Banning Large Sodas to Decrease Obesity- A Critique on New York Soda Ban- Disha Shah

Banning Large Sodas to Decrease Obesity- A Critique on New York Soda Ban- Disha Shah

Introduction:

Obesity is one of the most daunting challenges for the public health, worldwide. Obesity rates in the United States are among the highest in the world. According to CDC, during the past 2 decades, there has been a dramatic increase in the obesity trend in the United States. More than one-third of U.S. adults (35.7%) and approximately 17% of children and adolescents aged 2—19 years are obese.¹

The prevalence of obesity in New York State is 24.5%.² As a step to control obesity, Mayor Bloomberg imposed a ban on super-sized sugary beverages larger than 16oz in public places such as restaurants, food carts, movie theatres, and delis. The ban won’t impact fruit juices, milkshakes, diet sodas or alcoholic drinks.³ Enforcement would be conducted by an existing corps of city restaurant inspectors. A violation of the law would lead to a $200 fine. This type of ban is first of its kind, and is becoming a growing national debate. The city pioneered in banning trans-fats, and it subsidizes fruits and vegetables for the poor through its Health Bucks  program.⁵ The intention behind this soda ban is to cut the intake of excessive calories from the large sized soda, thus to control obesity. Thomas Farley, commissioner of New York City’s Health Department, writes that if the new regulation “leads to New Yorkers simply reducing the size of one sugary drink from 20 ounces to 16 ounces every other week, it would help them avoid gaining some 2.3 million pounds a year.”³ Thomas Farley may be right here, but there are so many alternatives to a supersized soda, which might be responsible for obesity, and which are not addressed by this ban.

Critiques: 

1.      Does Not Create a Sense of Perceived Susceptibility:

To start with the flaws, the proposed ban on large, sugary drinks actually is not really a ban on anything. According to the ban, people will not get the choice of drinks larger 16oz. A large drink of soda (34 oz.) has about 108g of sugar.⁴   A small sized drink (16 oz.) has about 39g of sugar. People still aren’t completely prevented from drinking soda. It doesn’t cover beverages sold in supermarkets or most convenience stores (which are not regulated by the city). Drinks are also exempt if they contain more than 50 percent milk (so people are permitted to have a large Frappuccino with whole milk and sugar, which might contain more calories than a large soda). Alcoholic beverages are not included in the ban as well. "This is the largest single driver of the obesity epidemic," said Dr. Thomas Farley, health commissioner of the city. "It is the largest source of added sugars to our diet."⁶ So what about the sugar content in 16 oz. drinks? Is it safe to consume 16 oz. soda? Or is it safe to have 2-3 donuts on a daily basis? So looking to all these aspects, the ban on large drinks is not a ban at all. According to Health Belief Model, perceived susceptibility, also called perceived vulnerability, refers to one's perception of the risk or the chances of contracting a health disease or condition.⁹ One of the important determinants is whether or not a person believes that the problem could happen to him or her. If people think that they cannot get a particular disease or have a particular problem, they often will not take an action to prevent it. By imposing a ban on large drinks, people are not informed about the harmful effects of the smaller portions of drinks which can be equally responsible to be one of the factors contributing to obesity. Also, other high calorie food are not being identified as risk factors and people are not made to understand that they are susceptible to obesity if they drink ‘soda’ and not if they drink ‘large soda’.

2.     Invokes Psychological Reactance:

Psychological reactance is an aversive affective reaction in response to regulations or impositions that impinge on freedom and autonomy.¹⁰ Psychological reactance occurs in response to threats to perceived behavioral freedoms. If a person’s behavioral freedom is reduced or threatened, the person will become motivationally aroused. Because of the fear of losing the freedom of that particular behavior, they get motivated to restore their freedom, by doing exactly opposite of what is desired. This brings them a sense of ‘re-establishing’ their freedom and regaining back the control of their lives.¹³ This ‘boomerang effect’ is psychological reactance.

According to the above explanation for invoking reactance in the masses, it can be concluded that this policy has all the ingredients to invoke the reactance in the target population. 6 in 10 New York residents were in opposition of this ban.¹¹

This policy is actually not a ban, just a cap on large sodas. But it has been framed as a ‘ban’. This is one of the factors giving rise to ‘liberty issues’ and ‘freedom to choice’ in the target population. The soda companies will be affected directly by this policy. The American Beverage Association, whose members could stand to lose millions of dollars in revenue if the mayor’s plan is approved, has argued that there is little correlation between soft drinks and obesity. The industry group has led a big-budget public-relations effort urging New Yorkers to “make their own choices” on soda. These commercials are being aired on local television and radio. This has added to contribute in the psychological reactance.

Many researches show that when people are restricted or told to exhibit certain behavior, they choose to do exactly the opposite of what they are being told.¹²

This is one of the major flaws of this intervention. It completely violates the psychological reactance theory. “I know what’s best for you” kind of attitude has created an image of ‘nanny Bloomberg’.¹⁴

In general, policy makers should be aware of reactance and should recognize that individuals may respond in a counterproductive manner to policies that appear to threaten their ability to choose freely.

3.     Violates the Social Cognition Theory

According to social cognition theory, self efficacy and environmental factors play an important role in determining whether a person will change health behavior. In this case, environmental factors are not in favor of the desired behavior. The change does not make a favorable environment for the public to show the desired behavior. It's important to look at where people acquire such large drinks. An average New Yorker does not go to a movie theatre often, and attends sports venues even less regularly. In fact going to a grocery or a convenient store are much more common occurrences. So there is every possibility of the city resident buying his/her drink from such stores and gulp as much as soda he/she wants relaxing at home. The ban does not consider the complexity of how and why people acquire food and drink, and instead applies a simplified solution to a layered problem. It does nothing to do the self efficacy of the people or does not consider creating a ‘healthy’ environment. Thus, it is likely, that the desired behavior cannot be obtained in the target population. Self efficacy which means strong intention, knowledge and skills to carry out likely behavior is a strong determinant of human behavior. This behavior is reinforced when there are no or very less environmental constraints and rewards for change in behavior. By introducing ban, the self efficacy of the people is being questioned. ‘Ban’ seems to be more like an enforcement, which in social sciences can be called a ‘punishment’ without obvious rewards. Punishment is less effective than reinforcement for teaching and modifying behavior.⁸ Moreover this policy fails to reach at the core of the issue by not being able to change core belief of the target population. They are not able to achieve this because still there are plenty of catchy advertisement floating all over media which lure them to buying more and more of unhealthy drink. Have they been able to add a knowledge element simultaneously such as making it compulsory to show that drink consumed in large portions is harmful to health just like it is mentioned on the cigarette packs. Therefore, it is pretty much less likely to impact New Yorkers in reducing obesity. On the contrary ban portrays something which restricts freedom and people tend to believe that their choices are controlled by higher authority and this will cause fewer acceptances and eventually will not modify behavior which is primary goal for introducing this policy.

Conclusion:

Articles published in some of the medical journals suggest that rising levels of obesity may be linked to increases in soft drink portion sizes; this implies that reducing the consumption of sugary beverages may lead to better health outcomes.  However, the manner in which Mayor Bloomberg is attempting to achieve this goal ignores a number of important insights from behavioral science. It stimulates rebellion and distrust with elected officials. If we want people to drink less soda then we have to make people not want it and not telling them that they can’t have it.

Counter-proposals for the critiques:

1.      Counter-proposal for critique 1:

As stated in critique 1, a state of perceived susceptibility is not being demonstrated by this policy. There have been researches conducted which demonstrate that perceived susceptibility leads to a desired behavior.¹⁵

To develop a perceived susceptibility amongst people regarding the fact, that high calorie drinks such as soda, can lead to obesity, number of things can be done. One way is to create a graphic warning (and not verbal message) on the soda cups. For example, the large cups of soda should portray a fat, obese family with a sad pictorial representation of heart. And on small cups, a slim, healthy family with a smiling heart.  In this way, the message can be conveyed implicitly and obesity can be projected as a ‘cardio-vascular hazard’ and not just ‘being fat’.

 This can be mandated to all the large sized high-calorie drinks and not just soda. Thus, it will be considering for all the drinks which contribute to obesity and not just soda. Pictures can help to increase the message’s accessibility by people with low levels of literacy and can help visualize the actual message to be conveyed. Color pictures can be used to make it more effective and attractive.

These types of graphic warnings are made mandatory on the cigarette packs. Researchers have shown that these warnings are actually effective to decrease the rates of smoking.¹⁶

2.     Counter-proposal for critique 2:

As stated in critique 2, a ‘ban’ can induce a reactance in the target population, even though it is not ban but just a cap. There are many possible actions which can be taken to decrease the reactance. One simplest way is taxation on the sugary beverages. This type of ‘soda tax’ has already been imposed in certain states in US and has been effective.¹⁷ Such tax can be imposed on all high calorie drinks and not just soda. Another option is increasing the price of drinks and discontinuing the increase volume discounts.

Along with this, messages should be effectively conveyed with the help of popular celebrities regarding relation between high calorie diet and obesity. The media and especially actors and actresses have a huge influence on today’s youth. If these celebrities are sought to educate the masses what is right for their health, it will have a much higher impact and will be acceptable as they are not forced but are shown a direction towards healthy living from their role model.

Simultaneous implementation of these steps may lead to decrease the psychological reactance as well as see the desired behavior.

3.     Counter-proposal for critique 3:

Self efficacy and environmental factors play an important role in determining behaviors of the population. So it is very important to look at the issues pertaining to the self efficacy and environmental factors when planning to change the behavior of the populations. Here the word ‘ban’ causes havoc as it is in direct conflict to the behavior we want to achieve. This causes negative reinforcement as it tend to make people think that they are being controlled and they do not have right to choose what they want. Instead of banning the choices that people want, one should focus on adding a knowledge element so that it can help people make better choices. Environmental factors can be controlled by imposing a soda tax. So, people have to pay more at all the places from where they can get a soda, and not just movie theatres or a restaurant.

Regarding self efficacy, it has been found that self efficacy operates best in concert with general life style changes, including physical exercise and provision of social support. Self-confident clients of intervention programs were less likely to relapse to their previous unhealthy diet. Chambliss and Murray (1979) found that overweight individuals were most responsive to behavioral treatment where they had a high sense of efficacy and an internal locus of control. Other studies on weight control have been published by Bagozzi and Warshaw (1990) and Sallis, Pinski, Grossman, Patterson and Nader (1988).¹⁸  Self efficacy can be increased by increasing  self-confidence of the people. One way to do this is to start a campaign named “I can do it by myself!” Through such campaigns, the obese and over-weight people can be motivated to reduce their weight and improve their life style by giving them real life examples from people who have been successful in doing so. Also, the people who achieve their goals can be rewarded (like replacing the previous people in the campaign commercials). This can act as a positive reinforcement.

Exercise should be made a part of school curriculum. It should be made compulsory in every school for the students to take part in any form of exercise, such as yoga, dance, or other gymnastics. This way, we can make them efficient to live a healthy life style from their childhood.

Thus, it should be our fight against “obesity” and not “soda consumption”.

 References:

1.       Obesity and Overweight for Professionals: Data and Statistics: Facts - DNPAO - CDC. (n.d.).Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/obesity/data/facts.html

2.      Obesity and Overweight for Professionals: Data and Statistics: Adult Obesity - DNPAO - CDC. (n.d.). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/obesity/data/adult.html

3.      N. (2012, September 14). Why Soda Ban Will Work In Fight Against Obesity; Food Regulations Have Proven Record. Forbes.

4.      How Much Sugar in Sodas and Beverages? (n.d.). Sugar Stacks - How Much Sugar Is in That?. Retrieved from http://www.sugarstacks.com/beverages.htm

5.      D. (n.d.). New York City looks out for health of its own; It's a shame the notion that governments should promote well-being is so derided. newsday.

6.      Large-size soda pop likely to be banned in NYC. (n.d.). korea times.

7.      New Yorkers for Beverage Choices | The Facts. (n.d.). New Yorkers for Beverage Choices. Retrieved from http://nycbeveragechoices.com/the-facts/

8.      Leach, D. (n.d.). Using Positive Reinforcement to Increase Desired Behaviors | Butterfly Effects. Retrieved from http://www.butterflyeffects.com/articles/using-positive-reinforcement-to-increase-desired-behaviors

9.      Theories and Approaches. (n.d.). Retrieved from http://recapp.etr.org/recapp/index.cfm?fuseaction=pages.theoriesdetail&PageID=13

10.   Psychological reactance theory Psychlopedia psych-it.com.au. (n.d.). Retrieved from http://www.psych-it.com.au/Psychlopedia/article.asp?id=65

11.    Grynbaum, M. (2012, August 22). 60% in City Oppose Bloomberg’s Soda Ban, Poll Finds. the new york times.

12.   Abel , Barksdale. (2012). Freedom of choice and adherence to the health regimen for african americans with hypertension. Ans Adv nurs sci. Retrieved from http://www-ncbi-nlm-nih-gov.ezproxy.bu.edu/pubmed/22918261.

13.   Quick BL, Bates BR. (2010). The use of gain- or loss-frame messages and efficacy appeals to dissuade excessive alcohol consumption among college students: a test of psychological reactance theory. J Health Commun. Retrieved from

http://www-ncbi-nlm-nih-gov.ezproxy.bu.edu/pubmed?term=20812123.

14.   'Nanny Bloomberg' Ad In New York Times Targets N.Y. Mayor's Anti-Soda Crusade. (2012, June 4). Huffington post. Retrieved from http://www.huffingtonpost.com/2012/06/04/nanny-bloomberg-ad-in-new_n_1568037.html.

15.   Rahman M, Berenson AB, Herrera S. (2012). Perceived susceptibility to pregnancy and its association with safer sex, contraceptive adherence and subsequent pregnancy among adolescent and young adult women. Retrieved from http://www-ncbi-nlm-nih-gov.ezproxy.bu.edu/pubmed/23083528.

16.   TOBACCO WARNING LABELS: EVIDENCE OF EFFECTIVENESS. (n.d.).www.tobaccofreekids.org. Retrieved from http:// www.tobaccofreekids.org/research/factsheets/pdf/0325.pdf

17.   Why Mike Bloomberg’s 'Soda Ban' Could Actually Work. (2012, September 14). the daily beast. Retrieved from http://www.thedailybeast.com/articles/2012/09/14/why-mike-bloomberg-s-soda-ban-could-actually-work.html.

18.   Ralf Schwarzer & Reinhard Fuchs (n.d.). Self-Efficacy and Health Behaviours. Userpage < ZEDAT < ZEDAT - Hochschulrechenzentrum. Retrieved from http://userpage.fu-berlin.de/~gesund/publicat/conner9.htm

Spring 2013: Will There be an Obesity Tipping Point in NYC – Aileen Ledingham

Spring 2013: Will There be an Obesity Tipping Point in NYC

–Aileen Ledingham

Introduction:

            These are very interesting times pertaining to the association of soda consumption and obesity, particularly in New York City.  Without any doubt, it is of benefit to the American people that the rate of obesity in the population begins to decline because obesity contributes to the disease incidence of diabetes and hypertension.  However, there is a fair amount of doubt regarding the best way to address this issue.   Is this an issue for the government to intervene?  Just as the government has intervened to protect drivers by mandating air bags verses teaching people to drive safely at the speed limit and teaching them not to fall asleep at the wheel.  Or is this an issue for people to make better decisions based on better knowledge of factors influencing obesity. 

            Mayor Bloomberg proposed a ban on the sale of sugary drinks in containers greater than 16 ounces.  The ban was approved by the Board of Health in September 2012 and hence, beginning in March of 2013, food service facilities will have to abide with the law.   Restaurants, movie theaters, street carts, delicatessens (delis) and sports arenas are all such food service facilities (1).  This paper will provide a critique on how the Public Health Department in New York City managed their obesity campaign, and it will provide suggestions on how to improve the campaign’s effectiveness.

First Critique Argument:  

Too much dependence on individual behavior change models

            Educating the public via health clinics and fairs, provision of food coupons for farmers markets, were all expected to reach individuals and help them change their behaviors to decrease obesity (2).  The use of the Health Belief Model, the Theory of Planned Behavior, the Transtheortical Model and the Precaution Adoption Process Model, all limit intervention to the individual level, without consideration for the environment or social influences that the world provides (3).  Secondly, these individual behavior models assume that by providing knowledge, you will change a behavior.  This could be valid, however there is evidence that behavior can change without any knowledge or planning.  In his book R.B Cialdini writes  “In fact, automatic, stereotyped behavior is prevalent in much of human action because in many cases it is the most efficient form of behaving, and in other cases it is simply necessary” (4 pg.6).   Lastly, the conceptual basis of these models asserts that people are rational; we know that is not true.  For example, Dan Ariely writes about  “The Truth of Relativity” how the use of decoy can create an illusion of a better deal, the “deal” being exactly what the seller wants us to buy, because our behaviors can be predictably irrational (5).

Second critique argument:  using health as a core value

            “We are absolutely committed to doing everything in our power to help you get on track and stay on track to maintain a healthy lifestyle,” he said (Mayor Bloomburg) “Because this isn’t your crisis alone — it is a crisis for our city and our entire country”(2).   This is one of many examples where health is used as a core value.  As if having good health is the secret to a lifetime of happiness.  The opponents to the soda ban are using Freedom as their core value.  The campaign by the soda industry emphasizes that individuals will lose their “freedom to buy beverages as they see fit” (1).  The meaning of Freedom instills much more emotion then the meaning of Health.  Resistance to loss is a strong emotion (5).   Once we own the right to buy any size soda we do not want to lose that right.  Intuitively, health should be a motivator, but irrational human reality speaks differently.   The New York City department of public health campaign would be more successful if the message delivered to the target audience had meaning to people who are obese.  Instead, the message is about health and at the end of the day, it is too weak a concept to combat freedom.

Third critique argument:  Poor use of advertising theory.

            One video advertisement I observed illustrated a young white adult male of normal body weight, wearing cloths I would describe as business casual, drinking a pint of liquid fat (6).  The purpose was to impose a fear to getting fat.  The New York City Department of Public Health were hoping that the “disgusting” illustration would promote a viral advertising campaign that will move people toward healthy eating habits, combating obesity (7).

            What were they thinking when they chose the actor?  Maybe they were thinking the demographics of obesity are more prevalent in young adult white males?  Are young white professional males the targeted audience?  I think not, because the area of New York City with the highest percentage of obesity is in the Bronx, where Hispanic race is the majority and White race is the minority (2).     A study conducted by Rehm et.al. reported 1. people of black race and hispanic race consumed more soda then white race; 2. households with lower income and 3. individuals with less education consumed more soda (8).    One lesson from the Communications theory to consider:  The person delivering the message has to be likeable, and the more familiar the person is to the audience, the more persuasive the message can be.   I have doubts that a young professional white adult was the right person for this message.  

            This same message “Don’t Drink Yourself Fat” was provided to print media. Were they thinking that capitalizing on psychological reactance would help this campaign?   Telling a person not to do something, only makes it more desirable to do that same thing (9).   “Don’t Drink Yourself Fat” will create a desire to drink fat, in this case fat being soda.  The bold explicit language of the message triggers reactance (10).  This campaign provides no compelling reason to abide by the message; there is nothing to like about it.  The use of a positive message would have more of a change effect then a negative message (11).

Proposed intervention. 

            Promote freedom from obesity.  The New York City public health professionals “need to steal the flag” of freedom.  They need to re-frame their campaign to foster the sense of freedom that can be achieved by having “normal” body weight.  Promote the right for individuals to have access to healthier choices, be free from that temptation of a “better deal” with a larger soda.  Get people to rebel against the soda companies that just want to sell more soda and make more profits.  Fire up some emotion to protect their freedom from the lure of the soda companies.  Find a better reason why people should want to drink less soda.  They need to find a substitution for the fear people have over loosing the control of purchasing larger drinks.  This would be supported by Kevin Hogan who writes “because we naturally resist what we don’t believe and we experience reactance to all that we fear, there is a real need to help customers create new pictures with new information to allow them to arrive at a new outcome in their head” (12).    The first step that needs to be taken is research.   What needs to be know is what aspires the targeted audience; what do obese individuals dream of.  Having this information will help formulate a better advertising campaign.  Having this information provides an opportunity to fit the product of less soda consumption, into a marketing campaign.  Having sound research information, provides opportunity to create a brand that can further help sell the idea of less soda consumption.  Having sound research can foster early adapters to trigger a  “skinny” herd of people moving the campaign across the nation via diffusion of innovation theory.   A campaign with the right frame, the right advertising principles and the right marketing principles can turn this rebellion against the NYC soda ban into a successful “let’s drink something other than soda” movement. 

Why change the core value to freedom

            Freedom is a stronger when compared to health as a core value.  Freedom comes with responsibility, but it has a distant association to loss.  When people feel freedom, they feel strength.  They feel confidence.  They feel like they can concur the world.  

            Freedom from obesity will bring freedom from ridicule of what you are eating or what you are wearing.

            Freedom from obesity will bring freedom from isolation or loneliness because you will feel more desirable to other people. 

            Freedom from obesity will bring freedom from embarrassment due to excessive body sweat. 

            My basic research into how it feels to be obese provided some insight to the idea that these individuals wish to feel desirable, but no one desires them.  Obese individuals are subjected to critical inspection when they eat in public, as to what they are eating.  They live in fear of embarrassing social situations, such as not being able to maneuver into the back seat of a car; or being told they must buy two seats to fly on a plane.  And on a day-to-day basis, they perspire more then most non- obese individuals, a situation that can crush self-confidence (13).

           

Why use more marketing theory and less individual theory models                    Marketing theory looks at what a group of people want compared to individual health theory which looks only at individuals.  Individual health theories virtually ignore the social aspects of people and the environment that surrounds them.  As if people live in a vacuum.  Marketing theory recognizing and maximizes the idea that people have universal wants and desires.   Knowing those wants and desires can foster a campaign to reach masses of people.  Behavior can be changed because an individual wants to become part of a group movement (11).   This change in behavior can happen automatically, without any planning (4). 

            One of the key aspects of marketing theory is creating a brand.  This strategy was successfully used in the Truth Campaign, which facilitated adolescents to rebel against the tobacco industry (14,15).  Having a brand provides an identity of a promise.  One promise that could be used in the NYC campaign is “NoSweat”.  It would be implicit to obese people.  It would promise that decreasing soda intake will decrease bodyweight, which in turn will decrease body sweat.  The term “no sweat” has an alternative meaning of “taking it easy”.  I think this positive message is far more attractive then “Don’t Drink Yourself Fat” and I am confident, because the positive message is also more subtle, there would be less psychological reactance and the message would be better received by the targeted audience. 

Why change the advertising campaign, and how to change it

            The message of the current advertising campaign is not effective, it instills psychological reactance and actually reinforces the act of drinking soda.  What follows are my ideas on how to make improvements to this New York City advertising obesity campaign.

            Create a promise of happiness due to being free of obesity.  By doing the right research, within a community of obese individuals, the means of their happiness can be discovered and used to sell the promise of being happy (16).   

            Incorporate the message with as many images as possible of overweight, Hispanic & Black people drinking water instead of soda.  Sell the message that water can be free, be happy not to spend money on soda.  Support the message with a popular song by someone like Enrique Iglesias.  The use of music can set a emotional tone that can reinforce the promise of happiness.

            Create a commercial using a celebrity such as Viola Davis.  I would choose someone like her because of a number of reasons.  First, she is a woman in her late forties.  A woman in her late forties can implicitly bring motherhood into the picture.  Mothers can influence a child’s choice and promote non-sugary drinks.   Second, she is black and therefore looks similar to a majority of people in NYC who are obese. Third, she is of average body size – not too skinny.   Because of her successes, I think the targeted audience can use her as a model of body weight to aspire to.

Conclusion:  Will there be a tipping point

             There are two points that Malcolm Gladwell writes about in his book referring to epidemics:  1. it needs to be contagious and 2. there is a need for geometric progression where the action is repeated to an explosive level and it is surprising how a little action is out of proportion to the cause. (17).

            I believe, given the right advertising campaign, early adapters of switching from drinking costly soda to drinking free water is a possibility.   “Free” is contagious and it could spark a tipping point.  This could be achievable given the right, multifaceted approach using Advertising Theory, Marketing Theory, Communication Theory and Diffusion of Innovation Theory to change behavior.

REFERENCES

            1. Grynbaum, M.  Health Panel Approves Restriction on Sale of Large                       Sugary Drinks, The New York Times 2012; May 30, 2012

            2. WINNIE H. Obesity ills that won’t budge fuel soda battle by Bloomberg,                          The New York Times 2012; June 11, 2012

            3. Edberg M. Individual health behavior theories (pp. 35-49).

                In: Edberg             .   Essentials of Health Behavior: Social and Behavioral                        Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers,                        2007.

            4. Cialdini RB, Introduction and Weapons of Influence (pp. xi-xiv and

                 1-16). In: Cialdini RB.  Influence: The Psychology of Persuasion

                 New York: Harper Collins Publishers, 2007.

            5. Ariely, D. Predictably Irrational: The Hidden Forces that Shape Our                     Decisions New York, NY: Harper Collins, 2008.

            6. New York City Department of Health and Mental Hygiene. Are you                     putting on the pounds? http://www.nyc.gov/health/obesity.                            www.youtube.com/watch?v=-F4t8zL6F0c

            7. Hartocollis, A.  E-mail reveal dispute over city’s ad against sodas,

                New York Times 2012; October 28, 2010

            8. Rehm, C.D., Matte, T.D., VanWye, G., Young, C., Frieden, T.R.                                  Demographic and behavioral factors associated with daily sugar-                                  sweetened soda consumption in New York City adults. Journal of                              Urban Health: Bulletin of the New York Academy of Medicine 2008;                         85(3):375-385

            9.  Brehm, S., Weinraub, M. Physical barriers and psychological reactance:               2-year-olds’ responses to threats to freedom. Journal of Personality                         and Social Psychology 1977, 35(11):830-836.

            10.Yan,C., Dillard, J.P., Shen, F. The effects of mood, message framing and                behavioral advocacy on persuasion. Journal of Communication 2010,                      60:344-363

            11. Thaler, R.H., Sunstein, C.R. Following the Herd (pp. 53-71). In: Thaler                               R.H., Sunstein, C.R. Nudge: Improving Decisions About Health,                     Wealth, and Happiness. New Haven, CT: Yale University Press, 2008.

            12.Hogan, K. The Psychology of Persuasion: How to Persuade Others to                  Your Way of Thinking. Gretna, Louisiana: Pelican, 1996.

            13. http://www.experienceproject.com/stories/Am-Morbidly-

                  Obese/752651

            14. Hicks, J.J. The strategy behind Florida’s “truth” campaign. Tobacco                      Control 2001; 10:3-5. 

            15.  Bauer, U.E., Johnson, T.M., Hopkins, R.S., Brooks, R.G. Changes in                         youth cigarette use and intentions following implementation of a                                 tobacco control program.  JAMA 2000; 284(6):723-728.

            16. Ogilvy, D. Confessions of an Advertising Man. New York: Athemeum,                                1980, c1963

            17. Gladwell, M.  The Tipping Point: How Little Things Can Make a Big                      Difference. New York: Back Bay Books 2000.