Why Iowa’s “Take a Dose of Truth” Campaign May Not Be Working - Brent Ardaugh

Introduction

The main goal of Iowa’s Take a Dose of Truth (TAD) campaign is to increase public awareness of the risks associated with the abuse and misuse of prescription and over-the-counter (OTC) drugs (1). The TAD campaign targets mostly teen audiences, although resources for parents, the elderly, and health professionals are also found on the TAD Web site. Although Iowa’s Office of Drug Control Policy (ODCP) has identified an important public health issue and demonstrated its willingness to act on the issue, the TAD campaign violates three important social science theories: social marketing theory, reactance theory, and social expectations theory. Poor use of these theories will cause almost any health campaign to fail; however, thoughtful and strategic use of these theories can contribute to a campaign’s success. The aim of this review is to critically analyze the shortcomings of the TAD campaign, and to discuss alternative solutions to influencing teen behavior.

Critique Argument 1 – Poor Use of Social Marketing/Advertising Theory

The term social marketing was coined in 1971 in a pioneering article by Kotler and Zaltman (2). Social marketing is the process of applying marketing principles and techniques to influence the behavior of a target audience, and it is intended to benefit both the target audience and society (3). Social marketing differs from commercial marketing because it aims to market ideas and behaviors.

The TAD campaign is trying to “sell” a healthy behavior to teens, but the campaign fails to communicate the benefit teens get from not misusing and abusing prescription drugs. The campaign is one-sided and communicates messages that only benefit ODCP. At most, the campaign is communicating to teens: “Don’t do drugs because they are bad for you” and “Help save the State of Iowa millions of dollars annually by allowing our police officers to focus on other crimes.” If ODCP would like teens to avoid drug abuse and misuse, ODCP needs to promise teens something more compelling than health, which is a product most teens (and other people) do not care to “buy.” According to Ogilvy, the selection of a promise should never be left to guesswork, and what is said is more important than how it is said (4). How might ODCP find out what promise to make Iowa teens? One way is to use Ogilvy’s method described in Confessions of an Advertising Man (4); the other way is to conduct market research, which is the first element of social marketing.

Social marketing comprises the following five elements: research, planning, development, implementation, and assessment (5). The goal of market research is gain an understanding of the target audience. Knowledge of sociodemographic and behavioral characteristics (e.g., education, age, needs, desires, wants, values, and beliefs), for example, enables social marketers to make predictions about their target audiences and ultimately influence behavioral outcomes (6). Planning is the second element, and it focuses on the intended delivery or presentation (i.e., frame) of the product to the target audience. This decision should be informed by research. Development is the third element, and it entails creating programs for specific audiences on which research was conducted. The last two elements, implementation and assessment, focus on the carrying out of the marketing plan and the continual evaluation of its performance.

The hallmark trait of social marketing is research, and if ODCP would like for teens to abstain from abusing and misusing drugs, ODCP should learn everything they can about the wants and needs of their teen market. A health campaign should be implemented only after market research is conducted, and following implementation, the campaign should undergo additional scrutiny on its effectiveness. It is one thing to implement a health campaign; it is another thing to implement one that works. Social marketing helps ensure that happens.

Critique Argument 2 – Poor Use of Reactance Theory

Reactance theory suggests that people become motivationally aroused by a threat to or elimination of a behavioral freedom (7). A threat to a particular behavior, even if the behavior is unhealthy or undesirable, motivates the individual to restore the behavior. An example of reactance theory is demonstrated on Philip Morris’s (PM) Web site, where it states: “Kids should not smoke or use any tobacco products. As the largest tobacco manufacturer in the US, we believe we have an important role to play in helping reduce underage tobacco use (8).” The literal meaning of this message suggests that PM discourages tobacco use among kids. However, PM knows about reactance theory, and PM intentionally publicized this reactive message to prompt kids to buy tobacco.

Although ODCP should frame the TAD campaign so that it does not threaten the behavioral freedoms of teens, there are parts of the TAD campaign that are reactive, and may actually prompt teens to abuse or misuse prescription drugs. Below are a few examples of reactive messages from the TAD Web site (1).

· “They [teens] see them [drugs] advertised on television, they see their parents and other adults take them, but they don’t hear about the negative consequences of their use.”

· “They [teens] don’t know that abusing these drugs can alter their brain activity and lead to drug addiction or severe medical problems, especially when they’re combined with illegal drugs or alcohol.”

The TAD commercial released by ODCP is too authoritative. The commercial essentially tells teen viewers they should not abuse and misuse prescription drugs because their parents and ODCP say so. Because most teens (and other people) find it exciting to rebel against authority, these health messages are reactive. After seeing these messages, many teens will ask: “Who is the government or my parents to tell me what to do? Because they told me not to engage in that behavior, I am now going to go ahead and do it.” Of course, that is the exact opposite action the commercial asks teen viewers to take.

Another disadvantage of this TAD commercial is it implies a two-sided power struggle: parents and ODCP vs. teens. Using this strategy, both sides will have an aspiration to be the winner and such competition promotes forcible resistance from both sides. When dealing with drugs, as we know, that battle can be both time consuming, expensive, and dangerous.

Critique Argument 3 – Poor Use Social Expectations Theory

Social expectations theory holds that people tend to internalize the norms, role definitions, and other understandings of social organization from their environment (9). In other words, people will try to “fit the role” expected of them when in particular groups or scenarios. For example, let us say that at the starting line of the Boston Marathon, one runner turns to another and says: “You look really pale, are you feeling all right?” The runner will now fit the role of a sick person and probably run poorly.

Social expectations theory can be used in positive ways and negative ways, and the TAD campaign uses social expectations theory in negative ways. The commercials released by ODCP label teens as people who use Rx drugs to get high, which causes many teens to feel they need to fit that role and use Rx drugs to get high.

The following commercials [Commercial 1, Commercial 2] use social expectations theory in negative ways by expecting that teens use Rx drugs to get high. Instead of using positive expectation that might say something like, “The ODCP trusts you’re smart and will do the right thing,” the ODCP places an expectation on teens that promotes unhealthy and illegal behaviors. If teens listen to ODCP and attempt to fit the role of a person who uses Rx drugs to get high, the ODCP will be partially responsible for the teens’ actions.

Articulation of Proposed Intervention

The alternative intervention proposed for the TAD campaign is based only on modifications to the existing campaign. Although many of the existing messages and theoretical applications of the TAD campaign are ineffective and flawed, the campaign does actually have a lot of favorable qualities. First, the ODCP has the willingness and desire to act on a public health issue. Many other states do not demonstrate such a strong commitment. Second, the ODCP is able to afford airtime and use the media as tools for reaching teen audiences. Third, the TAD Web site offers information about drugs commonly used by teens. The TAD Web site just does not tell people drugs are bad for their health; it gives them reasons why.

The proposed intervention for the TAD campaign entails using social marketing theory, reactance theory, and social expectations theory, more thoughtfully and strategically. In the next section, methods for improving the TAD campaign are suggested based on the previous criticisms.

Defense of Intervention Section 1 – Good Use of Social Marketing Theory

Using prescription drug abuse and misuse as an example, let us say that while researching, market researchers learn that in addition to independence, power, relationships, and autonomy, teenagers aspire to have control over their lives. The market researchers now know the aspirations of their target audience, and they can frame promises that will deter teens from abusing and misusing prescription drugs. As stated previously, if ODCP would like for teens to abstain from drug use, ODCP must be able to offer teens something compelling. By learning the values of the target audience through market research, ODCP is ensuring their messages appeal to the teen audience. Notice, however, that the teens get something out of the transaction—the promise made by ODCP. According to Ogilvy, the promise does not have to be true; it only has to be large (4). The promise is a critical part of the campaign’s communications strategy.

There are four major components of a communications strategy: messages, messengers, creative strategy, and communication channels (3). The message ODCP wants to communicate is that abusing and misusing prescription drugs is risky and hazardous to teen health. There is nothing wrong with this message; however, as it stands, there is a problem with the messenger of the campaign. In the opinion of the teen audience, ODCP may not be a knowledgeable, trustworthy, or likable source of information. According to Kotler and Lee, what a target audience thinks about a particular messenger can make or break the deal (3). Therefore, the TAD campaign would most likely benefit from a teen or young adult telling his/her story about prescription drug abuse, and how it infringed on the values of independence, power, relationships, autonomy, and self-control.

The power of story-telling in health messages is beautifully illustrated in a documentary about OxyContin^® abuse (see OxyContin^® Express at: http://www.hulu.com/watch/100279/vanguard-the-oxycontin-express), where a young man claims that his physician sells him prescription drugs when the physician knows the young man is addicted. This story alone would be a powerful addition to a health campaign because it shows how drugs threaten the teen values of independence, power, autonomy, and self-control. Not to mention, the fact that the physician-dealer is concerned only with his own self-interests would make most teens feel manipulated and taken advantage of. The TAD campaign could amplify the message that one way to be free from the manipulation of the drug dealer is to stop buying drugs. This situation would benefit both the ODCP and teens. Notice, however, that health is not the product being sold; the product is freedom from the manipulation of the drug dealer.

The third component of communications strategy, creative strategy, entails translating the content of the intended messages to specific communications (3). This component deals mainly with the presentation of the message. For example, what logos, fonts, visuals, and catch phrases will be used? How will the message be framed? These questions are all answered during this stage. Communication channels, the fourth component, deals with where and when the health messages will appear. Because the TAD campaign was not deficient in this area, no recommendations are made.

Defense of Intervention Section 2 – Good Use of Reactance Theory

The main issue for reactance theory is to determine when teens do and do not show reactance in the face of threats to freedom (10). One of the best ways ODCP could learn whether the TAD messages engender reactance is to test messages before they go public. These tests may be conducted in teen focus groups, where the teens would tell the ODCP what works and what does not. This strategy could help save time, energy, and tax-payer money while simultaneously investing in the health of Iowa teens.

Another strategy is not telling teens what to think; give teens the information they need to make their own choices. For example, if somebody were to claim that all pizza tastes horrible, a reasonable person might say: “Don’t tell me what tastes good and what does not taste good; let me find out on my own.” This example emphasizes the importance of not telling people what to think or do. It does not mean, however, that messages cannot be framed or strategically communicated to prompt desired actions.

The TAD campaign may reduce reactance in its commercials by making them less authoritative. For example, the OCDP may have two teens talking about drug use as opposed to a teen with his mother. Another way to reduce authoritativeness is to remove the oversized OCDP logos from the campaigns. The TAD campaign should portray parents and the ODCP as resources, not the superior parties. Everybody should be on the same team: there should be no winners or losers.

Defense of Intervention Section 3 – Good Use of Social Expectations Theory

The TAD campaign needs to give teens the benefit of the doubt because not all Iowa teens use prescription drugs to get high. There are many responsible teens who use prescription drugs according to their physicians’ instructions. If ODCP publicizes that Iowa teens use prescription drugs to get high, then teens will have a tendency to fit that role. The current TAD campaign places such a high degree of stigma on being an Iowa teen that it is almost shameful and embarrassing to be one. This campaign is one of the poorest examples of a good use of social expectations theory, and anybody who approved the use of the “Iowa teens use Rx drugs to get high” slogan should be fired.

Social expectations theory should be used in the TAD campaign to inspire teens to make the right choices. The campaign should have positive, high expectations for teens and give them an opportunity to become better people. The campaign should not bring teens down; it should bring them up. For example, the TAD campaign may communicate a message that asks teens to talk to their friends about abuse and misuse of prescription drugs. This strategy accomplishes two goals: first, it conveys that the government trusts teens as responsible people who can help disseminate knowledge, and second, it gives teens an opportunity to fit the roles of being intelligent, independent, and free individuals.

REFERENCES

1. Iowa Governor's Office of Drug Control Policy. Take a Dose of Truth. Des Moines, IA: Iowa Governor's Office of Drug Control Policy. http://www.takeadoseoftruth.com/.

2. Kotler P, Zaltman G. Social Marketing: An Approach to Planned Social Change. Journal of Marketing 1971;35:3-12.

3. Kotler P, Lee NR. Social Marketing: Influencing Behaviors for Good. Thousand Oaks, CA: Sage Publications, 2008.

4. Ogilvy, D. Confessions of An Advertising Man. New York, NY: H. Wolff, 1963.

5. Siegel M, Doner L. Marketing Public Health: Strategies to Promote Social Change. Sudbury, MA: Jones and Bartlett, 2004.

6. Kotler P, Roberto EL. Social Marketing: Strategies for Changing Public Behavior. New York, NY: The Free Press, 1989.

7. Brehm JW. Psychological Reactance: Theory and Applications (pp. 72-5). In: Srull TK, ed. Advances in Consumer Research. Provo, UT: Association for Consumer Research, 1989.

8. Philip Morris USA. Help Reduce Underage Tobacco Use. Mansfield, MA: http://www.pmusa.com/en/cms/Responsibility/Helping_Nav/Helping_Reduce_Underage_Tobacco_Use/default.aspx

9. DeFleur ML, Ball-Rokeach SJ. Theories of Mass Communication. White Plains, NY: Longman, 1989.

10. Silvia PJ. Deflecting Reactance: The Role of Similarity in Increasing Compliance and Reducing Resistance. Basic and Applied Social Psychology 2005;27:277-84.