Saturday, May 8, 2010

Improper Design Of “Above The Influence” Anti-Drug Campaign Leads To Counterintuitive Outcomes – Jenna Volpe

“Above the Influence” is an advertising campaign in public health that was designed with intentions of reducing and preventing the use and abuse of alcohol and drugs among adolescents in the United States (3). This campaign was created in 1998 for the National Youth Anti-Drug Media Campaign, which is a program currently funded by the Office of National Drug Control Policy (1, 2). The overall goal of this policy is “to educate and enable America’s youth to reject illegal drugs, to prevent youth from initiating use of drugs…and to convince occasional users of these…to stop using drugs” (3). The “Above the Influence” campaign reaches out to adolescents via an official online website (www.abovetheinfluence.com), a collection of television commercials, and magazine ads which were all designed to make teens in America more aware of which factors most strongly influence the decisions they make (2). The campaign also claims to reflect what teens nation-wide have reported is going on in their lives regarding peer pressure, stress, and self-control (2). However, despite the “Above the Influence” campaign’s attempts and efforts to minimize drug use among the American youth, ample evidence supports that the campaign has been ineffective and perhaps even counterproductive, “leading those exposed to an increased perception that others use marijuana” (1). One reason why the “Above the Influence” campaign has been ineffective is that the messages it is trying to convey are largely based on assumptions from the Health Belief Model, which has not been an accurate model in predicting or controlling people’s behavior (6). Another major flaw of the campaign is that the messages it sends out are negative and mixed; the campaign focuses on showing teens what they do not want to happen, as well as some of the worst-case scenarios that could result from using drugs, rather then zoning in on the potential positive benefits of staying sober and drug-free. Research has proven that the most powerful brand-name companies in the U.S are those which are able to convey positive feelings in their consumers by airing commercials which associate their product with great and wonderful ambience, as demonstrated in the Marketing Theory (9).

Evidence supports adverse effects of campaign

A large study was conducted by Westat from 1999 to 2004 which reported that the “Above the Influence” campaign has been counterproductive (3). The study was designed to measure changes in drug-related knowledge, attitudes, beliefs and behavior in youth and parents, as well as to assess the relationship between these factors and self-reported measures of media exposure (3). Additional objectives of the study were to assess the association between parents’ drug-related knowledge, attitudes, beliefs and behavior with those of their children, and to assess the changes in these factors which may be related to the “Above the Influence” campaign (3). The study finally examined the effects of the campaign by comparing groups of people with high exposure to groups with low exposure to the ads (3). After collecting longitudinal data through conducting multiple observations on a set of participants over a long period of time, Westat investigated if there was a relationship between exposure to campaign advertisements and both drug use and intermediate outcomes (3). Analyses of data concluded that when non-drug-using youth in America were exposed to the “Above the Influence” campaign, “greater exposure to the campaign was associated with weaker anti-drug norms and increases in the perceptions that others use marijuana” (3). Despite a favorable relationship between campaign exposure and parental beliefs and behaviors, there was no relationship found to lead to correlating changes in their children’s beliefs and behaviors regarding drug use (3).
According to Above the Influence of Wasteful Spending by Houston (2006), the Marijuana Policy Project (MPP) has been fighting to reduce funding for the anti-drug Media Campaign after reading in Westat’s 2003 independent report which stated that messages conveyed in “Above the Influence” ads are thought to cause a boomerang effect in drug use among American youth (4). Houston expresses deep concern for teens which have been exposed to “Above the Influence” ads because under the assumption that the above statement is true, these teens are more likely to have developed attitudes approving of drug use over time (4). Houston also refers to campaigns within the White House’s Offices of National Drug Control Policy such as the “Above the Influence” campaign as “wasteful, misleading, and ineffective anti-marijuana campaigns” (4). In spite of overwhelming evidence for the campaign’s lack of success in influencing teen attitudes and behaviors regarding drug use, as well as discernible efforts to cut funding for the “Above the Influence” campaign, it is clear that this public health campaign is severely flawed and in need of reform. However, before reforming the campaign it is important to examine why it is at fault and what needs to be changed.

Health Belief Model was a poor model to choose as frame for campaign design

Although there are multiple factors which can be accounted for the adverse effects of the “Above the Influence” campaign, a major determinant of ‘boomerang’ results is the campaign’s emphasis on assumptions and values which are stated in the Health Belief Model. The Health Belief Model is psychological and attempts to predict and explain human health behaviors by focusing on an individual’s attitudes and beliefs (5). According to the Health Belief Model, an individual’s health behavior is motivated by four factors: perceived susceptibility (of a health problem), perceived severity of the potential health problem, perceived benefits of an action, and perceived barriers of taking that action (6). In this case, the action being measured is the choice not to use drugs. The potential health problem would be negative physiological and psychological consequences of drug use. However, growing bodies of evidence are suggesting that the Health Belief Model is not effective in predicting or manipulating health behaviors of people, especially adolescents, for several reasons (6). The Health Belief Model operates under the assumption that people think rationally and plan their decisions and actions through a cost-benefit analysis, assessing the risks, severity, and possible outcomes of an action (6). However, studies have shown that there are many other factors influencing people’s decisions, such as social, environmental, and socioeconomic circumstances (6). In reality, it has been observed that people behave in predictably irrational ways and make decisions spontaneously (7). Another limitation in the Health Belief Model is that it “defines motivation as a combination of likelihood and severity of beliefs” (15). This assumption is inaccurate because many other dimensions to motivation have been identified, such as social norms which are described in the Theory of Reasoned Action and self efficacy which is emphasized in the Theory of Planned Behavior (15). An additional weakness of the Health Belief Model which severely inhibits its effectiveness in reaching out to a large target population is that the model is individually-focused (7). Models with an individual focus are severely limited in that they do not take into account the “wider social context within which the individual must circulate, such as the families and any communities of which that individual may be a member” (7).
Components of the Health Belief Model are demonstrated on the website for “Above the Influence” in that much of its content contains detailed facts and information about the negative effects of drugs on the body, assuming this will make teens more conscious and aware of their decisions. For example, there is a link explaining detailed facts about alcohol, cocaine, ecstasy, gamma-Hydroxybutyric acid (GHB), hallucinogens, heroin, inhalants, ketamine, marijuana, crystal meth, prescriptiond, over-the-counter drugs, Rohypnol, steroids, and tobacco (12). Many young people may not have heard of these drugs, and exposing them to new information about drugs could increase the likelihood that they will try new drugs because the website is promoting curiosity. The official website for “Above the Influence” also contains a list of street terms for drugs and explains in detail how each substance is made and ingested, as well as the physiological and psychological effects of each drug (12). A list of potential negative consequences and long-term health problems are provided at the bottom of the page (12). For example, when a teen clicks on facts about marijuana, he or she will be bombarded with a long list of health risks including: impaired judgment and motor coordination, shortened attention span and distractibility, anxiety and panic attacks, increased heart rate, increased risk of heart attack, increased risk for schizophrenia in vulnerable individuals, impaired judgment, problems with memory and learning, lowered motivation, decreased alertness and coordination, addiction, and withdrawal symptoms from stopping drug use (in a chronic user) such as irritability, sleeplessness, anxiety, impaired appetite, and aggression (13). Since the Health Belief Model has been proven to be ineffective in influencing one’s actual health behaviors regardless of his or her intentions, the long list of risk factors for each drug is not going to make teens less likely to try the drug; if anything, the website could be promoting curiosity about new drugs.

Campaign advertisements convey negative and confusing messages to youth

Another reason why the “Above the Influence” campaign has produced adverse effects is that its advertisements and commercials are delivering negative and mixed messages to teens. This is especially demonstrated in the “Shoulders” commercial shown on television and displayed on the website. In this ad, a teenage boy is offered a joint at a party (8). Prior to making the decision to accept or reject the joint, the boy looks down onto his left shoulder and sees a devil, a “stoner girl”, a pizza-delivery man, and a fifty-something year old “Flower-child” woman from the 60s with a smoker’s rasp, pressuring him to take the hit because they “turned out okay” and it’s the cool thing to do (8). On the right shoulder, the teen sees an angel, an astronaut, four members of his basketball team, Shakespeare, and his parents (8). These people argue that he should not smoke because if he does then he will ruin his future, jeopardize his basketball team, not get into a good school, and make his mother cry (8). In the midst of the boy weighing out both sides and listening to everyone’s arguments at once, a narrator states: “The only voice that matters is yours” (8). At the very end of the ad, the boy chooses not to take the joint. Although this commercial is intended to represent the pressures that teens must face when offered drugs, and how teens must deal with them, it exposes teens to negative consequences of drug use and delivers a very mixed message. The “Shoulders” ad is attempting to tell teens that aspects of their life such as their future, teammates, academics and family are going to be negatively affected it they smoke weed, without directly telling them not to smoke weed, because teens do not like being told what to do. However, the narrator’s statement at the end of the commercial (“the only voice that matters is yours”) implies that one should disregard the voices of other people in their lives, including their parents and teammates. Teens will see this and infer that regardless of what others tell them, they should and will do what they want because that is what matters, even if what they want is to use drugs.
In the “Human Puppet” ad by “Above the Influence”, a teenage girl is shown intoxicated and passed out at a party. The girl is surrounded by other peers at the party, who are drawing on her and making fun of her. One of the voices refers to the girl as a “puppet”, and another voice exclaims that she is going to have “such a headache” the next day (8). At the end of the commercial, everyone ditches the girl and a written message is displayed at the bottom of the screen that says: “If you’re not in control, who is?” (8). A major problem with the “Human Puppet” ad is that teens who see it will most likely disagree with the message being implied. Teens could argue that if and when they drink, they will not get as intoxicated as the girl from the puppet ad. Teens could also conclude that if they ever did get intoxicated to the same extent as the girl from the ad, then their friends would not treat them the way this girl was treated, thus making the premises of the commercial invalid. One can rationally conclude from the puppet ad that “Above the Influence” does not want adolescents not to drink because that they are going to pass out, be made fun of and have a headache, therefore it is very likely that adolescents will decide they are willing to take these silly risks and surround themselves with friends who will not treat them like a puppet if they pass out.
A third example of a mixed message sent out by “Above the Influence” is their list of reasons why people do drugs, which can be found on the campaign’s website (14). This message is counterintuitive in that teens are being told not to use drugs, yet they are being bombarded with reasons why people their age are using drugs. If teens are on the website and come across this long list of reasons, even if the reasons are negative and/or do not necessarily apply to their own personal life, teens will be more likely to believe that lots of people are using drugs, which was previously confirmed in Westat’s study (3). If public health campaigns aim to successfully reach out and send a message across to youth in efforts to manipulate their knowledge, beliefs, attitudes and behavior, these campaigns need to do more than merely provide health facts and negative, mixed messages. The message should be positive, clear, and concise. The underlying reasons behind why company brand products are noticed, retained and popular are hidden within the message of the company’s advertisement. Figuring out what type of message attracts the American public to a particular brand product advertisement is crucial to designing or improving a public health campaign.

Anti-drug campaign improved through the Marketing Theory

In order for a campaign to effectively reach out to a target audience and affect their knowledge, attitudes, beliefs, and behaviors regarding drug use, the campaign’s message must be appealing (9). A successful public health campaign should be designed based on a theory or model which has been proven to work. One of the most influential social science theories used in media and advertising is the Marketing Theory, which has been applied to ads by many brand-name companies in order to sell a product to their consumer market (9). Rather than trying to convince a target population to avoid doing something bad, public health interventions should aim to promote something positive and desirable to viewers. The Marketing Paradigm within the Marketing Theory states that a company or brand must first find out what people want, and then create and package their product so that it fulfills those needs and wants, appealing to more basic human values (9). According to Siegel (2007),
“The key is for public health practitioners to abandon the traditional approach of deciding what they want the target audience to buy…Instead, public health professionals must first find out what the consumer wants and then redefine, repackage, reposition, and reframe the product in such a way that it satisfies an existing demand among the target audience” (9).
This concept is demonstrated in the Nike commercial featuring Kobe Bryant and five other athletes; these athletes are filmed excelling in different sports, while wearing a pair of Nike sneakers (10). Although this advertisement is intending to sell Nike sneakers to an athletic population group, it clearly demonstrates the Marketing Theory and advertising techniques through three basic principles: the promise, the support, and the core values (9). In marketing and advertising, the promise does not have to be something true, but it must be large; it must relate back to the consumer, not the product (9). The promise of a brand’s ad targets the deep aspirations of people. For example, Nike sends out a promise message stating that “Anything is possible” (10).
The ad should reinforce values that are already present or fill a void of values that are desired or lacking (9). Common examples of core values that are promoted in the world of advertising include love, freedom, opportunity, power, sex, and self-esteem because they are typically desired by consumers and yet portrayed as tangible through advertisements (9). The Nike commercial with the athletes makes Nike sneakers appealing to consumers because the ad is supporting how Nike can provide core values such as control and autonomy. This support is provided to viewers by flashing very brief scenes featuring each athlete excelling in his or her sport of choice (10). The Nike ad is effective in manipulating people’s attitudes, beliefs and behaviors subconsciously because it is supportive and positive, showing consumers what they can have. Although consumers will not necessarily achieve what the ad is promising, the ad is still effective because it invokes feelings of wanting or being able to attain those core values.
The main problem with the “Above the Influence” campaign and with public health campaigns in general is that they tend to focus on the actual product and support it with data (9). Another problem is that these campaigns emphasize negative consequences that result from a particular action (i.e. using drugs) which viewers do not want to experience. Ads for an anti-drug campaign could be significantly improved if they were based on the Marketing Theory and not the Health Belief Model because the Marketing Theory is positive rather than negative, group-focused rather than individually-focused, and proven through research to be favorable (9). A more conducive anti-drug ad to reach out to adolescents in America would be one which is positive and promotes the attainability of core values rather than threatening people’s health or exposing people to the possibility of losing core values (9).

Intervention

I would like to propose an anti-drug use campaign called the “Choose Sobriety” campaign. The target population for this campaign is American youth, just like the “Above the Influence” campaign. However, the frame for “Choose Sobriety” is derived primarily from the premises of the Marketing Theory and not the Health Belief Model. The commercial and magazine ads for this campaign would deliver a large promise to teens by implying that choosing to be sober offers many positive outcomes in life (core values) such as opportunity, relationships, love, security, empowerment, autonomy, dreams, family, and purpose. The support for the promise of these core values would be demonstrated in each of five different scenes which depict a person or people fulfilling an accomplishment or enjoying a special moment, experiencing the core values which were made possible by choosing sobriety.
One of the five scenes in the “Choose Sobriety” commercial is a senior male in his cap and gown, receiving a high school diploma on graduation day. Another scene is of a young couple smiling and bonding with their baby, outside on a beautiful day. The third scene in the ad is of a young man or woman running a marathon. The fourth scene is of an all-star athlete with a clean, sober drug history, whom American youth admire and respect, practicing his sport alone in a gym or outside. The final scene will feature a teenage girl playing her little sister.
In the beginning of the commercial, each of the five scenes will alternate flashing across the screen (a few seconds at a time) while catchy, positive music is playing in the background. After each scene has been shown several times, the first scene with the graduating senior will appear. The boy (holding his diploma) will look at the camera and exclaim, “I choose sobriety because I’ve worked hard and I have big dreams for the future.” This scene will fade; the scene with the married couple and their baby will emerge. The young woman will look at her husband and baby, then at the camera, stating: “I chose to be sober because I wanted to fall in love and establish a family.” Next, this scene will disappear and the third scene will come into view. The marathoner will run across the finish line victoriously, look at the camera and say: “I chose to be sober so that I could follow my dream to finish a full marathon.” Next, the famous athlete will be shown practicing the sport alone in a gym or outside, and then scoring a goal in a real game. The scene will go back to the athlete when he or she is alone in the gym or outside, and the athlete will state: “I chose sobriety because I’m passionate about (insert sport). When I play (insert sport) I feel strong, free and empowered.” Finally, the fifth scene will appear. The teenage girl playing with her younger sister will exclaim, “I choose sobriety because my loved ones are counting on me.” The music will have been playing in the background throughout the ad. At the very end, either a narrator or words will read the campaign slogan: Live your life to the fullest. Make big plans. Achieve your goals. Follow your dreams. Choose sobriety.
In order to maintain a consistency within the campaign so that viewers will be able to easily identify with and remember it, “Choose Sobriety” magazine ads and billboards would consist of the same five scenes described above, but individually. An example of a magazine ad for “Choose Sobriety” would be a picture of the teenage girl from the fifth scene, playing with her little sister. Text would be written at the top of the page reading, “I choose sobriety because my loved ones are counting on me.” Each of the five scenes would have a different message written at the top of the page, respectively. The campaign’s slogan Live your life to the fullest. Make big plans. Achieve your goals. Follow your dreams. Choose sobriety would appear at the bottom of the page for all five variations of “Choose Sobriety” magazine ads.
Contrary to the focus of www.abovetheinfluence.com, the “Choose Sobriety” campaign would make a website called www.choosesobriety.com which would provide links leading to people (especially teens) stating what is important to them in their lives and why they choose to be sober and drug-free. Another link would lead teens to information about the positive benefits of being sober. The website would also contain statements intended to motivate, inspire, and encourage teens to make the most out of their lives.
The “Choose Sobriety” campaign would have a large, positive impact on the knowledge, beliefs, attitudes, and behaviors of teenagers throughout America for several reasons. “Choose Sobriety” would work because it is not individually-focused; the message being conveyed is simple, and it is one to which everybody can relate. This campaign is strong and concise; there are no mixed messages about what this campaign is advocating for, unlike those created by the “Above the Influence” campaign. The core values demonstrated in this campaign are positive and desirable, and they are portrayed as tangible and attainable through choosing the right path in life (sobriety versus drugs). The advertisements for “Choose Sobriety” are inspiring in that they are encouraging the youth of America to make the personal choice to be sober and work hard, setting goals and following their own dreams for the future.

References

1. Amentano, Paul: "Must Not See TV: Stoners in the Mist", page 18. High Times, September 2008.
2. http://www.abovetheinfluence.com/about.aspx
3. United States Government Accountability Office. Contractor’s National Evaluation Did Not Find That the Youth Anti-Drug Media Campaign Was Effective in Reducing Youth Drug Use. Washington, DC:GAO 06-818, 2006.
4. Houston A. Marijuana Policy Project. Above the Influence of Wasteful Spending. District of Columbia: Marijuana Policy Project. http://www.mpp.org/library/above-the-influence-of-1.html
5. Glanz, K., Rimer, B.K. & Lewis, F.M. (2002). Health Behavior and Health Education. Theory, Research and Practice. San Fransisco: Wiley & Sons. Individual health behavior theories (Ch. 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.
6. Choi K, Yep GA, Kumekawa E. HIV prevention among Asian and Pacific Islander men who have sex with men: a critical review of theoretical models and directions for future research. AIDS Education and Prevention 1998; 10(Supplement A): 19-30.
7. http://www.abovetheinfluence.com/the-ads/default.aspx?path=nav
8. Siegel M. Marketing social change: An opportunity for the public health practitioner (Chapter 3). In: Siegel M, Doner L. Marketing Public Health: Strategies to Promote Social Change (2nd edition). Sudbury, MA: Jones and Bartlett Publishers, 2007, pp. 45-71.
9. http://www.youtube.com/watch?v=v9nCPbbngmI
10. http://www.abovetheinfluence.com/facts/default.aspx?path=nav
11. http://www.abovetheinfluence.com/facts/drug-facts.aspx
12. http://www.abovetheinfluence.com/facts/drugs-marijuana.aspx
13. http://www.abovetheinfluence.com/facts/whydrugs.aspx
14. Salazar MK. Comparison of four behavioral theories. AAOHN Journal 1991; 29:128-135.

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