Wireless Carrier Sponsored Anti-Texting Campaigns Targeted at the Teenage Population – Daniella M Wodnicki

Introduction
Motor vehicle crashes are the number one cause of death in the United States for persons 3-34 years old, and the leading cause of death among teenagers (1). Each year, approximately 6,000 teenagers are killed in a motor vehicle accident (2). Among all drivers, teenagers exhibit the riskiest of driving behaviors including low usage of seatbelts, increased likelihood to speed over their adult counterparts and allowing shorter headways (3). Therefore, focusing on teenagers is a legitimate and relevant target population (4).
With the dramatic growth of cell phone use over the past 15 years, “distracted driving,” the use of digital devices while “on the go,” has become more prevalent among all age populations, especially teenagers. Of the 90% of teenagers who admit to doing multiple tasks while driving, 75% admit to texting while driving, also known as DWT (2). Texting, or “sending a text message,” refers to the exchange of brief written messages between mobile devices and is typically used as a substitute for voice calls in situations where voice communication is impossible or undesirable.
Today, the most dangerous distraction on the highway is the cell phone. DWT delays a driver’s reaction as much as having a blood alcohol concentration at the legal limit of 0.08% and makes an individual 4 times more likely to cause a crash resulting in bodily injury (2). Using a simulator, David Strayer, a professor at the University of Utah and a leading researcher on distracted driving, found that texting while driving caused teenagers to slow down, weave in and out of lanes and in some cases run over pedestrians (5). Despite understanding the risks of texting behind the wheel the desire and intense social pressures to stay connected is so strong for teenagers and their parents that safety sometimes takes a back seat to staying in touch with family and friends (6).
Current Intervention
The current programs that I am analyzing are wireless carrier sponsored anti-texting while driving campaigns that are targeted towards the teenage population. More specifically, I have chosen to look at those campaigns created and disseminated by two of the nation’s largest wireless carriers, AT&T and Sprint. Both of these nation-wide anti-texting while driving campaigns are no older than 2 months and their main intent is to keep teenagers from DWT using the Health Belief Model.
In Sprint’s “Thumb Wars” campaign, the company, along with dosomething.org – a non-profit group that promotes volunteerism by teenagers – allows teenagers to join the “war on thumbs” by ordering thumb socks online. Within 6 weeks, teenagers receive their thumb socks as well as two additional pairs to share with friends and classmates. The website encourages teenagers to wear the socks through a “witty” celebrity public service announcement, a photo album of peers wearing said socks and ominous statistics on teen driving and distracted driving. The intent of the thumb socks are to render one’s thumbs from being able to properly text and to serve as a constant reminder that texting while driving is a dangerous act.
In AT&T’s “Txting and Drivng…It Can Wait” campaign, AT&T uses celebrity television spots and public service announcements to disseminate their “don’t drive while texting” message to teenagers. Through graphic stories of motor vehicle accidents combined with “last word” text messages, AT&T is attempting to drive home how insignificant a text message such as “where u at?” is, compared to the potentially dire consequences of reading or responding to a text while driving.
Critique of Current Intervention
Wireless carrier sponsored anti-texting while driving campaigns such as “Thumb Wars” and “Txting and Drivng…It Can Wait” are misguided and ineffective at curbing DWT among teenagers. They rely heavily on simple individual-level models such as the Health Belief Model and Theory of Reasoned Action. The campaigns are threat-based appeals featuring serious overtones and authoritative messengers and the very content of AT&T’s “It Can Wait” campaign argues against the basic function of the text message, failing to measure the psychological reactance of its target population.
Critique 1: Fear and Efficacy
The content of a public health campaign is very important. Campaign messages alert audiences to a particular issue and through various persuasive strategies, attempt to influence, and even modify behavior. Many campaigns use fear as their main strategy to persuade their target population into producing these specific changes in attitude, intentions and/or behavior (7). According to researchers at Queensland University, road safety campaigns are particularly renowned for its use of graphic, threat-based appeals which aim to “evoke a negative emotional response” in the audience, namely fear (7). Threats illustrate undesirable consequences from certain behaviors and fear is a potential emotional response to these threats (4). In turn, this fear is expected to “motivate compliance” with a message’s recommendations (8).

“Thumb Wars” and “It Can Wait” both utilize threat-based appeals to evoke a negative emotional response from teenagers in an attempt to keep them from DWT. Sprint’s “Thumb Wars” campaign focuses on disseminating statistics on DWT and uses the thumb sock to serve as constant reminder of the dangers associated with the risk. In AT&T’s “It Can Wait” campaign, the wireless carrier provides a consistent somber tone throughout all of its messages. Featured in the campaign are real life stories about DWT – including the text messages sent or received moments before someone was seriously injured or killed due to the risky behavior. At the beginning of every public service announcement (PSA), the campaign features a “last-words” text that is meant to appear insignificant, even meaningless. Examples of such texts include “where u at” and “yeah t.” At the end of every “It Can Wait” PSA, a threat-based appeal such as “no text is worth permanent brain damage” and “no text is worth losing a loved one on” flashes across the screen (9).
In brief, the Health Belief Model is an individual level model based on a rational decision making process. It is a basic cost/benefit analysis, which takes into account how perceived susceptibility and severity affect the perceived benefits and barriers that lead to intention and eventually behavior. The Health Belief Model draws on the idea that people rely on fear to influence their decision making process and eventual behavior. Were teenagers to view these campaigns, perceive a high severity and susceptibility to risk from driving while texting - they would then modify their intent and behavior. What this model and campaign fail to consider is that teenagers do not think rationally, and a high-perceived severity does not always correlate with increased efficacy and positive behavior.
In a study conducted among undergraduate students at a Belgian University, two threat appeal messages were created starting from an existing anti-speeding PSA (4). Both messages show young people leaving a party, getting into a car and driving into a tunnel having fun (4). In both campaigns, the car does not emerge from the tunnel, implying that the driver had experienced an accident – however, in the second PSA, added is the sound of a car crashing as well as an ambulance and images of an injured individual. Researchers used a 3-item 7-point Likert scale to measure evoked fear and cognition among students (4). They measured perceived severity of threat (‘a car accident is severe’), probability of occurrence (‘I run the risk of getting involved in a car accident’), response efficacy (‘driving more slowly is an effective way to avoid car accidents’) and self-efficacy (‘I can drive more slowly and in that way reduce the chances of getting an accident’) (4). While the messages studied appeared to have a significant effect on evoked fear, it had hardly any effect on perceived threat and efficacy. This study implies that there is “no support for the idea that evoked fear enhances threat perception” (4). One possibility is the “ceiling effect,” the idea that most people are convinced of the threats of a risky behavior and that more emphasis on these threats does not really increase the perceived threat level (4).
Critique 2: A Rated-R Approach to a PG-13 Problem
Alongside content, the tone and messenger are very important components of a public health campaign. Sprint’s “Thumb Wars” takes on a light, witty tone to communicate its threat-based appeal. Their public service announcement features two popular adult actors and comedians most known for their appearances in rated-R films and television shows intended for mature audiences only. In the PSA, Ken Jeong, 41, advocates against DWT while playfully criticizing his colleague, Joel McHale, 39, for texting throughout their PSA. Standing against a bare backdrop, the two go back and forth between comedic and serious tones as they read off harrowing statistics on teenage DWT and promoting thumb socks in the style of an infomercial.

More recently, AT&T’s “It Can Wait” campaign has added a celebrity PSA similar to that of Sprint. In their celebrity spot, two actors from the popular adult drama, Melrose Place, stand against a bare backdrop with their cell phones in hand. For the next minute, the actors discuss a character on the show that practiced DWT and the dangerous statistics of the risky behavior using fear to evoke a negative emotional response among viewers.
The introduction of “parasocial interaction” occurred in 1956 and suggested that communication media can provide viewers with “an apparently intimate, face-to-face association with a performer” (10). Because “the human brain processes media experiences similar to how it processes ‘direct experience,’ people typically react to televised characters as they would real people (11). Part of the Parasocial Contact Hypothesis is that viewers formulate impressions of televised characters to reduce uncertainty about social behavior (10). In optimal conditions, participants must feel of equal status, share common goals, have sustained non-superficial contact and not be opposed to salient authority (12).
In exploring whether mediated forms of contact could influence attitudes about minority groups, researchers observed the parasocial interaction among undergraduate students at a major Midwestern university. In several studies, students were exposed to various television shows and comedy specials with identifiable characters of the social behavior they are trying to appeal. This social interaction is measured along the Likert scale. While there are several limitations to this study, the hypothesis has significant theoretical and social implications and results exhibit a relationship between mediated performers and viewers’ beliefs and behavior (10).


The Theory of Reasoned Action also draws upon the importance of opinions of others on social norms and behavior. According to this theory, attitude of other people, combined with the importance of their opinions is intended to influence social norms and in turn intention and behavior. Spring and AT&T assume that teenagers value the opinions of older actors and that their opinion on DWT will influence their behavior in a positive manner.
In both of the wireless carrier sponsored anti-texting campaigns, the celebrity messengers are un-relatable. In “Thumb Wars,” both actors are decades older than their target audience, and have collectively appeared in over 10 rated-R films (13). The actors featured in the AT&T PSA appear on a television drama targeted toward the 18-34 demographic, a range that does not include the target population that the very issue of their campaign is attempting to address (13). While teenager viewers have experienced sincere contact with the actors through viewing the PSAs, under this theory, it is unlikely that the messengers and viewers share common goals. Their unfamiliarity with the adult actors gives them the appearance of a salient authority figure and in turn has the opposite intended effect of psychological reactance.
Critique 3: It Can’t Wait
The “It Can Wait” message that AT&T has made popular through its campaign goes against the very purpose of the cell phone and text message. Text messages are meant to be brief and are typically used as a substitute for voice calls in situations where voice communication is impossible or undesirable. Many phones today come standard with preset “click and send” texts, and with the creation of the text message, wireless users have come to expect immediacy. According to LG, teens use more than 2,000 unknown words in their texts (14). The use of acronyms is extremely popular in texting among teenagers and it is not uncommon for texts simply to inquire about the location of another. The “It Can Wait” message therefore does not reframe the device, but argues against its very purpose. By simply telling users to abstain from the behavior, AT&T is again using the Health Belief Model in assuming that teenagers are rational individuals and are eliciting psychological reactance.
In Brehm’s Psychological Reactance Theory, messages that are perceived to reduce or threaten personal freedoms arouse a motivational state or reactance, which directs individuals toward re-establishing the lost or threatened freedom (15). This reactance effect is illustrated in a study that compared different types of alcohol prevention advertisements. In the study, undergraduate students rated high threat and low threat ads. High threat messages included phrases such as “conclusive evidence” and were looked upon more negatively and prompted greater intentions to consume alcohol than low threat messages that suggested to viewers that they “may wish to consider these conclusions” (16). In a follow up study, more students consumed alcoholic beverages in a taste test after exposure to high threat ads than to low threat ones (16). According to this theory, behaviors and/or objects that are perceived to be off limits for certain audiences are more attractive to members to whom the restriction applies. In the alcohol study among undergraduates, exposure to alcohol prevention ads actually increased alcohol consumption (15).
Integrated into everyday life are driving and sending text messages. Teenagers text friends and parents to inquire about their location, obtain directions, even flirt. Overtime, teenagers have been conditioned to believe that text messages require an immediate response and sometimes, as when driving, it is hard to ignore the phone (17). For teenagers, the death of freedom is far worse than the risk of DWT (17). AT&T’s “It Can Wait” campaign does a poor job at measuring psychological reactance as their message is coming from un-relatable and dominant figures who are attempting to take away a device of great value to them.
Proposed Intervention
To create a more successful campaign, it is essential to first change the overall tone of the message. The campaign needs to take on a unified tone and move away from threat-based appeals and towards successfully changing social norms. Instead of a messenger that teenagers are unable to relate to, it would be more effective if other teens were to deliver the anti-DWT message. Moreover, a better way to go about addressing this public health issue is to use a combination of the Psychological Reactance Theory, Optimistic Bias and Social Expectations Theory. The message of both campaigns should move from adult scorn to social scorn, from being told to wait by authority figures to being told that it is ok to wait by friends. After the 3rd defense are several PSA examples utilizing the proposed changes and theories.
Defense 1: The Optimistic Bias
The first critique of Sprint and AT&T’s campaigns cited the ineffectiveness of fear on perceived threat and efficacy. In a survey conducted by the AAA Foundation, 83% of respondents said drivers using cell phones is an “extremely serious” problem - more so than speeding and running red lights (1). Despite this admission, more than half of the same survey respondents reported using their cell phones while driving and half of these respondents admitted to doing this behavior “often” (1). These studies demonstrate that it is not enough simply to convince teenagers how bad these risks are but that they themselves are at risk.
The Health Belief Model predicts that those who perceive less threat to their health will be less likely to take precautions to reduce that threat (18). Despite the fact that many teenagers are generally aware of the health risks associated with DWT, this knowledge does not necessarily alter teenager’s perceived susceptibility of a motor vehicle accident and/or injury. Optimistic Bias is the theory that people tend to underestimate risks that apply to them. In a study on smokers and perceived susceptibility, smokers acknowledged a greater susceptibility to related illnesses but tended to predict a lower likelihood of contracting one disease (18).
In order to convey to teenagers that they should refrain from DWT, campaigns must focus on personal stories from peers and other teenagers. Campaigns should not attempt to alter behavior by distributing statistics through salient authority figures. The tone of the campaigns should be casual and the message should focus on empowerment and behavior rather than fear and threats.
Defense 2: Social Scorn v. Adult Scorn
The second critique evaluated parasocial interactions and the theory of reasoned action in the Sprint and AT&T campaigns. It observed that the messengers in both campaigns are inappropriate for delivering the anti-DWT message to teenagers. In constructing a new intervention, the Social Expectations Theory is a more effective approach to changing social norms and behavior.
The Social Expectations Theory is concerned with how socially received expectations motivate behavior. The theory focuses heavily on normative behavior and states that in order to change behavior one must change norms. In media, actors and their characters influence people’s expectations of behavior and as an effect, people alter their behaviors to meet the expectations that those norms provide (19). In a campaign promoting tobacco-free school policies, experts agreed that youth would be the best people to appear in ads (19). Their belief aligned with the social expectations theory in that they understood that it was important for any person appearing in their campaigns to have some personal connection and experience with the issue (19).
To make this a more effective campaign, it would be best to change the messenger. As in the tobacco-free school policies campaign, it is important to have a teenager convey the anti-DWT message to other teenagers. An actor 20 years their senior is hard for a teenager to relate. Often time, teenagers perceive older unfamiliar adults as talking down to them. This perceived adult scorn creates a psychological reactance – which is important to measure before conducting any public health campaign especially those that are targeting adolescents and vulnerable populations. Adult scorn should be replaced with social scorn, a teenager telling his/her friend that DWT is stupid. The person delivering the message becomes part of the peer group, releasing the targeted individual from social responsibility and promoting social change. By making the act of DWT seem un-cool, the campaign is changing the normative beliefs and in turn behavior.
Defense 3: I Can Wait
In the third and final critique, AT&T’s “It Can Wait” campaign is criticized for telling users only to abstain from texting. Telling users that it can wait is arguing against the very purpose of the device and act. No alternative behavior or social norm is provided and therefore the campaign is ineffective at changing the current behavior or teenagers who DWT.
When people have something, they value it very highly. Ownership is not limited to material things and can apply to ideas and behavior as well (20). Behavior can be considered a form of ownership; therefore, if one wants to change behavior they must either reframe it or offer an alternative. Overtime, the constant use of cell phones conditions teenagers to believe that text messages require an immediate response. Prohibiting this behavior can cause a psychological reactance as seen in the study comparing different types of alcohol prevention advertisements. In order to reframe and control for psychological reactance, the message should not be “Txting and Drivng…it can wait,” but a friend saying “I can wait” or “we can wait.” This change in tone takes texting from being an immediate need to something that is not so pressing. Having a friend tell another that they can wait, rather than a parent of a distracted driving victim telling a teenager that they can wait has a much larger effect on perceived social norms and behavior.
In the improved intervention, a series of PSAs would feature a group of typical teenagers. One ad would include a group of teenagers standing around in a school parking lot discussing plans to hang out this upcoming weekend. As one of the teenage boys breaks off and enters his car, he yells to his friends “just text me when you figure out what the plans are.” His friends scoff at him and yell back, “Dude, it can wait.” An alternative to this scenario is the teen, while entering his car, tells his friends that he will text them tonight’s plans on his way home. The leader of the group responds, “Don’t be stupid, we can wait.” One more version of this campaign features a teen pulling up to a red light. At the stop, the teen begins reading a text message when all of a sudden a car filled with playful teens pulls up alongside to the “texter.” When the teens notice that the other driver is texting while driving, they become quiet and then begin to heckle the teenager. The safe teen driver looks over at the texter and says, “Hey, it can wait.” The light then turns green, and the teenage texter, flushed with embarrassment places their cell phone in the glove compartment of their vehicle as the other car drives away.
Conclusion
Texting while driving is a risky behavior for all persons, especially teenagers. With the dramatic growth of cell phone use of the past decade, wireless carriers have begun to develop public health campaigns to address the negative effects of driving while texting. Sprint and AT&T have attempted to appeal to teenagers and alter their behavior by using the Health Belief Model and Theory of Reasoned Action. Through threat-appeals and unidentifiable role models, their campaigns have been ineffective at curbing this behavior. In the proposed alternative campaign, it is suggested that wireless carriers abandon their fear tactics in favor of an effective teen-driven campaign focusing on promoting social change and normative beliefs.

REFERENCES
1. National Safety Council. Understanding the distracted brain: Why driving while using hands-free cell phones is risky behavior. Itasca, Illinois: National Safety Council, 2010.
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9. AT&T. Multimedia Gallery – Texting & Driving - It Can Wait. http://www.att.com/gen/press-room?pid=6209&cat=92&u=1135
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Why the “Go With Your Own Glow” Campaign is Flawed and Ideas to Fix It – Li-Hui Ueng

Why healthy glows are important
In the United States being tan is a sign of health and beauty. One way to achieve a healthy and beautiful tan is through the use of tanning salons. Tanning salons allow their patrons an inexpensive and fast way to achieve the healthy glow of life and vitality. However, research has linked these salons to increased risk of melanoma and non-melanoma skin cancers (1). The culprit is the ultraviolet A (UVA) rays found in tanning beds. These rays contain two to three times higher the amount of UVA versus rays delivered by natural sunlight (1). The UVA rays not only are associated with skin cancers, but also include the risk for: sunburns, pruritis, nausea, dryness of skin, and blistering (1). In the United States, studies have shown the highest prevalence of use of tanning salons are among female adolescents (1). In the Growing Up Today Study (GUTS), conducted by O’Riordan et al (1), among older girls aged 15 – 18, 24.6% reported having used tanning beds to achieve a tan in the previous year. With the well-documented risks for tanning salon use, and the prevalence of female adolescent use, there should be interventions to discourage use of tanning salons.
One program attempts to intervene and deter tanning salon use, and this program is called the “Go With Your Own Glow” campaign (10), sponsored by the Skin Cancer Foundation. The goals of this media campaign include encouraging the population, more specifically, females, to be happy with their natural beauty and skin color, discouraging tanning, and revealing the truth about tanning salons. This campaign includes: print advertisements in women’s magazines, speakers who used tanning salons and developed melanoma, and other options to achieve the healthy glow through use of make-up techniques. There are a few flaws in the “Go With Your Own Glow” campaign, which include assuming the readers of the advertisements make rational decisions, focusing on the wrong audience, and not addressing what healthy is in the context of United States culture. By addressing these issues, the campaign will be more effective in the decrease use of tanning salons.
People do not make rational decisions
The “Go With Your Own Glow” campaign’s first flaw is thinking that people make rational decisions. One advertisement in the campaign equates tanning with a grape changing into a raisin. The advertisement states that as a result of being in the sun, wrinkles, crow’s feet, and burns show up on the skin, and that humans should be smarter than grapes turning into raisins, and therefore not tan. However, humans do not make rational decisions. The health belief model, first created by Hochbaum, Rosenstock, and Kegels, attempts to explain and predict health behaviors. In the model, there are four factors that Hochbaum et al. described that motivate health behaviors. These four factors are: perceived susceptibility, perceived severity, perceived benefits of an action, and perceived barriers to taking that action.
By applying the health behavior model to the “Go With Your Own Glow” campaign, readers should look at the advertisement and think they are susceptible to wrinkles and crow’s feet. Therefore the severities of these effects from tanning outweigh the benefits, and the reader should stop tanning. However, human behavior is not rational. Salazar criticizes the rationality assumption in the model, stating the “focus [is] on rational, intentional behavior and does not take into account the spontaneous activity that characterizes much of human behavior” (2). The readers of the “Go With Your Own Glow” campaign are not all rational, because irrationality is ingrained in human behavior, and as a result will not modify their behavior as described by the health belief model.
Focusing on the wrong audience
The marketers of “Go With Your Own Glow” created a flawed campaign in choosing their target audience. The target audience should not be just females, but more specifically, female teens since this group represents the main customers of tanning salons (1). Each advertisement in the campaign has illustrations of older women, probably women to whom the adolescents cannot relate. Therefore, the advertisements are not focused towards the main audience.
The campaign is also only focused on an individual level. There have been many critiques against the theories of predicting behavior on the individual level. The critiques include not taking into account external forces such as social and cultural pressures. By only targeting a single individual, the campaign does not account for humans wanting to fit in. David Marks wrote that most interventions are erroneously created to change individual behaviors (11) and the “Go With Your Own Glow” campaign falls into this category. Instead of focusing on the individual level, Marks proposes that interventions should be based on group level interventions to be more effective (11). One reason individual level interventions are inferior to group level interventions is because they do not take into include the herd mentality that is part of human behavior. Herd mentality occurs when humans want to mimic the actions of others (15).
Herd mentality can be translated into peer pressure in the female adolescent population. Female adolescents typically want to conform to a standard and as a result are more susceptible to peer pressure (17). The campaign disregards an integral part of adolescent life by not addressing peer pressure. Teenagers especially want to conform to the standard and not be left out, and if this is being tan, they will take action to fit into this standard.
The print advertisements were mainly in magazines that older females would read, including: Food & Wine, Shape, and Time magazine. These magazines are not widely read by adolescents and therefore the campaign is missing the main target audience by not running the advertisements in the correct magazines. “Brands capitalize on consumer self-interest by targeting the wants and needs of the target audience” (7). Branding requires that the target audience believe that the product being sold (natural and healthy skin), is a better solution than the unhealthy behavior (tanning). The “Go With Your Own Glow” campaign cannot start to brand natural healthy skin because they do not target the correct audience, which is essential to a successful marketing campaign.
Being tan = health and beauty?
The “Go With Your Own Glow” does not address a greater concern of being tan and the social status. In the United States having a tan is equated with being healthy, having a higher social status, and wealth. This idea is made evident by many studies showing people equate having a tan as being healthy. Bagdasarov et al. (3) conducted a study in which they found a strong correlation between tanning image beliefs and tanning behavior among adolescents. The research showed adolescents “with greater beliefs that tanned images are attractive will be more likely to use and have greater intentions to use tanning beds” (3). When someone turns on the television or opens a magazine, the celebrities are glamorous, tan, and look happy and healthy. Female adolescents look to these celebrities as role models and want to emulate the same characteristics as the celebrities. The adolescents will wear the same clothing, use the same products, and also want to be tan, using the celebrity as a standard (8). The campaign does not address the standard of being tan and therefore is not fully effective.
By the campaign not addressing socio-cultural norms, the campaign cannot be successful. Body image is extremely important in humans, especially adolescent females. In the study performed by Cafri, Thompson, and Jacobsen (12), they searched for the connection between cultural norms and tanning behaviors. The study found if there was a socio-cultural standard to be tan, the participants were more likely to tan to reach the standard. Since the campaign does not address present-day cultural standards, the campaign will not be fully successful in changing tanning salon use.
What do to now
There are many ways in which the “Go With Your Own Glow” campaign can be improved. The campaign first needs to address the lack of education among the target population, adolescent females. There should be education for the target population regarding the dangers and side effects of tanning, and that this population is susceptible to these effects, not just older people. Second, the campaign needs to rework who the target audience, instead of focusing on females, they campaign should further focus on female adolescents since the prevalence of tanning salon use is so high among this population. And lastly, the campaign should find relatable spokespeople to relay their message of natural beautiful skin to the female adolescents.
Educate the users of tanning salons
One fix to the campaign is to inform female adolescents of the actual risks of tanning and that they are susceptible. Research has shown that the perceived susceptibility of complications from tanning is low within the population (2). In a 1988 survey, only 33% of adolescents were aware of the correlation between tanning and skin cancer. By a decrease in perceived susceptibility (I am not going to get skin cancer by tanning), the perceived severity also decreases. Consequently, the perceived benefits of tanning outweigh the perceived potential for complications, and behavior will not change because the female adolescents do not think they are at risk. The campaign should include information about the risks, both in the short and long-term.
The article written by Mermelstein and Riesenberg suggests that the majority of adolescents do not even think about sun exposure precautions (4). Sun exposure precautions include wearing sunscreen, staying in the shade, wearing hats and avoiding sunburns. The Skin Cancer Foundation should increase their focus on teens, and make this population aware that wrinkles can occur at any age, and by tanning, the teens only increase the risk for short-term effects. By taking sun exposure precautions, the teens will decrease the effects of sun exposure. In this case having wrinkles earlier in life. Adolescents, when choosing their behaviors, do not typically think about the future consequences. An effective program should focus on short-term rather than long-term consequences since youths do not think far into the future (6). They do not think about wrinkles, crow’s feet, and blotches, because adolescents believe these characteristics are only associated with older adults. The program should increase education regarding the harmful effects of tanning salons and promote safe tanning practices, such as sunless tanning lotion and wearing sunscreen (9).
Find the right target audience
By doing formative research, the “Go With Your Own Glow” campaign can be more effective. Formative research is a key factor in the efficacy of campaign in changing health behavior. The purpose of this research is to find the correct target population and understand the “needs, desires, and values” (16) of this population and create an effective campaign to change their health behaviors.
The goal of the campaign should be to target teens and stop the behavior before it starts or stop the teens from future tanning. The concept of formative research should be applied by finding what drives adolescent female behaviors and adjusting the advertisements to those drivers. The campaign can take some examples from the “truth” campaign. In the “truth” campaign, the marketers try and successfully decrease the prevalence of teen smoking in the United States. The marketers achieved a successful youth campaign through many techniques, including research and focus groups (5). The marketers/researchers found that the youth population did not want to be told what behavior decisions to do, and also, perhaps more importantly, the youths did not want to be manipulated. These techniques should be used in the “Go With Your Own Glow” campaign to be more effective.
In the “truth” campaign, the marketers were able to re-brand smoking, instead of being considered cool for smoking, they re-branded smoking as to being manipulated by the big tobacco companies. As a result, there was a documented decrease of prevalence in smoking among youths in Florida because youths did not want to be manipulated (5). The “Go With Your Own Glow” campaign should focus on re-branding natural skin. The advertisers can re-frame natural skin from pale and unhealthy to beautiful, healthy, wrinkle-free, and long lasting. Also, the advertisers should incorporate the concept that it is main stream media that creates the standard of tan being healthy, and the youths are being manipulated into thinking healthy is tan. And if there are the same results as with the “truth” campaign, there should be a decrease in tanning among female adolescents.
Also, the campaign should not focus on an individual level, but on a group level. By focusing on a group level, the advertisement departs from the individual behavior models, and now addresses tanning on a community level which is proven to be more effective (13). The advantage of changing a behavior on the community level is that the information can be diffused to a larger population in a shorter amount of time. The “Go With Your Own Glow” campaign can focus their advertisements on television commercials between shows that teens watch. By having these advertisements between the shows the teens watch, the campaign can reach a large amount of their target population at one time.
As mentioned earlier, the campaign advertisements are mainly found in magazines that female adolescents do not read. To improve the campaign, the advertisements should be run in teen magazines. Some examples of teen magazines include Seventeen, Teen Vogue, and CosmoGirl. By having the advertisements in these magazines, the campaign reaches the target population more effectively and quickly.
Find a relatable spokesperson
The advertisers of the “Go With Your Own Glow” campaign also need spokespeople to which the target, female adolescents, can relate. The campaign currently uses former beauty pageant contestants as spokespeople, and most teen girls can neither identify nor relate to these beauty queens. Instead, they should find relevant spokespeople that are in the public eye. For instance, this past year, the show Jersey Shore on MTV became a huge hit. The premise of this reality show is following a group of young Italian-Americans and their summer on the New Jersey Shore. One of the mottos on the Jersey Shore was gym, tanning, and laundry (GTL). All of the stars of the show were extremely tan, and they achieved the tan through tanning salons. The “Go With Your Own Glow” campaign should recruit these reality television stars and inform them of the reality of what tanning does, and have them has spokespeople against tanning since a lot of youths, the at-risk population, watched Jersey Shore. Using relatable people rather than celebrities is more effective in changing youth behaviors (6, 14). In the article written by Paglia and Room, the writers state that youth can be skeptical of celebrities and their endorsements, so therefore by having “real” people, they can relate better.
Final thoughts
With the “Go With Your Own Glow” campaign, the writers assume that the reader will see the complications of tanning, their increased susceptibility and the severity of not having a wrinkle-free, flawless face, and be motivated to stop tanning since the benefits outweigh the barriers. In reality, the target population is female adolescents, and this campaign does not apply to this population. By redesigning the campaign to address and educate youths, re-branding what a healthy glow is (from tan to natural skin color), and recruiting relatable spokespeople, the campaign can be more successful in changing tanning salon use habits.
 
References
1. O’Riodran DL, Field AE, Geller AC, et al. Frequent tanning bed use, weight concerns, and other health risk behaviors in adolescent females (United States). Cancer Causes Control 2007; 17:679 – 686.
2. Salazar M. Comparison of four behavioral theories: a literature review. AAOHN Journal 1991; 39:128 – 135.
3. Bagdasarov Z, Banerjee S, Greene K, Campo S. Indoor tanning and problem behavior. Journal of American College Health 2008; 56(5):555 – 561.
4. Mermelstein RJ, Riesenberg LA. Changing knowledge and attitudes about skin cancer risk factors in adolescents. Health Psychology 1992; 11(6):371 – 376.
5. Hicks JJ. The strategy behind Florida’s “truth” campaign. Tobacco Control 2001; 10:3 – 5.
6. Paglia A, Room R. Preventing substance use problems among youth: a literature review and recommendations. The Journal of Primary Prevention 1999; 20(1):3 – 50.
7. Blitstein JL, Evans WD, Driscoll DL. What is a public health brand? (pp. 25 – 41). In: Evans WD, Hastings G, eds. Public Health Branding: Applying Marketing for Social Change. Oxford: Oxford University Press, 2008.
8. Cox CR, Vess M, Arndt J, Cooper DP, Goldenberg JL. Bronze is beautiful but pale can be pretty: the effects of appearance standards and mortality salience on sun-tanning outcomes. Health Psychology 2009; 28(6):746 – 752.
9. Brooks K, Brooks D, Dajani Z, et al. Use of artificial tanning products among young adults. American Academy of Dermatology 2006; 54(6):1060 – 1066.
10. The Skin Cancer Foundation. Go with your own glow. New York, New York: The Skin Cancer Foundation. http://www.skincancer.org/Go-With-Your-Own-Glow/.
11. Marks DF. Health psychology in context. Journal of Health Psychology 1996; 1(1): 7 – 21.
12. Cafri G, Thompson JK, Jacobsen PB, Hillhouse J. Investigating the role of appearance-based factors in predicting sunbathing and tanning salon use. Journal of Behavioral Medicine 2009; 32:532 – 544.
13. Crosby RA, Kegler MC, DiClemente RJ. Understanding an applying theory in health promotion practice and research (Chapter 1, pp. 1 - 15). In: DiClemente RJ, Crosby RA, Kegler MC, eds. Emerging Theories in Health Promotion Practice and Research: Strategies for Improving Public Health. San Francisco, CA: John Wiley & Sons, Inc., 2002.
14. Larson RJ, Woloshin S, Schwartz LM, Welch HG. Brief communication: Celebrity endorsements of cancer screening. Journal of the National Cancer Institute, 2005; 97(9): 693 – 694.
15. Sornette D. “Herd” behavior and “crowd” effect and forces of imitation (pp. 91 – 114). In Sornette D. Why Stock Markets Crash: Critical Events in Complex Financial Systems. Princeton, NJ: Princeton University Press, 2003.
16. Siegel M, Lotenberg LD. Marketing social change – an opportunity for the public health practitioner (pp. 45 – 71). In Siegel M, Lotenberg LD. Marketing Public Health: Strategies to Promote Social Change. Sudbury, Massachusetts: Jones and Bartlett Publishers, 2007.
17. Brown BB. The extent and effects of peer pressure among high school students: A retrospective analysis. Journal of Youth and Adolescence, 1982; 11(2): 121 – 133.

Combating and Invariably Reducing the Rates of Unintentional Teenage Pregnancy: A Program Critique of MTV’s Teenage Pregnancy Intervention “16 and Pre

1) Introduction:
Unintended teenage pregnancy is a critical issue evident in society. The United States’ birthrate for teenagers ages fifteen to nineteen is 41.9 per 1,000 women, illustrating the dire need for innovative policy and program intervention aimed at reducing unintended pregnancies among this vulnerable age group (4). In an attempt to intervene and reduce the rate of teenage pregnancy, the cable channel MTV has implemented an intervention program whose popularity has far exceeded expectation yet whose success in reducing teenage pregnancy has remained rather questionable.
2) Scope of Problem:
Roughly half of adolescents in the United States are sexually active: 46 percent of teenage girls and 48 percent of teenage boys have reported being sexually active by senior year of high school and one in ten sexually active teenagers has reported engaging in sex with at least four partners within the past year (2). High rates of sexual activity coupled with the lack of adequate contraceptive use render many adolescents at increased risk for pregnancy. The United States teenage pregnancy rate is significantly higher than that of many other industrialized countries with rates two to six times greater than those in countries of Western Europe (12). By the age of twenty, over 30 percent of females have become pregnant at least once in their lifetime: 72 percent of these pregnancies are unplanned and 84 percent of these pregnancies are to unmarried females (15). Ninety percent of teenage mothers that give birth elect to raise their baby (2). Teenage mothers are more likely to drop out of high school, have large families, remain single parents, and never attain a college education (12). In fact, eight out of ten teenage mothers drop out of high school after having a baby (18). Infants of teenage mothers are more likely to be born preterm, have a low birth weight, have higher rates of infant mortality, experience neglect or physical abuse, have lower levels of cognitive attainment and proficiency, exhibit behavioral problems, have chronic medical conditions, rely more heavily on public assistance, become incarcerated, drop out of high school, become teenage parents, and be unemployed (4). The home environment of teenage parents often places the infant at increased risks due to: physical living conditions, decreased educational stimuli, and poorer quality of parent-child interactions (5).
Teenage pregnancy costs the United States taxpayers an estimated nine billion dollars per year (12). Of that, $1.9 billion per year is allocated towards increased public sector health care costs, $2.3 billion towards increased child Welfare costs, $2.3 billion towards state prison systems, and $2.9 billion in lost revenues and taxes from teenage mothers (12). Seven out of ten teenage mothers rely on welfare while Medicaid pays roughly 66 percent of the health care needs of teenage mothers and their babies (18). From the years 1991 to 2004 the estimated cumulative costs of teenage child bearing totaled: $161 billion (12).
Due to the lack of adequate use of contraceptive methods, adolescents are at an increased risk for pregnancy. Adolescents commonly cite the following reasons for failure to utilize condoms during sexual activity: odor affiliated with the latex, lack of lubrication, excessive lubrication, lack of condom access, difficulty disposing of the condom, the thickness and feeling of the condom, difficulty opening the package, diminished sensation, partner pressure to not use condoms, condom inexperience, overestimated belief that other teens are not utilizing condoms, and diminished perceived susceptibility to pregnancy and infection when engaging in unprotected sex (8). Teenagers in monogamous relationships are less likely to use condoms even when another form of contraception is not used (8). In addition, adolescents often cite ‘the power of passion’ as the predominant reason for failure to utilize condoms during sexual activity: these individuals state that rational judgment is often removed in the heat of the moment during sexual encounters (8).
3) Current Intervention:
As a means to combating teenage pregnancy, the cable television company MTV has partnered with the National Campaign to Prevent Teen and Unplanned Pregnancy to create a reality show titled: “16 and Pregnant” aimed at reducing United States teenage pregnancy rates. The show follows pregnant teenage mothers, their partners, and families as the teens struggle through pregnancy, delivery, and childcare to illustrate the perils and life-altering experiences of teenage parenting (1). The show recruits participants from its website, where pregnant adolescents desiring to participate can complete and submit an application (1). For those applicants that are selected, the teenage mothers are financially compensated for their time and filming begins around the start of the second trimester of pregnancy. The show’s executive producer, Morgan J. Freeman claims the show is targeted as a public service to minimize national teenage pregnancy rates (7). In addition, Freeman claims the casting directors spend a substantial amount of time screening applicants as a means to ‘weeding out’ those who want to be on the show solely to gain publicity rather than to share their experience as a pregnant teen (7). Ironically, the little information that is presented during the television show is presented in times when the majority of viewers have already flipped the channel or disengaged, such as immediately pre or post-commercial break.
In addition to the television program, the National Campaign to Prevent Teen and Unplanned Pregnancy distributes free copies of the show along with teenage-appropriate discussion guides to schools and other adolescent-affiliated organizations (7). These discussion guides contain brief summaries of each of the program’s television episodes, in addition to statistics and thought-provoking questions aimed at preventing teenage pregnancy (12). Furthermore, MTV has created a “16 and Pregnant” website, equipped with copies of the show’s episodes, photos of the teenage mothers and their babies (as well as a completely different section dedicated solely to pictures of the babies), soundtracks to the episodes, message boards, insider-alert news feeds, a link to casting information and applications to next season’s episodes, Facebook links, and links to purchase the season’s full episodes on DVD (12). The website also contains links to two additional MTV-affiliated websites: stayteen.org and parentsconnect.org.
4) Critique of Current Intervention:
The show “16 and Pregnant” designed as an intervention to minimize the rates of teenage pregnancy has remained a repeated source of controversy and conflict. Critics not only question whether the show can actually dissuade adolescents from becoming pregnant but also question the ethics of using high-risk teenage mothers as public examples of ‘what not to do’ during an intensely vulnerable, life-altering time in these adolescent’s lives. Many critics have wondered whether the show’s participants truly comprehend the potential ramifications of being on a reality television show watched by millions of viewers (7). Detractors have also questioned MTV’s motives when creating and subsequently renewing the reality show for a second season: when does the program stop being an accurate depiction of the perils of teenage pregnancy and start becoming a means to raking in money, viewers, and overall net profits (7)? In addition to the ethical and moral questions associated with the show, public health practitioners have also cited a number of social science theories as to why the show will not actually fulfill its proposed goal of reducing the incidence rates of teenage pregnancy. There are three main arguments as to why MTV’s “16 and Pregnant” will not reduce United States unintended teenage pregnancy rates: (1) the program does an ineffective job of educating adolescents about teenage pregnancy prevention and fails to take into account the physiological state of the adolescent brain, relying on the program’s website to educate viewers (2) the program utilizes scare-tactics as a means to preventing teens from engaging in sexual activity rather than educating about contraceptives and pregnancy prevention and, (3) the program presents adolescent viewers with contradictory messages regarding teenage pregnancy and parenting.
a) Critique One:
Given the developmental state of the adolescent brain, the subtle means in which the television episodes educate adolescents about pregnancy prevention is ineffective and will not provide adolescents with the tools necessary to prevent pregnancy when in a sexually aroused state. During adolescence, the brain is not yet fully developed, remaining in a crucial state of physiological development. During this time, the amygdala controlling the brain’s emotional response is in a stage of advanced development while the brain’s frontal lobes, controlling the executive functioning, remains underdeveloped (10). Variation in brain development renders it increasingly difficult for teens to plan ahead for the future and make responsible, rational decisions regarding their bodies. This mismatch often motivates adolescents to follow their impulses and emotions when engaging in sexual activity (10). Therefore, adolescents watching “16 and Pregnant” may not perceive themselves at increased risk for pregnancy, and may not consequently feel the need to educate and prepare for contraceptive use prior to the onset of sexual activity. The fact that the television show does not incorporate an extensive educational component within the show, instead instructing viewers to access the show’s website for educational information renders many teens unlikely to access the website and gain crucial knowledge about pregnancy prevention.
In addition, the small amount of educational material that is presented to viewers during the course of the show is offered in a manner that does not prepare adolescent viewers to respond and protect themselves when in a state of sexual arousal (such as right before or during sexual activity). Material regarding pregnancy risk and prevention is stated as facts rather than in a way that is conducive to adolescent learning: adolescents may hear the material and assume that they would know better than to engage in unprotected sex because they material is presented while viewers are not sexually aroused. However, when adolescent viewers are placed in a situation of sexual arousal, the program’s educational means do not adequately equip them with the skills necessary to refuse unprotected sex and engage in safe sex negotiation.
In addition, presenting adult-generated information to adolescents (rather than peer-generated information) may generate Psychological Reactance, based on the theory that individuals adversely reacting to behavior recommendations may perceive these recommendations to impede on one’s autonomy, consequently causing the individual to rebel from suggested behaviors (12). Program contraceptive information created by adults but targeted to adolescents may cause adolescents to rebel from the suggested behavior changes, inevitably placing them at an even higher risk for pregnancy outcomes.
When in a non-aroused state (such as one that a viewer would naturally be in while watching the program), individuals tend to underestimate the influence of emotional arousal in terms of preferences and decisions, rendering them less likely to pay attention to the program’s cues and suggestions to view the website for prevention information (3). When the adolescent brain receives cues that are commonly associated with sexual intercourse (experiencing an increased state of arousal) there is increased motivation to engage in sexual activity, despite risks associated with pregnancy (3). Sexual arousal narrows the focus of motivation, creating a ‘tunnel vision’ effect where goals other than sexual fulfillment are overturned by the motivation and desire to engage in sex (3). This distorts judgment associated with the risks of unprotected sex: the state of sexual arousal influences the judgment and choice executive functions of the brain, causing adolescents to minimize the significance of other factors such as protecting oneself against pregnancy (3). Inevitably, the program’s educational tactics fail to provide viewers with the knowledge and skills necessary to avoid high-risk sexual encounters and risk of pregnancy.
b) Critique Two:
The television program focuses on informing teens to prevent pregnancy by avoiding sexual activity rather than by increasing regular use of effective contraceptives. The show utilizes a ‘scare tactic’ as a means of motivating teens to abstain from sex: this tactic is similar to those used in abstinence-only sexual education programs, rendering many viewers susceptible to proceeding based on inadequate knowledge (18). Not only has research proven that it is easier and more effective to change one’s contraceptive use than to change one’s engagement in sexual activity, research has also shown that it is extremely difficult to deter sexually-experienced teens from having sex (18).
The show’s use of scare tactics as a means to preventing teenage pregnancy is questionable: fear messages can be an ineffective means to promoting long-term behavioral change (such as involvement in sexual activity or contraceptive use), especially if the threat is perceived as irrelevant or insignificant to the adolescent viewer. In situations where the adolescent does not perceive oneself to be at risk for the occurrence (teenage pregnancy) there is no motivation for one to further process the program message and create a protective response (such as contraceptive use and education) (18). If the campaign only succeeds in scaring the audience, it will inevitably fail because it does not state how to explicitly prevent this induced fear from occurring (18).
In addition, the use of scare tactics often sends adolescent viewers the message that the majority of adolescents are engaging in unprotected sexual intercourse. When coupled with the lack of contraceptive education available during the hour-long episodes, adolescent viewers may fail to realize the need and availability of effective contraceptive methods, placing many viewers at increased risk for pregnancy. Social norms have a significant influence over adolescents. Perceived social norms establish the basis for how individuals, particularly adolescents, will construct and act out social expectations: individuals tend to adopt social norms and modify behavior to reflect those of the mass (6). If adolescent viewers perceive the majority of teenagers to engage in unprotected sexual intercourse, then these viewers are more likely to themselves fail to utilize contraception during sex. Inevitably, the show’s use of scare tactics to prevent teenage pregnancy not only fail to adequately educate viewers on contraception, but also provide a false sense of social norms incorrectly based on the idea that all teens are engaging in unprotected sex.
c) Critique Three:
The program sends adolescent viewers contradictory messages regarding teenage sex: while telling viewers to abstain from sexual activity, the show dually ‘glorifies’ teenage pregnancy by presenting viewers with teenage mothers who have evolved into ‘celebrities’. The show’s inability to send a consistent message to viewers that unintended teenage pregnancy is undesirable, places many vulnerable adolescent viewers at increased risk for pregnancy.
The program’s episodes sport teenage mothers receiving increased levels of attention from family and friends alike, while celebrating baby showers with extensive gifts, guests, and excitement. The season episodes and reunion episode present ample time for the teenage mothers to ‘show off’ their babies in adorable outfits, getting much desired attention. Viewers may become ‘awed’ by the adorable babies dressed in stylish outfits. Having teenage mothers bring out their infants while concurrently discussing teenage pregnancy prevention sends out conflicting messages to viewers as it is extremely difficult for teenage mothers to admit their baby was a mistake (rather than the best thing that has ever happened to them) post-birth. At the end of the shows, the teens, perhaps as a method of preserving their reputation, often repeatedly state how happy they are as mothers and how they feel an irreplaceable bond and love for their babies. Not only does this send conflicting messages to viewers, but it also may render particularly vulnerable teens more likely to yearn babies of their own as a means to filling a void and feeling loved, appreciated, and needed.
The show’s website further conflicts the message aimed at adolescent viewers: the website is eye-catching and trendy, containing fun, interactive components linking further resources for pregnant and teenage mothers. The site contains a section where pregnant and parenting teens can get free messages to their cell phones containing information to help the teen through the pregnancy and the baby’s first year of life. Viewers are motivated to text “baby” to the given phone number to obtain these fun, interactive messages. The website contains an entire section with photo galleries of images of the episode’s featured babies, dressed in adorable outfits guaranteed to gain the attention of adolescent viewers. These photos can be very distracting for teenagers, who may feel an inconsistent message sent by MTV: one should not become pregnant as a teenager, however, if one does, one will have an adorable baby and could potentially become a ‘celebrity’ featured on MTV. The teenage mothers featured on the show’s first two seasons have fan pages where viewers write affectionate and supportive messages to these mothers: in fact, the program’s Facebook page contains 161,976 ‘fans’ in support of the teen mothers. For adolescent viewers lacking adequate attention and affection in their present lives, these factors may attract and motivate them to become pregnant as a means to gaining likewise attention and support.
In addition, the show often perceives the teenage mothers as the victims while (in most cases) the teenage male involved in the pregnancy (often the boyfriend) evolve into the villain. This gender labeling sends the incorrect message to female adolescents that pregnancy prevention is solely controlled by the male, deterring female adolescents from accessing the program’s website to obtain further information about pregnancy prevention as a means to adequately protecting oneself.
According to Social Expectation Theory, which focuses on the idea that individuals conform to the norms of the society in which they are living, individuals are heavily influenced by media sources. The ways in which media sources (such as those previously mentioned) present people, social interactions, and social norms significantly affect and motivate individual behavior (6). Therefore, if teenage pregnancy is presented and perceived in an attractive manner by adolescent viewers, a significant proportion of these viewers may perceive unprotected sex, teenage pregnancy, and teenage parenting as attractive, popular social norms (6). Media such as the “16 and Pregnant” television show and interactive website are prime examples of sources influencing the behaviors and norms of its target audience.
In addition to the Social Expectation Theory, the Diffusion of Innovation Theory similarly explains the above concept. Diffusion of Innovation Theory is utilized to predict and explain the spread of behavior and social norms over a particular population (17). This theory suggests that ‘media and interpersonal contacts’ provide individuals with knowledge that influences one’s opinion and personal judgment (17). Therefore, adolescent viewers who conclude through the “16 and Pregnant” television show and website that teenage pregnancy is a positive and desirable norm are more likely to desire to themselves engage in activities that would likely result in becoming pregnant. If the program’s ‘cool, celebrity-like’ teenagers become pregnant and are now currently teenage mothers, other adolescents may be more inclined to adopt the same behaviors and consequences.
5) Proposed Intervention:
Research has shown that short, interactive videos, such as hour-long episodes of “16 and Pregnant”, do not alone have an effect on behavior such as increased usage of contraception or abstaining from sexual activity (12). Therefore, in order to ensure that MTV’s “16 and Pregnant” intervention program actually minimizes the rate of teenage pregnancy, efforts need to be made to alter the current intervention as a means to making it more effective, realistic, and efficacious. Program coordinators and project developers of MTV’s “16 and Pregnant” should make the following alterations to their program: (1) the program should increase the educational content presented during the actual television episode to model techniques conducive to the adolescent brain and learning (2) the program should cease use of a scare tactic as a means to preventing teenage pregnancy and instead focus on providing prevention strategies and resources and, (3) the episodes and websites must be edited and modified to prevent contradictory messages and viewer interpretation of teenage pregnancy. The following three defenses further explain the rationale for modifying MTV’s “16 and Pregnant” intervention program:
a) Defense One:
Currently, the program’s episodes do not contain adequate educational information about teenage pregnancy prevention, relying on the program’s website to guide viewers to further information. Given the underdevelopment of the adolescent brain’s cognitive executive functioning, viewers are often unable to foresee themselves as at risk for pregnancy, thus failing to access the website for further information (3). In addition, adolescent viewers remain in a physiologically un-aroused sexual state when watching the episodes thus failing to recognize that they may place themselves in high-risk sexual situations when in an aroused state and may not be adequately prepared to negotiate safe-sex practices (3). Therefore, educational components of the program should include techniques such as role-playing and condom negotiation to provide viewers with techniques that would be useful when placed in aroused, high-risk situations. This information should be presented using age and racially appropriate ‘models’ that teach and illustrate these techniques to viewers (4). Educational information should not be presented immediately pre or post-commercial break, as the number of viewers during these times may be minimized. By incorporating more information and educational techniques within the television episodes, the responsibility to access the program’s website for adequate information is not left up to the discretion of the adolescent viewer.
Adolescent sexual activity occurs sporadically and is often unplanned (3). If adolescents underestimate the likelihood that they will have sex, or the likelihood that they would potentially engage in unprotected sex when condoms are unavailable, they are likely to fail to take adequate precautions (such as accessing the program’s website) to prevent adverse occurrences (3). It is imperative to include further educational components to the program’s episodes combining role playing, safe sex negotiation, condom demonstrations, contraceptive information and access to adequately prepare teens to manage situations that may place them at increased risk for pregnancy (12). By integrating pregnancy prevention education techniques into every episode of the intervention program, contraceptive use becomes a social norm to the adolescent population, rendering them more likely to engage in proper and consecutive use, diminishing the prevalence of unintended pregnancies.

b) Defense Two:
Currently, the program’s usage of scare tactics to prevent adolescents from engaging in sexual activity relies on the belief that these scare tactics will deter adolescents from having sex and consequently does not provide adolescents with adequate information about how to prevent pregnancies from occurring if indeed sex does occur. The reality of the situation is that showing teenagers unrealistic situations that have a small possibility occurring do not prevent them from engaging in these behaviors (18). Therefore, it is imperative to equip viewers with the knowledge and skills necessary to prevent pregnancy when sexual activity does occur (5). It is much more difficult to stop teens who are already having sex from engaging in sexual activity than it is to delay first sexual encounter for teens that are not yet having sex (5). This education is especially prudent for teens who have already engaged in sexual activity because although sexually experienced adolescents are unlikely to cease sexual activity, they are likely to alter activity to reflect safer practices if provided with adequate and reasonable knowledge (5).
Replacing program scare tactics with educational techniques that enable viewers the ability to develop skills necessary to resist pressures relating to dating, sexual activity, and contraception will significantly reduce the number of unintended pregnancies (12). Providing viewers with effective contraception strategies that include discussion of where to access contraception and how to properly use the contraception while presenting information in the least embarrassing and most inexpensive manner will help to ensure program success (18).

c) Defense Three:
Creating an intervention program aimed at reducing teenage pregnancy will remain ineffective if participants are presented with conflicting messages about teenage pregnancy and parenting. Currently, the program’s episodes and website send adolescent viewers with conflicting messages, glamorizing teenage pregnancy in a way that may inevitably persuade some adolescents to intentionally become pregnant as a means to filling an emotional void and gaining attention.
By restructuring the episodes and website to minimize contradictory information, the show will allow adolescent viewers to focus on the underlying message regarding the financial, emotional, and social struggles associated with teenage pregnancy. In addition, it is imperative to make viewers understand that both the female and male are involved and responsible for protecting against unintended pregnancy: presenting the female as the victim while the male as the villain often place full responsibility for pregnancy prevention on the male, dissuading adolescent girls from advocating for themselves and their needs. It is imperative that female adolescent viewers take responsibility for safe sex practices to prevent unintentional pregnancy. Although it is important for the show to portray the reality of the relationships of teenage parents (the majority of teenage parents do not remain together and often times the female is left with the vast majority of responsibility) as a means to ensuring that female adolescents do not assume that the male involved in the pregnancy will remain committed to the female or the baby, methods need to be employed to empower female viewers to make safe sex decisions and prevent them from receiving contradicting and perhaps damaging messages about babies and life post-pregnancy.
It is necessary for the program to positively incorporate the Social Expectation Theory and Diffusion of Innovations Theory as a means to altering the social norms presented to adolescent viewers to prevent teenage pregnancy. Using these two theories, the program could alter the perceived social norms of the target adolescent population, sending a message that not only is teenage pregnancy undesirable, but the adolescent and larger population norm is to engage in methods to prevent pregnancy such as contraceptive use or abstaining from sexual intercourse. This can be done by presenting statistics and information about the number of adolescents who are not engaging in sexual activity: roughly 54 percent of high school seniors have not engaged in sexual intercourse (12). In addition, by including adolescents on each episode that self-identify as abstaining from sex or consistently using a long-acting contraceptive method, adolescent viewers are more likely to perceive these behaviors as the social norms. By making these individuals into teenage ‘celebrities’, adolescents are more likely to desire to replicate these actions and safe-sex behaviors (6). Use of these safe-sex teenage celebrities will further prevent contradicting messages for adolescent viewers. Use of these techniques through media such as the program episodes and website will ensure a positive impact and subsequent drop in teenage pregnancy rates (6, 17).
6) Conclusion:
The current contents of the MTV program “16 and Pregnant” aimed at reducing rates of unintended teenage pregnancy fail to address and combat its targeted issue due to three main reasons: (1) the program ineffectively educates adolescents about teenage pregnancy prevention during the television episodes, relying predominantly on the program’s website for educational references (2) the program’s scare tactics fail to educate teens about pregnancy prevention methods and contraception and, (3) the program sends contradictory messages about teenage pregnancy to viewers, glamorizing aspects of the program’s teenage mothers.
It is imperative that measures be taken to alter and improve the efficacy of the current intervention in order to effectively target and reduce teenage pregnancy. By integrating a heavier educational component into the program’s episodes, including more information regarding pregnancy prevention and contraception, and by minimizing the potential for viewers to obtain conflicting images about teenage pregnancy, the program will significantly improve its ability to combat one of public health’s greatest issues: unintended teenage pregnancy.










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Netherlands: Communication and Information Technology. http://www.cw.utwente.nl/theorieenoverzicht/Theory%20clusters/Communication%20and%20Information%20Technology/Diffusion_of_Innovations_Theory.doc/
18. Witte, K. Preventing teen pregnancy through persuasive communications:
realities, myths, and the hard-fact truth. Journal of Community Health 1997, 22(2): 137-155.

Is There Any Buzz to the “Buzzed Driving is Drunk Driving Campaign”? – Matthew Reeder

Introduction

Since its inception in 1980, Mothers Against Drunk Driving (MADD) has campaigned to bring greater awareness of the all too often fatal consequences of driving under the influence to the U.S. public. Unfortunately, drunk driving still remains a serious public health problem 30 years later. According to the 2008 summary statistics from MADD every 45 minutes someone is killed by a drunk driver (1). In addition, the Centers for Disease Control and Prevention (CDC) reports that an estimated 700 or more individuals are injured each day in alcohol-related crashes (2). Though down from recent years, the total estimate for people killed due to a drunk-driving related incident still reached nearly 12,000 in 2008. (1).
Statewide and community-based interventions have been implemented to combat the unfortunate results of this reckless behavior (3). National drunk-driving campaigns, such as the “Over the Limit. Under Arrest.” and “Friends Don’t Let Friends Drive Drunk” campaigns have flooded household televisions across the country in an attempt to bring about change (4). An additional intervention was added to the mix by the Ad Council and the National Highway Traffic Safety Administration (NHTSA) entitled “Buzzed Driving is Drunk Driving” aimed towards those who feel that it is okay to drive home if they are only a little “buzzed”. It is a compliment to the “Friends Don’t Let Friends Drive Drunk” media campaign but instead of focusing on the influences of friends and family the intervention concentrates on personal responsibility (4).
This review focuses on the “Buzzed Driving is Drunk Driving” campaign with the intention of critiquing its potential effectiveness in successfully creating behavior change among its main audience and also to provide some possible alternative approaches to addressing the problem with this particular campaign.
A Clip from the Campaign
The commercial is set in the back of an ambulance. For a moment you feel as if you are watching a Thursday night medical drama on television. Two paramedics work intensely on a body marked with cuts and bruises lying on a stretcher. On the other side of the stretcher sits a man, clearly upset by the recent events that have just taken place. The distraught man places his head in his hands and says, “This can’t be happening, we were just buzzed.” The paramedics at this point stop doing CPR, look at him, and say, “Just buzzed? You didn’t tell us that sir. You’re right, this isn’t happening, he’ll be fine.” Then, like a scene from a sitcom, the body of the man’s friend sits up on the stretcher and rather nonchalantly remarks, “yeah, I feel good.” Astonished, the man looks up and replies, “Really?” The paramedic replies, “No, not really” and the body on the stretcher lies back down and resuscitation begins once again. The scene ends with the words “Buzzed driving. Maybe we should stop acting like it’s no big deal” (5).
Critique 1: A Comedy of Errors
The first issue with this particular campaign video is the comical approach taken with an otherwise serious and humorless public health problem. After viewing the video the main content that sticks in the viewers mind is the rather comical part where the injured individual sits up and starts talking. This surely is not the overall message that the authors wished to convey with this commercial. In fact, commercials of this nature have received mixed results regarding their effectiveness in delivering their intended message. A study examining the effectiveness of health promotion television advertisements targeted toward 55 to 70 year-olds in Canada found that when humor was used in the commercial some individuals found it rather quite amusing and attention-grabbing, but the majority of viewers responded negatively, commenting that the use of comedy shifted the focus and took away from the overall message (6).
Indeed, using comedy as a means to deliver a message related to alcohol-use and driving unintentionally shifted the focus of this campaign advertisement. In essence, the creators of this campaign are trying to sell their message utilizing advertising and marketing theory techniques. At the core of every successful advertising campaign is a promise built around core values and beliefs (7). The promise that many who view this commercial may come away with is that drinking and driving is not that serious of a problem. The abrupt change in the mood of the commercial ineffectively portrays the consequences of drinking and driving as comical. This is likely to have a lasting effect on the consumer of this message. Ultimately, the commercial should convey the message that injury is a serious consequence of driving drunk, and death is an even more serious one. In this particular advertisement, though, it appears that the use of humor detracts from the main message and, therefore, may be less likely to alter drinking and driving behaviors. If the commercial itself is not taking drunk-driving serious, how do they expect viewers to take it serious when placed in a similar situation?
Critique 2: Belief in Rational Behavior
The second potential issue with the “Buzzed” media campaign is the underlying assumption that individuals make rational decisions and are able to do so at any time. The Health Belief Model is one of many traditional social science theory models that do not take into account the irrational behavior and decision making of individuals. At the core of the model is the belief that individuals assess the costs and benefits of adopting a particular health behavior along with their perceived susceptibility to a particular health problem (8). The “Buzzed” campaign is asserting that individuals who are under the influence are able to coherently and systematically weigh the costs and benefits of drinking and driving, thus making a rational decision to either drive drunk or not drive drunk. Indeed, there may be no better definition of irrational or unplanned behavior than being under the influence of a drug or substance.
In fact, there are additional variables that go into an individual’s decision-making process. A study performed by Gulliver and Begg (9) found that an individual’s personality influences their decision of whether or not to be involved in risky driving behavior. The authors found that individuals, particularly young adult males, who harbor aggressive behaviors or feelings of alienation, are more prone to dangerous driving behaviors. Therefore, there may be multiple factors interacting concomitantly to influence behavior. Interventions that do not take these factors into account are likely to be less successful than those that do.
Critique 3: Lack of a Defined Promise and Core Values
As described previously, it is difficult to establish exactly what the authors of the “Buzzed” campaign wish to emphasize in their commercial. One may come away with the notion that driving under the influence, even if a little “buzzed”, can result in serious consequences. On the contrary, another individual may come away thinking that it can’t possibly be that serious given the humorous delivery of the message. Still, others that see the commercial may rebel completely against the commercial’s message because they may feel as if it is suggesting that they not drink at all. The lack of clarity of the “promise” of the ad and supporting core values may be a potential issue for this particular campaign message.
Convincing people to change their attitudes and feelings about certain risky behaviors is a daunting task. In fact, those who participate in risky behaviors such as drunk driving oft times know that they are putting themselves or others in harm’s way, but may feel that accidents or injuries related to such behavior only happens to other people who do not have control over their own situation. Such an optimistic bias has been seen in studies regarding smokers and their perceived risk of death or disease from smoking habits. In a study of 200 adolescent smokers, the majority of smokers recognized that smoking was an addictive behavior and could result in early morbidity and mortality; however, with regards to their own personal risk of disease or death, smokers were more likely than nonsmokers to doubt that it would ever happen to them (10). With the additional challenge of convincing individuals that they too are at risk, a campaign without a clear and concise message is surely to be less effective and reach fewer people.
Proposed Intervention
The “Buzzed Driving is Drunk Driving” media campaign has several strengths. First is the fact that the campaign is an extension of the “Friends Don’t Let Friends Drive Drunk” campaign, aimed primarily at an individual’s social network. Understandably, the authors also wished to target the individual’s behavior and attitude as well concerning drunk-driving. Running these two campaigns together may have a greater ability of influencing behavior-change than running any one alone. Second, the campaign does not rely on citing multiple public health facts and statistics about the detrimental effects of drunk driving in its campaign advertisement, but rather tries to convey its message through a form of storytelling and depiction of possible real life events. Doing so is far more interesting and attention-grabbing than the citation of statistical facts alone, no matter how alarming those statistics may be.
By adding a few components to the program and simply by looking at it from a different point of view, the creators of the “Buzzed” media campaign could improve the quality and effectiveness of its message. Fear appeal has been used in a variety of public health campaigns to help promote behavior-change in individuals (11). Incorporating more fear-based characteristics into the campaign message rather than comedy may have a greater impact on the audience.
Additionally, by understanding why individuals choose to drink and drive, the authors of this campaign could establish a more effective message tailored to a particular audience of individuals. Utilizing research, focus groups, and questionnaires could help the creators of the program identify their target populations. Finally, through the use of core values and a public health promise, the authors of the “Buzzed” campaign could improve the effectiveness of their message by attacking the specific needs and wants of its audience.
Defense 1: Serious Times Call for Serious Measures
Though comedy is refreshing at times and can help grab the attention of viewers, there is a time and a place for everything, and comedy in an anti-drunk driving campaign may not be the place for it. Rather, a more serious approach could be taken, such as eliciting fear. There has been some controversy in the past as to the actual effectiveness of campaigns that use fear to promote or change behavior (12). A meta-analysis of fear appeals found that the use of fear can actually help to motivate attitude, intention, and changes in behavior, especially when this approach is combined with messages of “high-efficacy” (11).
Removing comedy from the campaign and instilling more fear into the campaign message would help to create a more serious atmosphere for the problem of drinking and driving. An example of a similar public health campaign that effectively uses the fear approach in their program is the “Idaho Meth Project” (13). The “Idaho Meth Project” advertisements delineate methamphetamine use as something that takes away freedom, happiness, and ultimately destroys lives. The graphic nature of their campaign creates an image that is long-lasting and the apparent decrease in methamphetamine use in the state of Idaho is evidence of its effectiveness (13).
There is a fine line, though, of how much fear appeal to use in a public health intervention. It has been suggested that if not properly executed, fear appeal campaigns can backfire, resulting in feelings of defensiveness and rebellion by the intended population (11-12). However, if effectively utilized, they may be successful in persuading individuals participating in a certain behavior to alter or abandon it (12). Utilizing fear appeal in the “Buzzed Driving is Drunk Driving” campaign may be necessary to get the message across.
Defense 2: The Ecological Approach
In a study examining the social and behavioral theories and models used to address unintentional injury problems, the Theory of Reasoned Action, the Theory of Planned Behavior and the Health Belief Model were all among the most often utilized theories (14). All of these models are individual-level models that assume rational decision making and fail to account for additional variables that may have an impact on behavior.
One particular social and behavioral model that takes the interaction of multiple factors into account is the ecological model. The ecological model states that an individual’s overall health and well-being is affected by their biological makeup, behavior, and the various environments in which they live (8,15). This theory-based approach has been utilized in the development of interventions addressing other behavioral-based problems, such as overweight and obesity in children and adolescent smoking (16-17). Though it may be quite difficult to create an anti-drinking and driving campaign advertisement that encompasses all of these variables within the span of 30 seconds, it may be efficacious to consider an ecological-type model when designing and executing the overall message of the campaign.
In an effort to account for multiple factors affecting irrational behavior, the “Buzzed” media campaign could take an in-depth look at the possible reasons to why individuals choose to drink and drive perhaps through the use of focus groups and questionnaires in varying parts of the country with a multiple range of age groups. Additionally, prior research has been conducted with the aim of identifying the social mechanisms behind adolescent drinking and driving (18-19). By utilizing the research findings of others in addition to the administration of focus groups and questionnaires, the campaign could target its advertisements to a variety of populations, personalities, and behavior-types more effectively.
Defense 3: Addressing the Core Values
An ideal template for an advertisement for a public health program is to first figure out what the audience wants to hear based on their needs, desires, and values, and then tailor it in such a way that they feel as if those needs, desires, and values will be met if they decide to participate or not participate in a particular behavior (7). In fact, when examining television advertisements today, many may seem completely irrelevant to the product that is being advertised. The creators of such commercials are focusing in on what the consumer’s wants, needs, and values are and have figured out what these particular things are from extensive research (7).
The very same advertising methods could be used in the “Buzzed” campaign. Viewers may not want to be told consistently that it is bad to drink and drive. In fact, most viewers probably already know that. Finding out what viewers want to hear and supporting that message with core values that the viewers can relate to may help the message come through loud and clear. For example, anti-smoking campaigns recently have been successful in their efforts to reduce smoking among youth by creating a message that is relevant to them and focuses on core values that every young person can identify with, freedom and independence (20). Similarly, the “Buzzed” campaign could focus on a particular demographic and support their message with the core values that that particular audience identifies with, whether it is freedom, independence, love, family, responsibility, or a combination of all of them.
Conclusion
The “Buzzed Driving is Drunk Driving” media campaign administered by the Ad Council and the NHTSA is a genuine message to help control and put a stop to the devastating effects of drunk-driving. Though there are many aspects of the campaign message that are effective, a few areas for potential improvement have been identified. Of these is the non-serious nature of the commercials in which a more serious approach may be more effective in communicating positive behavior-change.
Utilizing fear appeal in the campaign message may help to effectively convey to the audience the seriousness and scope of the problem. The next identified area for improvement is the campaign’s underlying assumption that individuals are able to make rational decisions at all times, even when under the influence. Utilizing an ecological-based model rather than the commonly used individual-based social and behavioral science models may help to identify the biological, social, and environmental factors that influence the decision-making process in those who choose to drive under the influence.
Finally, developing a campaign message that is clear and supported with core values, such as freedom, love, independence, and family, to name a few, may help to influence viewers to change their behavior while at the same time fulfilling their wants and needs as individuals.

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