. The Super Bowl is one of the most widely watched programs during the year and it is usually watched in the company of family and friends where ample amounts of food are present. These factors all add up to the teenage consumers being in a high state of enjoyment when the ad is played, leading them to adopt positive feelings towards the message.

Defense of Intervention Section 2:

The commercials outlined above will be much more successful than the MyPlate campaign because of a superior usage of Advertising Theory and Marketing Theory. Additionally, the commercials will be very influential because they will utilize a captivating form of media. Research shows that messages are more effective when they come from a non-computer source, a fact possibly explained by non-verbal cues which contribute to the “richness” of the message (19). The promise inherent in the MyPlate message, in accordance with Advertising Theory, will be that eating healthful foods gives teenagers the freedom to pursue and fulfill their dreams. In the same way that Aly Raisman went from unknown to international gymnastics star and Peeta Mallark, Hutcherson’s character from “The Hunger Games”, was able to raise up from poverty and trying familial conditions to survive his fight to the death, US teens will be able to envision themselves achieving their dreams as a result of eating more healthfully when they watch these commercials. The support aspect of Advertising Theory will be fulfilled through music, images, and a compelling story. Finally, because both of these individuals are attractive and athletic, or at least the characters that they portray are, these commercials will fulfill the aspirations of US teens by indirectly imply that eating healthfully will allow them to achieve the goals of becoming more attractive and athletic, the two biggest motivating factors for US teenagers to eat better (3). Furthermore, this new intervention will successfully use Marketing Theory because the message will be specifically tailored to US teenagers, a factor shown to increase compliance with a recommended health behavior (17). Lastly, this message will be more effective because it comes from a low-authority source, a motivating factor for teens to adopt a given behavior (22).

Defense of Intervention Section 3:

Despite the beliefs of companies and organizations such as the USDA, humans do not always behave in a rational manner. In an aroused state, humans are more willing to engage in risky sexual behavior (29). In the same way that sexual behavior is not always made in a rational fashion, dietary choices and opinions can fluctuate given different contexts. It has been proven that nutrition knowledge, health awareness and the ability to self-assess nutrient intake do not necessarily lead to more healthful eating practices (23). For this reason, the proposed intervention will not use the Health Belief Model or focus on appealing to the core value of health. Instead behavior will be assessed and planned for at the group level through the implementation of alternative models of behavior change.

Diffusion of Innovations Theory, which states that certain events can serve as a “tipping point” in the adoption of a specific behavior (27), will be implemented in the commercials, hopefully leading to a mass change in teen nutritional behaviors. Once the “tipping point” occurs, practice of the modeled behavior increases exponentially. With these compelling and highly publicized commercials, teens will be influenced to adopt the modeled nutritional practices, leading to improved dietary choices among US teens. Similarly, with the increased percentage of US teens eating more healthful foods, social norms will be changed. This plays into another alternative social science model which has proven to be very effective, Social Expectations Theory. This theory essentially hypothesizes that mass change can be achieved just by changing social norms (30). Once social norms become more inclusive of healthful eating practices among teens, mass change will ensue. Lastly, these commercials will be highly effective because they will utilize Agenda-Setting Theory. This theory states that capitalizing on what is being covered in the media makes a message more effective. Since both of the chosen teens have generated high amounts of publicity due to recent successes, using them as the voice of the new campaign will lead to increased adoption of healthful eating practices among teens.

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