Improving Living Conditions in the House of Beauty: Nail Technician Participation in Policy Change - Tiffany Skogstrom

DISCLAIMER: This is my personal opinion. The opinions expressed here represent my own and not that of my employer or any of the mentioned organizations.

The current regulations enforced by the Massachusetts Board of Registration of Cosmetologist’s (BORC) fails to protect public health from the emerging issues of infections, sanitation and safety in nail salons. Regulations must be reformed to involve and meet the needs of the stakeholders who can make real change – nail salon workers. The current method of regulation is designed to prevent stakeholder participation, marginalizes the largely immigrant workforce and lacks necessary reassessment to proactively deal with newly materializing public health issues.

Awareness of safety and sanitation problems in nail salons stems from a series of nail salon complaints regarding sanitation and infection reported to the Boston Public Health Commission (BPHC) in 2009. The heightened number of calls may be a consequence of raised awareness generated by the Safe Nail Salon Project – a program working with nail salons on environmental health and chemical safety issues (1). Attention to this public health problem culminated when on December 31, 2009 BPHC closed down a nail salon after a consumer was hospitalized and treated for a Methicillin-resistant Staphylococcus aureus (MRSA) infection believed to have been contracted via a manicure with unclean tools. Research reveals that outbreaks of a variety of foot-spa related skin infections have occurred in Georgia (2, 3), California (4), Ohio (5) and Kentucky (5). Many nail salon infections are likely to go unreported. Although the Safe Nail Salon Project educates nail technicians on protecting themselves from chemical exposure while at work, staff was blindsided by the emerging concern about sanitation and infection.

The Massachusetts BORC is the sole regulating agency with which the nail technicians have interaction. The agency guides hygiene, sanitation and general salon standard operating procedures and its stated mission is to protect “the health and safety of the public by maintaining high standards for the industry.”(6) The BORC’s expectation that nail technicians will follow Massachusetts regulations is built upon the Health Belief Model (7). For example, once a nail technician has passed her examination for licensure, she is aware of the Massachusetts regulations. A licensed nail technician knows that not following those regulations would make her ‘susceptible’ to disciplinary action and that the ‘severity’ of penalty could result in a loss of license or closure of her salon. Once she has become a legally trained nail technician, there are no ‘barriers’ to her following the regulations. The ‘benefits’ of following the regulations are employment and a safe work environment. All of the above circumstances are ‘cues’ that should bestow in her the ‘intention’ to abide by the law and then ‘act’ on that intention. When a nail salon worker does break the law, she is faced with penalties and left on her own to remedy the situation.

A more holistic and inclusive approach would be the better method for bringing nail salons into compliance. The problem with applying the Health Behavior Model to this program is that “there is no attempt to facilitate empowerment of those involved in the (research) process, nor is there opportunity for reflection.”(8) To put this into context, it is important to note that nail technicians in Boston and beyond consist of a young, female and mostly immigrant workforce. Working long hours for low wages and being exposed to an array of toxic chemicals, nail salon workers are so marginalized that Time Magazine identified their job as being one of the worst in America (9). The BORC online licensing database shows that more than a third of working Vietnamese immigrants in the Boston area work in nail salons (10). Furthermore, according to an article titled Results from a Community-based Occupational Health Survey of Vietnamese-American Nail Salon Workers by Roelofs and Azaroff, “Nail salons are the core of the Vietnamese immigrant and refugee community’s economic support. Low entry requirements, limited need for English language skills, ethnic business networks, and flexible work schedules draw many Vietnamese women and some men to the work.”(11) The BORC, on the other hand, does not have any Vietnamese representation (12).

While it is not surprising that the BORC would fail to mirror the demographics of the people working within the salons, several of its outdated policies impede participation and some are even detrimental to worker and public health. It would be to the benefit of the BORC and public health to have nail technicians participate in the revision of regulations, and to identify how to remove barriers to compliance.

The theory of frame alignment states that pitfalls in organizational participation include: failure to correctly interpret the communal grievance; treating constituent participation as a static means to an end; and over-generalization of participation-related processes (13). This paper will demonstrate these shortcomings as a road blocks for stakeholder involvement in the BORC and reinforce the idea that nail technicians need to be linked and mobilized within an alternative organization that is external from, and can put pressure on, a government agency.

The Three Frame Alignment Participation Pitfalls:

The BORC and Interpretation of Grievances (13)

The grievance most often heard from nail salon workers relates back to language barriers and takes the form of economical and job security concerns. The main complaint is that while in other states, such as California, “the nail salon industry draws so many Vietnamese workers that Vietnamese is one of the primary foreign-language option for the license examinations” (14), the Massachusetts BORC requires all examinations for licensure to be taken in English and refuses to allow translation. The BORC website declares that “EFFECTIVE OCTOBER 1, 1998, all examinations for licensure by the Board of Registration in Cosmetology will be administered in English only. Interpreters, dictionaries and other translation aids will not be permitted at any of the examination sites as of October 1, 1998. The decision of the Board to discontinue the use of interpreters and foreign language examinations is based on public health and safety concerns relating to the proper use of chemicals in the cosmetology profession and examination security issues in general.” (15)

The BORC ‘English-only’ policy for nail technician license exams forces people to work unlicensed and untrained in sanitation or any other trade skills. As a result, competing nail salons use cheap and unlicensed labor and undersell the businesses who are in compliance and abiding by the letter of the law. This also fosters potential for an underground economy for the buying and selling of nail technician licenses resulting in various forms of indentured servitude, and in extreme cases, human trafficking (16, 17, 18).

As outlined in Social Conditions as Fundamental Causes of Disease by Link and Phelan, “health policymakers should consider whether a proposed intervention will have an impact on just one disease or whether, because of its influence on a fundamental cause, it will affect many diseases.” (19) Failure to address the language grievance not only prevents the Vietnamese nail technicians from participating in mainstream government and society but also perpetuates the cycle of poverty, unsafe working conditions, unsanitary salons and general exploitation that has become ‘business as usual’ in nail salons.

The BORC and Dynamic Participation (13)

Nail technicians interactions with the BOC are a one-way relationship. Once nail technicians have passed their examination for licensure, the only expected interaction is through license renewals or a chance salon inspection. In 2003, there were 3 BORC inspectors and 1,206 salons in the state of Massachusetts (20). The BORC websites shows that a during a 2009 strike of 163 Boston beauty salon inspections, “56 were cited for violations ranging from unsanitary conditions to employment of unlicensed individuals and unlicensed shops.” (21) That one out of three of the businesses that were inspected had serious violations provides a telling snapshot of salon conditions. Salon employees tell tale of being issued citations without a clear understanding or direction on how to resolve the offenses. To draw an analogy from Siegel’s The Importance of Formative Research in Public Health Campaigns: An Example from The Area of HIV Prevention Among Gay Men, “public health efforts to change” a marginalized group’s “behavior must include efforts to change the way society treats” that group (22).

The BORC and Participation-Related Processes (13)

The BORC has put up many barriers for nail technician’s participation. For this reason, in June of 2009, a group known as the Massachusetts Healthy Cosmetology Committee met with the BORC with the goal of ‘nudging’ the agency to reconsider and revise some of cosmetology regulations for the sake of public health (23). This committee sought, among other things, to address:

·Allowing testing, training and hearings in languages other than English.

· The current requirement that nail technician licenses (as well as individual ‘health certificates') (24), which include home addresses, be prominently displayed in salons. The committee recommended that licensees’ home addresses not appear on licenses due to a story of a licensee being followed home and mugged for her tips.

· Clear and effective instructions for sanitation of nail salon tools (25).

· Eliminating the requirement for Steri-Dry (26) (dry sanitizer) and prohibit the use of any formaldehyde-based chemical in salons including Steri-Dry and formalin. Formaldehyde is a carcinogen, asthmagen, and strong irritant (27) and is unnecessary to assure salon hygiene and sanitation.

With the exception of the language request, the BORC was in agreement with the above mentioned items. However, rather than go through the process of rewriting and revising legislation, the BORC informed the committee that it was applying a ‘non-enforcement’ policy on those issues. The problem lies in the fact that if the laws are not formally changed, the nail technicians are unaware of which BORC rules are enforceable and which ones are not. In order to comply with regulations, nail technicians will continue to implement practices that put themselves and the public in harm’s way.

The BORC reluctance to make adjustments to outdated regulations demonstrates “collective conservatism” or ‘the tendency of groups to stick to established patterns even as new needs arise.” (23) The groups’ resistance to consider any outside suggestions, especially those with which they are in agreement, shows that the only way to participate in the BORC is if you are an appointed member of the Board or on the receiving end of a disciplinary action. Working conditions, sanitation, and environment cannot improve or get resolved with the current lack of opportunities to reevaluate situations. Even though the BORC agreed with most of the recommendations for improvements, the entity refused to be nudged. As stated in Klandermans’ Potentials, Networks, Motivations, and Barriers, “willingness is a necessary but insufficient condition of participation.” (28) The method of participation is ‘one-size-fits-all’, meaning that impermeability ensures that no one outside of the BORC gets to participate.

Analysis of the Three Participation Pitfalls and the BORC

The issues presented in the three pitfalls to participation reveal the BORC as an entity that works counter to its mission statement to “protect the health and safety of the public by maintaining high standards for the industry.” (6) The rigidity of the organization in terms of adapting to the training needs of the Vietnamese workforce results in consumers contracting infections. In any language, the BORC regulations continue to be outdated and unclear, and fail to address emerging infections or salon conditions.

Furthermore, during these turbulent economic times, low wage service workers are even more desperate for income and happy to do the work as unlicensed and exploited nail technicians. Unlicensed workers not only hurt the local economy by underselling their law abiding competitors, but create the perfect circumstances for indentured servitude where licenses can be bought and are worked off for exorbitant prices. The English-only examination policy further alienates an already marginalized community of people and makes young immigrant women even more vulnerable to exploitation through cheap labor and human trafficking.

Clearly there is no method to work within the BORC to make the necessary public health and worker safety changes. For this reason, Vietnamese nail technicians must link with an organization that shares their values, ideologies and beliefs in order to externally pressure the regulating agency to make important policy changes. Furthermore, the process of reviewing the pitfalls is valuable to make improvements because “efforts to reduce risk by changing behavior may be hopelessly ineffective if there is no clear understanding of the process that leads to exposure”.(19) Proactive public policy and interventions can be created by reflecting on the shortcomings of existing regulations.

The Intervention:

Frame alignment is a theory of collective action where un-mobilized individuals and an organization are linked together based upon shared ideology and a need to act (13). Social movements are comprised of people working together as ‘framing agents’ to define the world within which they live (29). According to Snow and Benford, the ongoing and necessary processes of a successful social movement are frame bridging, frame amplification, frame extension and frame transformation.

The four processes of frame alignment act as an organizational prophylactic against participation shortcomings and are necessary, flexible and fluid parts that aim to ensure momentum. Frame bridging (13) is the process of linking two or more ideologically congruent ‘frames’ (individuals and an organization) and building momentum through recruitment, leadership development and activities that are consistent with the shared ideology. Frame amplification (13) consists of value and belief amplification. Value amplification is the process where the group decides upon goals and mobilizes on them. Belief amplification is faith that the value amplification actions will have the desired impact. Frame extension (13) is the organization’s flexibility in what it can offer and incorporate to meet the needs of its constituents. Frame transformation (13) is the process of redefining or nurturing new values to find commonalities between the individual and organization that may not be immediately obvious. Frame transformation can be ‘domain specific’ where actions result in a change in status for a group of people, or ‘global interpretive’ which is a philosophical process of being “the change you want to see in this world.” (30) When linked together, the four frame alignment processes inoculate against the three pitfalls of participation and can create meaningful change.

1. Frame Alignment and the Interpretation of Grievances:

The first step of the process, known as frame bridging, involves identifying the organization best capable of properly interpreting the Vietnamese nail technician’s grievances and with which they would be best aligned. The Vietnamese – American Initiative for Development (Viet-AID) is a prominent organization within the Vietnamese community. Viet-AID’s mission to “provide comprehensive economic development programs and services to alleviate poverty and advance civic participation” (31) is complementary to the values and reflects the grievances of the nail technicians’ struggle for decent employment. Viet-AID has good relationships with the Vietnamese business leaders and plays a major role in the Safe Nail Salon Project and the Massachusetts Healthy Cosmetology Committee. This sets the stage for aligning the un-mobilized nail technicians with Viet-AID in a pact to force policy change.

Nail technicians working with Viet-AID for changes in the salons would vicariously be partnering with the BPHC Safe Nail Salons Project. BPHC is a governmental agency, and a population such as the Vietnamese community, who fled their country of origin to escape an oppressive government, may be gun-shy at the prospect of such a partnership (22). Through frame transformation, ‘regulatory’ values and activities would have to be made appealing to participants. Activity examples include creating model regulations that would be adopted by various municipalities across Massachusetts that would: require annual nail salon registration with the health department; make Safe Nail Salon training a condition of the annual registration; and create specific local requirements for sanitation.

To appeal to nail technicians, these regulatory methods must be framed to address nail technician’s grievances of an unsafe work environment, inequity amongst business’ underselling practices and low wages. The unlikely partnership between a government agency and the Vietnamese workers is made more attractive by revealing how BPHC’s public services might be beneficial. The BPHC Safe Nail Salon Project has a rich history of frame extension through helping people access health care and providing valuable public health services. Therefore, the closer relationship with a local government agency would be a partnership to bring nail technicians into the mainstream, rather than an additional regulatory burden.

While BPHC focuses on local regulations, Viet-AID may be the more appropriate vehicle to turn nail salon worker’s grievances into an active campaign to put external pressure on the BORC. These simultaneous efforts could lead to effective public health change.

2. Frame Alignment and Dynamic Participation

Frame bridging is needed to mobilize leaders and interpret grievances into movement activities. Viet-AID’s frequent visits to the salons helps recruit leaders who participate in activities, get the community talking about the problem and encourage others to take part. As stated by Klandermans, “informal recruitment networks are necessary conditions for the arousal of motivation to participation.” (28) This paves the way for frame value and belief amplification, where nail technicians “employ an ‘injustice framework’ that links personal and vicarious experiences of stigma and discrimination” (32) to Viet-AID’s mission of social and economic development.

Frame value and belief amplification involve articulating grievances in terms of ‘injustice’ and forming them into solution oriented actions. The conditions of belief amplification (13) are that people will mobilize when (a) they believe there is a serious problem; (b) there is an antagonist (the BORC) that is defined as the source of the problem and (c) with whom the constituents have stereotypical beliefs about power; (d) people believe that the identified actions will lead to change; and (e) there is importance in standing up together to overcome the injustice.

The frame transformation is domain specific, where actions result in the change in status of how a group of people are treated by the BORC. Potential actions, depending upon the will of the constituents, could include letters to the editor or public demonstrations demanding that the governor command the BORC to provide examination translation, or Vietnamese representation on the BORC. The dynamic participation feeds the recruitment aspect of frame bridging where “people show more of a tendency to participate in collective action if they expect that others will do so as well.” (28)

3. Frame Alignment and Participation-Related Processes

The theory of frame alignment requires that participants are active in all processes. Participation-related processes consist of recruitment and leadership development of frame bridging, identifying goals and strategic activities during frame amplification, recognizing innovative ways to meet the ongoing needs of the community through frame extension, and nurturing new values that serve the benefit of the community through frame transformation.

Where Vietnamese nail technicians have been alienated by the BORC, the frame alignment process of this proposed campaign welcomes participation in the ‘linked’ organization at all levels. If the frame alignment recipe is followed correctly, the result will be a functioning organization that serves the needs of its constituents. The processes could be the blueprint for a Nail Salon Business Leadership Council that might be housed within Viet-AID. The new leadership group would autonomously decide the best course of actions in the interest of nail technicians. It would drive its agenda through participation in other economic and social justice initiatives, and ideally, the BORC itself.

Ongoing success is only guaranteed if all of the frame alignment processes are participant driven. Furthermore, it is necessary to reevaluate and adapt all processes to meet emerging needs and realities in order to retain and accumulate constituents. An ideology that becomes set in stone will lose members and momentum (29), and becomes susceptible to mirroring the rigidity of the entity that it seeks to influence.

Conclusion:

In absence of the nail technician’s ability to participate in the BORC, the most sensible intervention involves collective action to improve public health policy. The most fundamental change would be to allow nail technicians to test for licensure in their own language. This single policy change will have astounding results such as giving people access to safe and well paying jobs and safer nail salons. While municipalities can put out fires by implementing city regulations, real change must happen within the BORC to tackle the root of these problems.

The frame alignment process has potential to bring a historically marginalized group of people into the mainstream. The multi-level methods address health inequities through strengthening individuals and communities, improving people’s access to services, and fostering economic and cultural change (33). This proposal builds meaningful, innovative and sustainable partnerships and a model that could be emulated in other parts of the country, further building momentum for social change.

References:

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“Scared Straight” To Juvenile Delinquency – Mary Kowal

Introduction
According to the Merriam-Webster Dictionary juvenile delinquency is “a violation of the law committed by a juvenile and not punishable by death or life imprisonment” (1). This definition encompasses a variety of actions and behaviors that are violations of the law and also ultimately affect health. Scared Straight Programs, jail tours, and similar programs bring attempt to scare “at-risk or delinquent children from a life of crime” (2). These programs that focus on deterrence and shock tactics are inherently flawed and are ineffective. A more reasonable and effective approach is implementing a program that addresses the motives and psychology of adolescent delinquents.
How is juvenile delinquency related to health? Violations of the law for youth include alcohol and drug use, use of firearms, and violence. These are actions and behaviors that can have a significant impact on health. From 1998-2008, 12% of violent crimes were committed by juveniles (3). Additionally, in 2008 21% of liquor law arrests involved juveniles along with 18% of sexual offense arrests, 18% of assault arrests, 15% of forcible rape arrests, 11% of drug abuse arrests, and 10% of arrests for murder involved juveniles (3). These numbers only reflect the numbers of teens being caught and arrested. Drugs, alcohol, and violence are a much wider problem. In the 2007 Youth Behavior Risk Survey, it was found that during the past 30 days 26% of teens binge drank and 29% rode with a drive who had been drinking (4). Additionally, 18% of students surveyed had carried a weapon in the 30 days prior to the survey and 35.5% of students had been in a physical fight in the year before the survey (5). The term “juvenile delinquency” readily correlates with teen health because of things like alcohol, drugs, and violence.
Scared Straight began in the 1970s as a program which inmates serving life terms in a New Jersey prison “scared” at risk youth and delinquents from lives of crime.2 The main objective of this program was deterrence by scare and shock tactics. Teens are brought into prisons through schools or parent initiative and then turned over to the prison guards for a “realistic” experience of prison life. Those in favor of the program (and others like it) believe that if teens experience this realistic view of life in prison they will be deterred from crime (2). However, many have published empirical evidence and data showing that Scared Straight and similar programs are ineffective. A 1982 evaluation found that 41% of Scared Straight attendees in New Jersey committed new offenses and only 11% from the control group (who did not attend the program) committed new offenses. Of eight other randomized trials analyzed, only one program was seen to have a positive result, though statistical insignificant. Overall these trials show that the Scared Straight program can actually increase the odds of juvenile delinquency (2). Despite their inefficentiveness, Scared Straight and other similar deterrence programs are still used in cities across the US today.
Critique 1: Negative Labeling
Labeling theory focuses on the formal and informal “application of stigmatization, deviant ‘labels’ or tags by society on some of its members” (6). This theory is widely used in criminology and sociology. Ronald Akers suggests that designating an individual as deviant or delinquent is not always determined by what s/he has done but rather who they are (6). This is problematic for “at-risk” teens who may come from troubled families or live in rough neighborhoods. While they might not be deviants, they may have a greater chance of being labeled as one simply because of circumstance. The symbolic interactionsim theory holds that those “…stigmatized as deviant are likely to take on a deviant self-identity and become more, rather than less deviant than if they had not been so labeled” (6). If the Scared Straight intervention is given to teens who are “at-risk” but not themselves delinquent, this can have the opposite intended effect. The program is showing them that prison is where they are headed and their life prospects are bleak.
Teens also feel powerless to resist labels applied to them by authority figures – teachers, administrators, and police and prison guards. Unable to fend off these labels, teens often integrate these negative labels into their own self-concept (7). With a negative label forced upon the, delinquency might become a self-fulfilling prophecy for teens that go through Scared Straight and similar programs. Although controversial this idea is very possible given that in randomized studies of both delinquents and non-delinquents, the experimental group that received the intervention did worse in follow-up actions (8). Even in less stressful or consequential settings, negative labels can lead to negative results for the subjects. After responding to a race prime question before taking the GRE verbal section, black participants scored worse than those who were not primed with a race label (9). It is reasonable to argue that a label as strong and as negative as “delinquent” or “deviant” may become self-fulfilling for the teens participating in Scared Straight or similar programs.
The negative labeling of teens in the Scared Straight Programs is one of its worst flaws. It harshly and deliberately labels teens as “delinquent” or “deviant” and expects that this will induce a behavior change. Moreover, authority figures and people in power apply these labels. By mentally and emotionally beating teens down with negative labels and stigmatization they may indeed feel they are doomed for a life of crime and substance abuse. Scared Straight offers no other options for them; it only shows them the negative side of who they assumed to become.
Critique 2: Scared Straight Is Likely to Provoke Negative Reactance
According to Jack Brehm’s psychological reactance theory, “people become motivationally aroused by a threat or elimination of a behavioral freedom” (10). They are then compelled to act in a way that restores that freedom. Reactance can occur in two ways: an individual can attempt to restore freedom by actions, or there can be an increase in the perceived attractiveness of the action or behavior being threatened. Likewise, it is also possible for individuals to attempt to regain a sense of control and freedom by exercising alternate freedoms than those specifically threatened (11). Although a freedom is not specifically being taken away by the Scared Straight programs, teens are told bluntly and harshly not to do certain behaviors. They are told it is not worth the prison time and consequences to do drugs, use alcohol, or commit violent crime. Teens may be motivated to restore their threatened freedom by engaging in illegal and harmful activities.
One factor in reactance is the explicitness of the message (9). This means the degree to which the message is clear about its intent. This factor can provoke reactions both ways, but usually tends to increase persuasion. In the case of Scared Straight, the message is very clear and as well as the intent of the message: delinquency will have serious consequences in your adult life and you should stop now or not even start delinquent behaviors. However, despite the clarity, it is possible in this scenario that even explicitness will not decrease reactance. The Scared Straight message is a firm “no” to alcohol, drugs, and violence. Teenagers may not care that the message is straightforward and unconcealed and instead choose to rebel against this threat to freedom regardless.
The second factor in reactance is dominance. This refers to the amount that the message reveals that the messenger can control the recipient (9). The greater the perceived dominance by the messenger, the greater the level of reactance will be in theory. Again the ideas of power and authority come into play. Scared Straight puts teens in a vulnerable position by showing then a realistic prison experience among prison guards and inmates. In interviews with participants done by James Finckenauer, they reported that the inmates and guards yelled, scared the participants “to death,” and that they were pushed and shoved (8). This shows the subordinate position of the teenagers in the intervention. Because of this decreased role and perhaps feeling of helplessness, teens may be motivated to act in a way that increases their sense of control and also protect their “freedoms.”
The last factor on reactance is the idea of reason. This is the idea that a justification is offered in support of the claim (9). The more reason given, the less reactance is the theory. A the time that Scared Straight began, the only types of prison visiting programs were for college students, and for educational purposes. The Scared Straight program had an entirely different agenda in mind (8). This program was and is about the shock value experience of prison life. As described in Finckenauer’s research, there is no education in the Scared Straight tours. Teenagers are given an experience, not a justification. A program so harsh with no lead up or follow up discussion can leave participants feeling angry or rebellious. Anecdotal evidence shows that many participants did not see how this program applied to them. For these reason, reactance to such tours and programs can be quite high.
Critique 3: Ignoring Motives and Circumstances
The final critique of Scared Straight and similar programs is that they focus on the outcome and not the motives. The programs solely aim to stop juvenile delinquency and scare teens out of illegal actions. However, there is a complex mix of motives and circumstances that lead teens to delinquency. The United Nations 2003 World Youth Report on Juvenile Delinquency notes that many programs to prevent youth crime and illegal activity are poor equipped to address these issues, or do not address them at all (12). Programs like Scared Straight fit into the category perfectly – there is no mention of the reasons behind of delinquency.
Families are a large factor in juvenile delinquency. Youth at risk for becoming delinquent are often raised and living in difficult circumstances. Parent alcoholism, poverty, lack of basic needs, broken families, and abusive home life are just a few of the factors influencing juvenile delinquency (12). Teens learn how to live and interact with society by observing family (13). Family environments can teach teens the wrong messages about interacting in society and what is acceptable behavior. Divorce is one sub factor that can promote an unhealthy family situation and teach dysfunctional behaviors to juveniles because of the lack of stability and concordance. Scared Straight is not a supportive environment in which to learn the “right” behaviors.
Socioeconomic status also plays a role in juvenile delinquency. Some argue that “antisocial behaviors have become entrenched norms within chronically impoverished inner-city environments, so that delinquency and criminality are now endemic facts of life” (13). Teens may feel as though they cannot change their circumstances, particularly if they see their families and neighbors in poor situations. Consumer standards and media pressure push teens to desire a lifestyle that is beyond their means (12). Those who feel that traditional and legal means of making income and advancement will not be successful to them turn to other activities like violent crime and drug dealing. Scared Straight and similar programs do nothing to address the motivations and desires of teens that may be precipitating their illegal and destructive behavior.
Finally, educational experiences factor into juvenile delinquency. Education is influential because it can “shape many youths’ sense of opportunity and self-worth” (13). If teens believe that their educational experience will help them excel, they are less prone to turning to illegal activities to earn money and freedom. However, “academic achievement is considered to be one of the principal stepping-stones toward success in American society” (13). Many teens do not have the opportunity for the same level of education as is required to succeed. Family and socioeconomic factors, as mentioned above, can also contribute to low educational achievement and poor encouragement from educators. Those who drop out of high school and have bad academic performance have higher incidence of delinquency (13).
Just from the examples of family, socioeconomic status, and education it is possible to see how programs such as Scared Straight effectively ignore the root causes of juvenile crime, alcohol use, and drug use.
Proposed Intervention
The proposed intervention does not focus simply on juvenile delinquency, crime and violence, and drug and alcohol use, but is more holistic in its approach to teenage problems and the causes of delinquency. Taking a broad approach to this topic can keep teens health both physically and mentally. The proposal is a based around a series of weekly workshop-style classes throughout junior and senior high school. It is important to begin an intervention early when most teens are not yet delinquent or experimenting with drugs and alcohol. The three overall goals are for teens to increased their decision-making skills and self-control, expand their knowledge of alcohol, drugs, and violence, and to give them concrete skills to use in everyday life.
Classes would be built into the normal weekly schedule for the students in participating schools. While this approach may be effective in a variety of settings, it might be most cost-effective in schools with a large number “at-risk” students. The intervention would be a universal program, meaning that all teens will attend this class regardless of “risk” status. It would be ideal to maintain the same instructor/facilitator as the students moved up in grade levels as this would provide continuity and stability. In addition, the classes would not be a complete top-down learning environment. It should be a non-threatening time for students to hear the instructor, each other, and themselves. At the beginning of the semester the instructor would review the goals of the class (see above) and ask for suggestions for specific workshops and conversation topics. Issues covered in each grade should be appropriate to that level and that stage of development and life.
The goal to increase decision-making skills and self-control can involve lessons, discussion, and practicing. Decisions should range from drugs and alcohol to decisions about life and school work. Some focal points can be narrowing down the real issues, listing one’s priorities, deciding who their decisions will affect, and attempt to project how one will feel at various points in the future from a decision (14). This can empower teens and pre-teens about decisions in their life.
The second goal is to expand knowledge of alcohol, drugs, violence, and crime and also the effects of these. Again these sessions should be a mix of instruction and discussion. Lessons about these topics should come from the instructor, but also the teens themselves. Groups should present on different topics regarding these actions and behaviors and their negative consequences. Facilitated discussions are also appropriate for these topics. This should be a time for confidential and candid discussion among the teens. Discussion topics can include issues related to drug and alcohol use, crime, violence, stereotypes, self-image, methods for quitting substances, and how these issues have touched their lives.
The final goal of this intervention is to give the teens tangible life skills. In addition to decision-making and self-control, there are other important life skills that can impact juvenile delinquency. Workshops can touch on topics to empower teens and give them a sense of control and hope for their future. Issues like study skills, essay writing, finding a part-time job, applying for college and financial aid, and how to cope with stress and peer pressure.
Defense 1: Avoids Negative Labeling and Supports Group Change
The universal approach to this intervention – having all students required to attend these classes – allows for the elimination of negative labeling and supports group change, unlike the Scared Straight programs.
As mentioned previously, there are detrimental effects to negative labeling, namely it can become a self-fulfilling prophecy. The universal approach of this intervention does not allow for negative labeling based on who participates, like the Scared Straight and similar programs. All teens are put in the same boat, receiving the same intervention and support equally. No one is labeled or seen as a delinquent. In fact, teens who go through this intervention can actually be labeled positively – as Resistors, as Successes, as Role Models. The attitude in the class should be one of empowerment and success – that these teens are going places. If other teachers at the school acknowledge this program and its goals, they too can be a part of the positive labeling of their students.
It is also important that the intervention is received among peers. The social network theory is a group-level model that says that behavior is determined by one’s social network. The implications are that the intervention should be delivered at the group level and if you can deliver it to the most connected person, you can influence the most people (9). This effect is shown by the Harvard smoking cessation study that diagrammed participants smoking cessation and their social connections. The diagrams showed how non-smokers and smokers clustered and how the relations change as people quit (15). This same concept can be loosely applied to this intervention. Since all the students in the school get the same intervention, you are likely to hit the key students who have major social connections. If the intervention is positive for them, they can influence a large group. The non-delinquents can potentially have an effect on the delinquents for the better. The idea of the social network theory is that imparting change is easier done on a group-level.
Defense 2: Gives Teens a Sense of Control
The proposed intervention gives teens both real control and a heightened illusion of control in their lives. This is an important counterpoint to the reactance that many juveniles may face when participating in the Scared Straight program.
The program gives the participants real control. They are encouraged to help select workshop topics, and to give presentations. Even facilitated discussion with the instructor posing questions and making suggestions, can make teens fee in control of he situation and avoid reactance (16). They are also given skills that allow them to better manage in life and school such as study habits and writing skills. These factors, combined with decision-making skills, can lead to teens making the decision not to use drugs and alcohol or to commit a crime. They have the knowledge and the tools to control part of their lives.
The factor also falls into line with the Illusion of Control Theory. This theory states that skill-related factors give people an expectancy of success that is “inappropriately higher than the objective probability would warrant” (17). Though theory this sounds negative, it does not have to be. Even if the participants are delinquent or have many risk factors for delinquency, they can be under the illusion of control. Perhaps odds are against them in terms of doing drugs, using alcohol, and committing violent acts. However, this program wants to instill the idea that they can in fact control their lives. Thinking about and practicing decision-making, having group discussions, and improving self-control all can create the illusion that these teens have the ability to control some aspects of their lives. By giving them this illusion of control, even when circumstances and statistics say they will fail, teens can take actual control and make the choice not to do illegal activities.
Defense 3: Addresses the motivations and circumstances
This proposed intervention has better chances of success because it addresses the motivations for juvenile delinquency and the factors that are behind it. The Juvenile Justice Panel’s report on the Interagency Panel on Juvenile Justice highlights successful crime-reduction programs in many countries that focus on the causal factors for juvenile delinquency: unstable home situations, school drop-out rates, skills training, and education (18). This intervention also targets the three critical factors in delinquency that the Scared Straight programs ignore: families, socioeconomic status, and education.
The intervention does not specifically address the role of broken families in juvenile delinquency, but it becomes a support system for the participants. The instructor will in theory stay with the same class of students as they complete the program. Having such a constant presence and mentor in their lives will provide teens with a sense of support and encouragement that they might not be receiving at home, as well as a positive role model. The classroom can also been seen a safe place for learning, expression, and conversation.
The proposed intervention also touches on the idea that socioeconomic status and education play a role in delinquency, as mentioned above. While nothing can change the circumstances in which the teens grew up, this program will allow them to see a successful future for themselves. After completion of the program, teens will have tools, skills, and resources to overcome obstacles they have in their lives. Learning to search for a part time job, to apply for college and financial aid, and to write a good essay gives teens tangible skills they can use to improve their lives. These skills will hopefully give teens another way to achieve their goals instead of delinquency.
Conclusion
When looking at the issue teen health in the United States, one must also look at the issue of juvenile delinquency including alcohol, drugs, and violence. The Scared Straight program and other like it attempt to resolve the issue of juvenile delinquency through deterrence and scare tactics. However, empirical evidence shows these programs are not working and actually increase delinquency. A better approach is a comprehensive intervention that targets all teens, avoids negative labeling, gives teens a sense of control, and addresses the root causes for juvenile delinquency.


References

1. Merriam-Webster. Merriam-Webster's Online Dictionary. . http://www.merriam-webster.com/netdict/juvenile%20delinquency. Updated 2010. Accessed 4/24, 2010.
2. Petrosino A, Turpin-Petrosino C, Buehler J. Scared Straight and Other Juvenile Awareness Programs for Preventing Juvenile Delinquency: A Systematic Review of the Randomized Experimental Evidence. The Annals of the American Academy of Politicial and Social Science. 2003. http://ann.sagepub.com/cgi/content/abstract/589/1/41.
3. Puzzanchera C. Juvenile Arrests 2008. Juvenile Justic Bulletin. 2009. www.ojp.usdoj.jov.ojjdp.
4. Centers for Disease Control and Prevention. Quick Stats: Underage Drinking. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/alcohol/quickstats/underage_drinking.htm. Updated 2008. Accessed 4/24, 2010.
5. Centers for Disease Control and Prevention. 2007 National Youth Risk Behavior Survey Overview. . 2007. http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbs07_us_overview.pdf.
6. Akers RL. Criminological Theories: Introduction, Evaluation, and Application. 3rd ed. Los Angeles: Roxbury Publishing Company; 2000.
7. Ray MC, Downs WR. An Empirical Test of Labeling Theory Using Longitudinal Data. Journal of Research in Crime and Delinquency. 1986. http://jrc.sagepub.com/cgi/content/abstract/23/2/169.
8. Finckenauer JO, Gavin P, W. Scared Straight: The Panacea Phenomenon Revisited. Prospect Heights, Illinois: Waveland Press, Inc; 1999.
9. Siegel M. SB721 Lecture: March 18, 2010. . 2010.
10. Brehm JW. Psychological Reactance: Theory and Application. Advances in Consumer Research. 1989;16. http://www.acrwebsite.org/volumes/display.asp?id=6883&print=1.
11. Dillard JP, Shen L. On the Natre of Reactance and its Role in Persuasive Health Communication. Communication Monographs. 2005;72(2). classweb.gmu.edu/gkreps/820/009.pdf.
12. United Nations. World Youth Report, 203: Juvenile Delinquency. . 2003. www.un.org/esa/socdev/unyin/documents/ch07.pdf.
13. Martin G. Juvenile Delinquency: Theories of Causation. In: Juvenile Justice: Process and Systems. Sage Publications, Inc; 2005. www.sagepub.com/upm-data/4880_Martin_Chapter_3_Juvenile_Delinquency.pdf.
14. Radical Parenting. Ten Ways to Teach Smart Decision-Making. Radical Parenting Web site. http://www.radicalparenting.com/2009/09/10/teaching-teens-to-make-good-decisions/. Updated 2009. Accessed 4/26, 2010.
15. Christakis NA, Fowler JH. The Collective Dynamics of Smoking in a Large Social Network. New England Journal of Medicine. 2008;358(21).
16. Skager RW. Why Youth Ignore Drug Education and Sanctions against Use: Individual Differences, Mismatched Strategies and Youth Friendly Alternatives. . . www.iirp.org/pdf/Bethlehem_2009.../Bethlehem_2009_Skager.pdf.
17. Langer EJ. The illusion of control. In: Kahneman D, Slovic P, Tversky A, eds. Judgement under uncertainty: Heuristics and biases. Cambridge, MA: Cambridge University Press; 1982.
18. Juvenile Justice Panel. Crime Prevention for Children: Developments and Good Practices. 2009. http://www.juvenilejusticepanel.com/resource/items/I/P/IPJJCCPCJSideEventReportApril09FINALVERSION.pdf.

The National Football League and Center for Disease Control and Prevention’s Public Service Announcement on Concussions:Missing the Mark– Jenna Carter

Introduction

According to the Centers for Disease Control and Prevention, an estimated 1.7 million traumatic brain, TBIs, of mild to moderate severity, most of which can be classified as concussions, (i.e., conditions of temporary altered mental status as a result of head trauma), occur in the United States each year. And, an estimated 135,000 sports related TBIs are treated in the emergency, among children five to eighteen years old. (1) Now, imagine if this happened to an athlete during a game or competition and they returned to that contest the same day without proper care? That has been the reality in many sports, but specifically in the National Football League until the end of 2009, when pressure was being placed on NFL commissioner, Roger Gooddell, by the House Judiciary Committee for their lack of action when it comes to head injuries to their players. In fact, during their hearing in October, the NFL’s concussion methods, or lack thereof, were being analogized to those of the tobacco industry’s methods when it came to tobacco causing cancer a few decades ago, by Representative Linda Sanchez (D-California). (2, 3) This hearing was called for following an internal study, announced by the NFL, which showed that NFL players who had suffered from head injuries are more susceptible to higher rates of dementia and cognitive decline than the rest of the population. (3) The NFL had been ultimately accused of ignoring the research linked to long term health problems caused by head injuries suffered by their players, but that is a different argument in itself. The news of this hearing arguably sent waves through the sport of football.

In an effort to combat the problem and finally take head injuries suffered by players seriously, the NFL, with the assistance of their newly formed “mild traumatic brain injury” committee, has come up with some proposed changes in its approach to make the sport safer. One effort was creating a public service announcement put together by both the NFL and the Centers for Disease Control and Prevention, released in December. (4,5,6) (You Tube) The intent was to debut this 30-second PSA during a Thursday night NFL game on the NFL Network and continue airing it during the commercial breaks of specific NFL games until the end of the 2009 season, including the Super Bowl (5).

There are several arguments that can be made as to why this effort will not be successful in its attempt to shed light on the issue of head injuries in sports due to several reasons. It is not persuasive, lacks the facts, and created a message of forceful change.

1.PSA frames message about concussions negatively and takes freedom to choose away

According to the Ad Council, who is a leading creator of PSAs in the United States, the most critical aspect of creating awareness in advertising is to “mobilize” the public and “make lasting positive social change”. (7) In this case, the NFL totally missed the mark. The PSA sounds like it should be an advertisement for a horror film, not a public health announcement. There is a man who speaks in a chilling voice about the problem of concussions and says, “Concussions and head injuries must be taken seriously”. He then states, “If you’re a player, protect yourself and your teammates. If you think you’re hurt, don’t hide it, report it, and take time to recover. If you’re a coach or parent, know concussion symptoms and warning signs and never let an athlete return to play before a health professional says it’s ok. Help take head injuries out of play.” At that point, it is mentioned that the CDC should be contacted for more information. (3) In addition to the terrifying voice, the music being played in the background could be associated with a horror movie soundtrack, such as “Jaws”.

To frame a message so that it has characteristics of persuasion, it is necessary for a message to grab the audience’s attention and it must be easy to understand so there is a sense that the audience would “get it”. The content must also be relevant to the receiver of the message and give them reason to think or talk about it. (8) It can certainly be argued that this message may have grabbed hold of some of its audience, but not enough to keep their attention.

In 1986, the elaboration likelihood model, which was outlined by Richard Petty and John Cacioppo, proposed that there are two routes a message can take to change a person’s attitude or behavior, the central route and the peripheral route. The central route requires careful scrutiny of an argument presented in a message that appeases to people who enjoy thinking through the logic of statements. (8) In other words, the message needs to be presented by a source that is credible and forms a compelling logical argument. The peripheral route focuses on the overall feeling that one would get from the message, rather than thinking critically. For example, the basis of this would be whether or not the character in the message is likeable or having a catchy slogan. (8) Obviously, the CDC is a very credible source and it was smart for the NFL to partner with them in this message. However, there is nothing likeable about how the message is delivered and doesn’t even offer a reasonable argument. In addition, this short announcement doesn’t offer any motivation or reason to support it’s plead. Why should the athlete report that they’re hurt? What is going to happen to them? What are the warning signs that a player needs to be treated by a health care professional? There is no information given that cites the dangers of concussions or any possible long-term effects. The implication of the announcement is clear, that concussions and brain injuries need to be taken seriously, but there is no evidence that gives viewers a reason to buy into the message and therefore, know which symptoms to report. (5)

Another point to add to this argument lies in Psychological Reactance Theory, where a person is not going to change just because they are told to do so. By approaching it in this way, the target audience may feel threatened that are losing their freedom to choose (“you must take concussions and head injuries seriously”) and in turn, try to find a way to restore that freedom. . (9) A large part of the target audience are teenagers and they like to rebel. This is a large reason why many anti-smoking campaigns were not successful, which will be covered later. (10) Also, with the message lacking support to back up the claim that symptoms must be reported and lacking attractiveness to the advertisement, there would be no reason for anyone in the target audience to follow through.

2. Assumes that the athlete, parent, or coach will do the research by putting owness on them rather than giving the facts in a compelling way

Not once during the PSA, did it mention what the symptoms of a concussion or head injury are, nor does it advice potential consequences of not reporting this type of injury. Ultimately, this advertisement imposes the work of doing research on its audience by stating they should go to the CDC for more information. It is clear that the athlete, parent, and coach must know or find out what the symptoms of a head injury are and then take responsibility for reporting it and lastly, taking the necessary precautions. Based on Social Marketing, there is a related principal, which is to take complete responsibility for the customer’s (i.e. athlete, parent, coach) satisfaction with the product and to not take for granted that they will have the ability, knowledge, and skills to put that product to use. In this case, the product would be the dangers of concussion and head injuries. (11) This would have been a tremendous opportunity for the NFL to make clear as to why they are sending the message and it’s importance in order to compel their audience to take action.

It also poses another dangerous problem in that; there may be a lack of communication between the athlete, parent, and a coach. It is very possible that an athlete may believe that his or her parent/guardian will do the research and educate them on the issue or for the parent/guardian to guess the same about the coach’s responsibility. In essence, there is a lack of clear direction that could potentially continue the risk of an athlete going forward. There should be a separate targeted message to all three populations.

Furthermore, here is nothing stated about the health consequences of not reporting a head injury, such as cognitive decline, Chronic Traumatic Encephalopathy (CTE), or Second Impact Syndrome. Research has shown that the most cognitive impairments following a concussion are related to visual motor reaction time and information processing, memory, and attention. (12) CTE is a degenerative brain disease that is caused by head trauma and is neuropathologically related to Alzheimer’s disease. According to research from the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine, this had been a disease only linked to boxers, but more recently, in other athletes. (13) Lastly, Second Impact Syndrome is a condition that occurs from a second and recurring concussion, which causes vascular congestion and increased intracranial pressure, and can be very difficult, if not, impossible to control, and potentially be fatal. This is more likely to occur if there isn’t complete recovery from a previous concussion. (12)

If the NFL justly wants to be the leader on this issue, it should at the very least, disclose the facts, symptoms, precautions and risks of concussions in the actually PSA, rather than asking the players, parents, and coaches to do their own research.

3. Assumes the athlete will report symptoms of a head injury Football is a well known “hitting” sport and it seems the harder the hit, the tougher the play or player, and the more entertaining the sport. Football has a persona that you must be tough to play and because of that stigma and perception, athletes will most likely never divulge that they are hurt. This is the most obvious critique of NFL’s approach to get the message out about the importance of concussions and head injuries. Children who grown up playing sports are always taught to “suck it up and play” so why would this change now? In fact within the NFL itself, nearly one-fifth of the one hundred sixty players surveyed by The Associated Press from November 2-15 replied that they have hidden or played down the effects of a concussion. This survey was done to assess what the players are really revealing in association with the NFL’s new concussion policy that was launched in December stating that a player may return to game play if they don’t have persistent symptoms after passing a neurological exam. (14) While this policy has it’s own challenges (i.e. players not wanting to get sidelined, fear of losing their job/position ranking and not getting paid, etc…), the PSA assumes the same for younger athletes as well.

To persuade athletes, parents, and coaches to change this engrained belief, and genuinely accept the message, there needs to be a connection to the audience or someone they can relate to. There is nothing for the target audience to connect with and in turn, urge individuals to genuinely accept the message and be persuaded to change this learned principal. To do this, the NFL must be keyed into the mindset of their target audience. (8) And attitudes such as Hines Ward from the Pittsburgh Steelers, when his teammate, Ben Roethlisberger had to sit out a game due to his recent concussion, when he said “I could see some players or teammates questioning, like, ‘It’s just a concussion. I’ve played with a concussion before.’ It’s almost like a 50-50 toss-up in the locker room. Should he play? Shouldn’t he play? It’s really hard to say. I’ve been out there dinged up. The following week, got right back out there”. is a great example of that stigma. (15)

The Proposed Intervention

In order to effectively prevent long-term health problems for athletes due to traumatic head injuries, players need to feel that they have the freedom to make decisions that will affect their lives. In the same sense, the parents and coaches need to have the correct information about signs, symptoms, and warning signs of concussions and what proper treatment needs to be given to the injured athlete so they can assist with proving education. As mentioned earlier, it is important that the message be relatable to the target audience, framed in a positive way so that it’s persuasive, and needs to be compelling to captures their attention. While the risks of concussion need to be known, it is important to portray the message of having the freedom to choose whether or not the consequence is worth it to the athlete. This can be done using an effective media campaign.

1.Message needs to be delivered to a more specific target audience to grab their attention in a compelling way

The “truth” campaign, that was launched in the year 2000 developed into one of the most successful and effective anti-smoking campaigns in U.S. history. Ads such as displaying 1,200 body bags laid out on the street, which covered two city blocks, as visual evidence as to how many people tobacco kills everyday was extremely eye catching. And, it was this sort of campaign message that inspired teenagers, the intended target audience, not to smoke. (10) It can be argued that the NFL is moving down the same road as tobacco industry giant Phillip Morris, when they made a failed attempt to release their own set of ads around the same time as the “truth” campaign. They’re slogan, “Think. Don’t Smoke.” was not so successful at changing the behaviors of teens. It portrayed a message of taking away a teenager’s freedom to choose. In fact, according to research published in the American Journal of Public Health in 2002, teens that were exposed to “truth” commercials were sixty six percent less inclined to smoke than those who saw the “Think. Don’t Smoke.” advertisements, which interestingly enough, had the opposite effect on a teen, who were more inclined to smoke by thirty six percent. (16)

To make this media campaign more effective, the target audience would need to be divided into three separate groups; athletes, parents, and coaches. Successful social marketing campaigns, similar to the media campaign used in Oklahoma County to combat one of their greatest public health problems, Syphilis, focused on delivering a specific message to a specific part of the population to change a specific behavior. Another approach using Social Marketing, allows the message and strategy to actually come from the target audience, increasing the effectiveness of the message instead of an expert view, who may have opinions and knowledge about the matter at hand, but are not actually part of the population that is affected. (17)

Formative research needs to be done to find out what makes each of the target audiences tick. This helps those planning a campaign produce messages that ring with the audience it is attempting to change their behavior. (10) One of the reasons why the “truth” campaign was so successful was due to the research done by those spearheading the campaign in order to directly relate to teens. They found that teenagers were looking for the facts and then wanted to be left to make their own decision. What they also learned in the investigation process was that a youth’s reasoning for tobacco use had nothing to do with making rational decisions, but rather everything to do with emotion. (10)

2. Encourage athletes, parents, and coaches to do more research based on evidence shown in the media campaign

Supporting what can happen from too many concussions or not taking proper care when they occur may be very powerful, so much that it would prompt additional research by the specified target audience. For example, a prevailing story is that of former San Francisco 49ers linesman George Visger. He now lives his life and has been for more than 20 years, using hundreds of small yellow notebooks. This is because of dementia, a condition he has acquired as a result of too many concussions, and he is forced to write down everything he does in a given day so he doesn’t forget. By him delivering the message that this is what his life has become and stating that he believes he had hundreds, maybe even thousands, of concussions from Pop Warner football all the way through his professional football career, there is no denying this would be an impactful message. (18) A case like George’s and showing his family and what they are left to cope with, could be targeted toward the parents to show how the potential of suffering from the consequences of repeated head trauma to their loved one.

For coaches, using a former NFL player who has suffered from concussions during his career and had a story about how a coach intervened or in some cases failed in this action, could serve as a strong spokesperson in targeting them, and compel them to be more involved in doing the same. Kurt Warner, the former St. Louis Rams, and most recently Arizona Cardinals quarterback, just retired from the NFL and is known for suffering from sustaining concussions. During a recent interview, he was quoted as saying; “I can tell you I wrestled with it when I was going down to that room to talk to them (before the game), saying, ‘Do I not want to tell them everything so I can play?’ But I had to go, ‘What are you thinking? This is bigger than that.’ The easy thing to do is play. The hard thing is to make that decision where you feel like you could be hurting your team, but you don’t know whether you’re putting yourself at risk or not.” (15) This is an important part of his story because most likely, this kind of thought goes through the mind of a player and it’s important that a coach keep that in mind. It may just be easier for a coach to step in and tell the athlete they are not allowed to return to play until cleared by a health professional.

Specific to children and teens, said Lisa Unsworth, the executive vice president of the Boston-based ad agency who is responsible for a separate state government sponsored anti-drug ad campaign, “Kids think they will live forever. Talking about a disease you may get when you’re 50 or 60 isn’t a compelling motivator.” (18) So, if this is true, then the evidence needs to be seen in a young athlete, someone like John Doe, whose name his parents asked to remain anonymous, was a multi-sport athlete, who suffered from multiple concussions and died at the age of 18. His brain was donated to the Center for the Study of Traumatic Encephalopathy (CSTE) at Boston University, who collects and studies the brain and spinal cord tissue of deceased athletes to gather more information and evidence on the effects of trauma to the human nervous system. John Doe, the youngest brain at the CSTE Brain Bank, was already showing signs of CTE, which was defined earlier. (19) This may motivate children and teens to re-think they’re attitude that they are invisible to this type of hazard.

3. In order to encourage athletes to report symptoms, the culture needs to change

This is where the NFL can set the bar and make the most impact. They can serve as the role model for not just college, high school, and Pop Warner football, but all of sports to achieve a trickling down effect. Fortunately, they are now really taking the issue seriously. In December, Roger Gooddell sent a memo to all NFL teams informing them of a new concussion policy where, if a player has symptoms of amnesia, poor balance and an abnormal neurological examination; they are required to be removed from a game. A player can return to the field with symptoms of dizziness and headache, but only if they are not “persistent”. Formerly, players could return to a game or practice once their symptoms subsided, assuming they actually reported it. (20) Most recently, the NFL formed a new “mild traumatic brain injury” committee and Roger Goodell hired two new chairman for this panel, Dr. H. Hunt Batjer, the chairman of neurological surgery at Northwestern Memorial Hospital in Evanston, Ill., and Dr. Richard G. Ellenbogen, the chief of neurological surgery at Harborview Medical Center in Seattle. Unlike the previous chairmen, who were paid by the NFL, which consequently, was considered a conflict of interest, the NFL, except for costs associated, will not pay these two doctors. (4) Other changes that are being looked at for future policies are banning helmet-to-helmet hits on ball carriers, roster exemptions for a player suffering from a concussion, stricter guidelines for practice that would limit the amount of hits, new helmet design, and a possible removal of the three point stance in the line of scrimmage. (20,21)

Instilling change is not easy and takes time. Being persistent and planning for a long time frame is necessary. If you consider the lessons learned from some of the cardiovascular risk reduction programs, it may take up to ten years for an effective distribution of new policies and ideas to produce social change that is measurable. (11)

Conclusion

While the NFL is taking other measures to make the game of football safer and implementing new policies for when a player is injured, they have a crucial opportunity to be the leader and send a clear and successful message to those athletes in any sport. They seem to be taking a positive step in the right direction and acting as the future role model to combat the traumatic brain injury problem. They just need to do a better job of delivering that message to instill change across the sports world.

References

1. “Traumatic Brain Injury” Centers for Disease Control and Prevention accessed from http://www.cdc.gov/TraumaticBrainInjury/index.html
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14. Associated Press NFL changes return-to-play rules ESPN, (2009) Accessed from http://sports.espn.go.com/espn/news/story?id=4707604
15. Chris Nowinski Written Testimony Before Committee on the Judiciary United States House of Representatives Hearing on “Legal Issues Relating to Football Head Injuries, Part II”, (January 2010) Accessed from http://judiciary.house.gov/hearings/pdf/Parrish100104.pdf
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