Parents: The Anti-Drug and the Target of a Bad Anti-Drug Campaign – Jason Blanchette
Adolescent substance use
Preventing adolescent substance use and abuse is a common concern among parents, educators, and politicians. According to the 2008 “Monitoring the Future” survey, 47% percent of high school seniors have used an illicit drug in their lifetime and 72% have used alcohol (1). Teen substance use is associated with more harm than just deaths. It plays a significant role in risky sexual behavior, including unwanted, unintended, and unprotected sexual activity (2, 3). It is also associated with developing substance dependence, contracting a sexually transmitted disease, being arrested for a crime, becoming pregnant early in life (4), and academic failure (5). Adolescent brains go through a dramatic developmental restructuring (6) and are susceptible to alterations in development or damage resulting from alcohol use (7).
Parents: The Anti-Drug
To combat underage substance use, The Office of National Drug Control Policy (ONDCP) has been implementing a youth anti-drug campaign since 1998, and has included with that a parent campaign branded “Parents: The anti-drug” (8). Campaign ads have appeared on television, on the radio, and in print.
The parent campaign encourages parents to protect their children from the risks of drug use (8). The logic for this theme stems from research demonstrating that parents have a tremendous influence on the behaviors of their children (9-16). For example, children who feel stronger connection to and support from their parents and families are at a decreased risk of substance use and delinquency (17-19), and children whose parents have less favorable and more restrictive attitudes about alcohol and underage drinking are less likely to drink heavily (11, 20-22).
The “Parents: The Anti-Drug” campaign attempts to increase parental monitoring of youth and increase parent-child communication regarding substance use. Parental monitoring of adolescents is a strong family protective factor against adolescent substance use (12-13, 16). The strength of the association of parent-child communication as a protective factor is not always as consistent as for monitoring (12, 23-24). However, children who have strong relationships with their parents are more likely to accept their parents’ influence about drinking, which may lead to reduced drinking (25), and therefore the type of communication could also impact the outcome. In addition, effective parent-child communication may modify parenting practices such as providing regulation and structure, monitoring, and communicating expectations (26).
Adolescents reported in one study that a top risk associated with drug use is “disappointing their parents” (27). In other studies, parents’ disapproval of underage drinking and their ability to set limits and enforce rules were identified as protective factors [14, 20, and 28). Therefore, it may be crucial for parents to effectively communicate their attitudes and rules against substance use. Parental communication can have protective effects against unhealthy drinking even after offspring have left for college (29-31).
A report released in 2006 provided evaluation results from years 2000 through 2004 of the campaign (8). The data reveals some small positive changes and some small negative changes, but mostly lacks evidence for effectiveness. Results demonstrate an increasing trend for parental monitoring of adolescents with a small but statistically significant effect size for the 12.5 to 13 age group and for the 14 to 16 age group. The parent reports and the adolescent reports in regards to the parental monitoring trend are very similar for every age group. However, the delayed effect analysis shows the number of advertisements viewed by parents as reported by parents in one round of data collection does not correspond with increased monitoring in the following round of data collection as reported by parents or adolescents.
The authors note that during the time period of the evaluation, the parent-child communication messages were implemented less often than parental monitoring messages (8). Despite that, it is evident that parent-child communication changed during the duration of the campaign evaluation, although the actual trend might not be positive. Parents of all age groups reported increased parent-child communication at the last round of data collection compared to the first round, with a communication index score increase from 2.24 to 2.46 on a scale of zero to three (8). The authors tout this as the strongest evidence of positive effects from the campaign. However, the adolescent reports demonstrate the opposite effect – they reported a decreasing trend of parent-child communication, a small but statistically significant decrease from 1.5 to 1.34. Research consistently demonstrates that when parent and child reports differ, it is the child reports that are more accurate predictors of child outcomes (32-34).
While it may be difficult to know whether talking behaviors increased or decreased during this time period, it is less likely that the increasing trend reported by parents had positive effects on adolescent substance use.
The only delayed effect for parent campaign exposure according to adolescent reports in regards to parent-child communication was that exposure in round 3 correlated positively to adolescent reports of parent-child communication in round 4 with a gamma coefficient score of .08, which although is statistically significant it can be described at best as a very weak correlation. The other rounds of data collection did not reveal such a statistically significant correlation, but in fact an analysis of round 2 data with round 3 data revealed a non-statistically-significant decrease. Three aspects of this study should put into question the validity of the very weak positive correlation. First, the correlation is very weak at best. Second, this is a cohort study. And last, adolescents reported overall a decreasing trend of parent-child communication, which is considerable for this campaign given that 84% of surveyed parents reported at least one campaign exposure per month (8).
Another possible explanation for the above positive correlation (gamma = .08) should be considered – whether parents who engage in the most effective preventive parenting strategies are the most observant of the campaign material and therefore more likely to recall exposure, and that the increased parent-child communication among those parents was a result of their children’s increasing age and increasing exposure to drug risks. In the presence of the very weak gamma score of .08 it is still possible that the campaign had either zero impact, or worse, had a negative impact on effective parent-child communication. It is also important to note that parent exposure did not correlate with adolescent substance use in following rounds of data collection.
It is absolutely necessary to evaluate and revamp the campaign in regards to parent-child communication while using modern research and social science theory. There was a downward trend of parent-child communication reported by adolescents. Increasing the effectiveness of the campaign in regards to parent-child communication can improve teen health outcomes. Failing to do so could result in harmful consequences.
Critique #1: The campaign’s use of the Health Belief Model discourages authoritative parenting.
Human behavior from the perspective of the health belief model is conceived to be a process of pulls by positive forces and repels by negative forces (35). The theory states that people make decisions by weighing the perceived costs and benefits of their options, and then selecting the seemingly most rational choices. In order for the campaign designers to influence parents to engage in preventive parenting strategies, from the perspective of the health belief model, they must convince those parents that their children are at an increased susceptibility to drug use and that the problem will be severe if they do not act on it.
Thomas (36) criticized the health belief model for being overly simplistic in predicting and attempting to change human behaviors within her nursing discipline. She wrote, “Personal histories and experiences are not validated and sharing and dialogue appear irrelevant to the process, and imbalanced power relationships ultimately result.” Similarly, use of the health belief model to change parental behaviors will likely produce interventions that ignore the quality, history, and the ongoing nature of parent-child relationships, and disregard the complexity of parenting and the unique aspects of each parent-child relationship.
It is effective for parents to clearly communicate rules and consistently enforce those rules in order to prevent adolescent substance use (14, 20, and 28). But it is also effective for children to be allowed to express their own thoughts and to communicate openly with their parents in order for them to develop increased psychological autonomy and self-regulation (9, 37-39) and be less likely to use substances (40). This blend of parenting behaviors characterized by consistent enforcement of clear standards in combination with support, responsiveness, and open communication is termed the authoritative parenting style. The authoritative parenting style is associated with the best combination of child outcomes, including psychological and social competence, academic success, and decreased substance use (9, 41-42). During open, trusting, and assertive parent-child communication, children’s self-worths are being validated and they are carefully thinking through the discussions, strengthening their psychological, cognitive, and social competence. They could develop less of a need to follow bad behaviors of peers but greater abilities to reject offers from peers to engage in bad behaviors. Stephenson et al.’s study (43) demonstrated that authoritative parents engage in the best combination of parenting practices shown to protect children against substance use.
Using the health belief model is likely to result in a “fear” or “threat” based campaign that is likely to be more successful at wedging a strict and commanding “drug talk” into each parent-child dyad than increasing open and conversational sharing of ideas and feelings that is inherent in authoritative parenting. The “Parents: The Anti-Drug” campaign ads do in fact attempt to increase parents’ beliefs that their children are susceptible to drug use, and that the drug use will lead to severe problems. Stephenson et al. (44) revealed in a content analysis of “Parents: The Anti-Drug” that the most common messages were ones that attempted to increase parental perception of their children’s drug risk, which included their children’s susceptibility of drug use or the severity of drug use problems. For example, one print ad reads, “Teens are abusing pills, prescriptions, and medicines that are easily accessible in the home. This behavior has many dangerous outcomes, including possible death.” An ad that portrays normal teen behavior as sneaky reads, “It can be medication left over from your last surgery. Maybe they’re the pills you keep on the dresser or tucked inside your purse. Teens are finding prescription drugs wherever people they know keep them — and abusing them to get high.” A campaign letter to parents goes as far as to suggest that their child’s drug and alcohol use is inevitable when they write, “We’re talking about your child’s drug or alcohol use.”
If the “Parents: The Anti-Drug” campaign is successful in establishing increased sense of child susceptibility and severity to drug use, it will also likely be successful in increasing parental worry, anxiety, agitation, and a sense of danger. The campaign is more likely to result in parental one-way communicative attempts at commanding and instructing than it is to increase healthy two-way expression of ideas in a conversational nature. Children who are discouraged from autonomous thinking are less likely to develop psychological and social competence (9, 38). Therefore, the campaign is potentially harmful in its effects on adolescent development and substance use.
Critique #2: Self fulfilling prophecy: Parent expectations directly influence child outcomes
The campaign increases parents’ expectations that their children will use substances, and therefore can encourage adolescents to use substances through the self-fulfilling prophecy. Some ads attempt to convince parents that today’s adolescent cultural norm is to abuse substances. One ad reads, “When you were a teen, you had about 20 channels. Your teen has over 200. Now apply that to drugs.” One internet ad shows a teen girl putting on make-up and words flash across the ad, “These days, teenage girls are into a lot more than makeup” followed by the change of view into her make-up mirror holder which is full of pills.
These ads may be troubling to parents and could increase their intentions to take action against their adolescent’s potential drug use. But increasing parents’ perceptions of their children’s susceptibility to drug use as an approach to increase parent action may simultaneously increase adolescent’s drug use through the self-fulfilling prophecy. The self-fulfilling prophecy states that the perceiver’s expectations can actually lead to its own fulfillment. For example, teachers’ expectations from randomly assigned assessments actually correlated directly with the outcome of their students (45) and military instructors’ expectations from randomly assigned assessments also influenced the outcomes of their recruits (46).
There is evidence that the self-fulfilling prophecy plays a role in parents’ expectations and adolescent substance use. A mother’s expectation of her children’s future alcohol use predicts her children’s future alcohol use (47), which appears to occur from the self-fulfilling prophecy through the process of “self-verification (48). According to self-verification theory, people desire to confirm their self-concepts because it provides a stable sense of self and it provides a more predictable social environment. Willard (49) found that children with lower self-efficacy to refuse alcohol from peers were more influenced by parents’ over-estimation of their alcohol use. A mother’s continued over-estimation of her children’s alcohol use seems to exacerbate her children’s alcohol use over time (50) and an over-estimation of both parents’ beliefs acts synergistically on their children’s future alcohol use (51).
One advertisement reads, “So lay down a few laws for your kids. And the sooner the better, because the average age when teens first try marijuana is under 14 years old.” Unfortunately, this is misleading for many parents who live in communities where the average age of marijuana may be well above 14 years old. Even for communities where the age is at or below 14, this ad presents the information as if teenage marijuana use is the societal norm regardless of the adolescent or the family the adolescent comes from.
Critique #3: Framing parents as the “saviors” during drug talk repels teenagers
“Parents: The Anti-Drug” discourages adolescents from engaging in a healthy and trusting relationship with their parents. By presenting to parents that the “drug talk” must occur soon in order to protect their children from imminent danger, the talk is framed as if parents are the “saviors” of their children’s bad choices. Although these advertisements are intended for parents, they can potentially influence adolescents’ perceptions of parent-child drug talk for two reasons. For one, some youth are going to be exposed to parent advertisements. And second, parents who present a “drug talk” in this way will essentially teach their children that this is the standard way that parents and youth communicate about drugs.
Adolescents experience cognitive changes that cause in them a need to develop their own sense of autonomy (52) and therefore can result in them rejecting or avoiding parental influences that seem to threaten their sense of autonomy. Communicating openly and freely with respect for each other’s autonomy is one way for parents to promote healthier adolescent development. It will allow parents to impress their healthy views and opinions onto their adolescents with less rejection from the adolescents. It can also promote their adolescent’s decision making skills through conversation.
Youth can benefit from open and ongoing communication with parents about alcohol and drugs. For example, Austin et al. (53) found that parent-child communication mediated the media’s negative influence on adolescent alcohol use. Therefore, it may be valuable for parents and teens to feel comfortable discussing alcohol and drugs as they arise in the media, whether in movies, television, advertisements, or inside the news.
The “Truth” anti-smoking campaign is a prime example of how to take into consideration adolescent development when designing public health interventions. It was a tremendous success at decreasing adolescent smoking (54). A large reason for its success may be because the campaign designers understood adolescents’ needs to develop a sense of autonomy and the designers formulated messages that were not preachy (54).
There is a risk that “Parents: The Anti-Drug” will disconnect parents and their children because of a tone that is likely to feel to adolescents as a threat to their immerging sense of autonomy. The tone might discourage adolescents from accepting parents’ influence and it risks encouraging adolescents to avoid discussions with parents that include mention of drugs or alcohol.
Improved intervention without the harmful flaws
The designers of “Parents: The Anti-Drug” were wise to target parents in a media campaign as a strategy to reduce adolescent substance use. Parents have a tremendous influence on their adolescents, and a media campaign has the ability to reach a wide spread of parents. This strategy should be maintained, but the campaign should be improved.
To revamp the campaign into a new intervention that encourages healthy parental action without harmful unintended effects, it is necessary to completely abandon attempts to scare parents. Instead, a campaign should influence parents in a more positive way. It should focus on promoting parent-child communication more than focusing in on their children’s risk of drug use, and then implicitly connect communication with open and honest discussions about substance use. The campaign should promote feelings of warmth, trust, and connectedness. It should promote drug talk as two-way communication occurring openly and as new ideas arise. In order to accomplish this, practitioners should consider advertising theory, social norms theory, and framing theory.
Suggestion #1: Advertising theory
Advertising theory can be utilized in order to promote parental action. A good campaign designed from advertising theory packages the target audience’s deepest aspirations with the behavior change that is intended by the campaign, and then promotes that behavior change by promising that the target audience can fulfill those aspirations if they engage in the behavior. Using advertising theory rather than the health belief model will allow campaign designers to abandon the use of scare tactics that essentially can drive a wedge in between healthy parent and child discourse. It could likely turn out to produce more compelling messages if the designers properly research parent core values and effectively connect those core values with the desired behaviors.
The “Truth” anti-smoking campaign reduced adolescent smoking significantly by using a campaign approach that paralleled advertising theory (54). In the case of the “Truth” anti-smoking campaign, the campaign designers packaged adolescent core values of rebellion, independence, and autonomy with the desired behavior of “not smoking.” The implicit promise was that teenagers can have these core values by not smoking. Siegel and Lotenberg (55) explain that “Often [the promise] is never explicitly stated. Rather, it is a conclusion that people draw after exposure to the communication.” In the case of the “Truth” campaign, the advertisers were able to compel teens to conclude that an increased sense of rebellion will come from not smoking by depicting adolescent rebellion against the tobacco industry (54).
In order to use advertising theory for a parent campaign it is crucial that the advertisers engage in thorough formative research to truly understand parents’ deepest aspirations. Their aspirations are likely going to be found within their parent-child bonding, their communication with their children, or something else in regard to their relationships. However, practitioners should not assume they understand parents even if they themselves are parents, but rather they should conduct research to get into the skin of their target audience and develop a deeper understanding of their emotions and aspirations. Once they discover the deep emotional and aspirational understanding, campaign designers have the task of designing a campaign that promises those aspirations will be fulfilled if parents engage in the behavior that is intended by the campaign.
Successful creation of such a campaign will lead parents to believe and feel that those aspirations are coming true by engaging in the promoted behavior. The key here is that parents must feel that it came true, because if they felt it then it became real. Such a campaign has the potential to be very powerful and without the harmful effects that come from using scare tactics.
Suggestion #2: Social norms
Social norms are simply the behaviors that people regard to be socially acceptable, desirable, or expected standards, and are considered the “normal” way of acting. The belief that a behavior is the expected and normal standard adds social pressure for others to engage in that same behavior.
The campaign designers attempted to increase parents’ beliefs that adolescent drug use was the “norm” in order to increase parent-child communication about drug use. Because that approach can be harmful to adolescents through the self fulfilling prophecy, it is necessary to abandon that approach and instead consider encouraging parent-child communication, rather than substance use, as the “norm.”
A successful campaign utilizing social norms will promote the desired behavior, such as healthy parent-child communication, as the expected and normal standard in our culture. It will show pictures or vignettes of parents and adolescents communicating in a healthy and positive manner, as if they engage in that behavior regularly and with enjoyment. That displayed behavior should be connected to advertising messages about parent-child drug talk. There will be two significant benefits. First, parents will be compelled to engage in that behavior if they see it working for other parents and also if they see that it is normal or expected for parents and children to engage in those healthy conversations with their children. The other benefit will be that children will not feel threatened from drug talk, but instead they will have greater expectations that their parents will respect their ideas during conversation and will therefore be more likely to engage in those discussions.
Suggestion #3: Framing
There are at least two ways to frame parent-child drug talks and both could include parents clearly defining rules and expectations. One could be a one-shot and one-way authoritarian attempt to control adolescents. Another could be a two-way, open, and ongoing discussion where opinions are respected. It is unnecessary for the “Parents: The Anti-Drug” campaign to frame the drug talk as a grim and grave discussion that is crucial to occur soon in order for parents to “save” their adolescents. Framing it as a comfortable conversation part of an ongoing discussion within parent-child relationships will likely yield a greater number of discussions as opportunities arise, such as when alcohol arises in the media or with the news that a friend was caught drinking underage. In addition, this more open frame will likely lead to increased acceptance of parental influence.
There is considerable evidence supporting the notion that people perceive situations and make decisions based from the way options or topics are framed or presented (56-57). Adolescents who perceive parent-child drug talks as one-way and didactic communication may feel uncomfortable engaging in such a talk and avoid discussion with parents that involves mention of drugs or alcohol. But on the contrary, presenting drug talk as a positive and comfortable discussion, both parents and adolescents can feel more comfortable going into the discussion and sharing openly. Therefore, advertisements should show two-way communication that includes children expressing themselves and the parents listening.
Children who feel stronger connection to and support from their parents and families are at a decreased risk of substance use and delinquency (17-19) and children who have strong relationships with their parents are more likely to accept their parents’ influence about drinking (25). To assure that this campaign has the most positive impact on parent-child communication it is essential to frame the parent-child drug talk in a way that will foster respect and acceptance for each other.
Parents are in a promising position to be their children’s most powerful anti-drug. Unfortunately, many parents are in disbelief that they can effectively cause their youth to avoid drugs (58). One challenge for ONDCP and other prevention organizations is to effectively encourage increased effective parenting behaviors. It is not enough for advertisements to encourage a behavior, such as talking, but instead the advertisements should be careful to encourage effective parenting behaviors, such as healthy and open communication.
It is ineffective for ONDCP to use fear or threat based messages to scare parents into talking. Such strategies can drive a wedge in between healthy parent-child communication, cause parents to react to their children in potentially harmful manners, and cause adolescents to avoid communications with their parents. Although it is uncertain whether effective parenting communication increased or decreased during this campaign, it is more likely that the downward trend of adolescent reporting of parent-child communication signifies fewer instances of healthy parent-child communication.
Tugging at the parents’ positive emotions about parent-child communication, encouraging healthy drug talk as the cultural norm, and presenting the parent-child communication in a healthy and two-way frame should be the new challenges for designers of parent anti-drug campaigns in order to create the most effective campaigns.
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