Chancellor Promotes Unwholesome Foods & Hinders Children’s Development & Empowerment: NYC Ban of Homemade Goods at School Bake Sales– Annabelle Ho

Introduction

Kellog’s frosted brown sugar cinnamon Pop-Tarts are allowed to be sold at school bake sales while homemade banana bread and Greek spanakopitas are not? In New York City’s Public Schools, this is the case. This past February, New York City’s Department of Education (DOE) revised Regulation A-812, Competitive Foods, “to improve the quality and nutritional value of foods and beverages that are available for children” (1). According to this revision, students may only sell food items at school that are in the DOE’s approved list between the time school begins and 6:00 pm, with one exception for PA/PTA fundraising sales. This exception allows PTAs to hold a fundraiser once a month with non-approved foods during the school day after the last lunch period, as long as the sales occur outside the cafeteria. The DOE’s list of approved foods to sell during the school day currently includes all fresh fruits and vegetables and around forty or so packaged items, including low-fat Cool Ranch Doritos, brown sugar cinnamon Pop-Tarts, and blackberry Nutri-Grain cereal bars (2). These packaged items all meet the DOE’s Food and Snack Guidelines, which, among other specifications, state that the products are each in single serve packages and meet a specific nutritional profile.

According to the Child Nutrition and WIC Reauthorization Act of 2004, an act which is to be renewed this year, school districts that participate in federally funded meal programs are required to develop and institute a wellness policy (3). According to this act, schools’ wellness policies need to incorporate goals for nutrition education and physical activity, and guidelines that promote student health and reduce childhood obesity (4). The DOE’s regulations regarding Competitive Foods will become a part of the DOE’s 2010 Wellness Policy, which is currently still under revision. The wellness policy addresses the obesity epidemic in the United States, which has become a growing problem, especially over the past few years. In 2003-2004, the National Health and Nutrition Examination Survey (NHANES) estimated that 17.1% of U.S. children who were between 2-19 years of age were overweight (5). This shows a significant increase in overweight children from previous years, as the percentage of overweight children of 2-19 years of age were 13.9%, 15.4%, and 17.1% in 1999-2000, 2001-2002, and 2003-2004, respectively.

Although the revision of A-812 was meant to promote student health and reduce obesity, there are many problems with this intervention. A-812 allows approved foods that meet “healthy food guidelines.” However, the food that is in the DOE’s approved list can be of much lower nutritional quality than fresh, homemade goods. In addition, preventing students and parents from selling homemade goods at bake sales during the school day inhibits children’s development as evidenced by the Ecological Systems Theory, and disempowers children according to the Empowerment Theory.

A-812 Does Not Promote Nutritious Foods

Although regulation A-812 was meant to promote student health and reduce obesity as part of New York City’s 2010 School Wellness Policy, the regulation and approved food list promote unwholesome foods. The Food and Snack Guidelines state that products must meet a specific nutritional profile. For example, each product must contain 200 calories or less, 200 mg of sodium or less, less than .5 g of trans fat per serving, and at least 2 g of fiber per serving if the snack is a grain-based product (2). However, even if a food meets the specified nutritional profile, this does not mean that the food is nutritious. For example, the main ingredients of Stacy’s Cinnamon Sugar Pita Chips, which are in the DOE’s approved list, are enriched wheat flour, sunflower and/or canola oil, and sugar (6). Stacy’s Cinnamon Sugar Pita Chips contains less than 2% of whole wheat flour, organic sugar, brown sugar, cinnamon, sea salt, active yeast, oat fiber, compressed yeast, malted barley flour, and inactive yeast. While Stacy’s Cinnamon Sugar Pita Chips do meet the nutritional guidelines set forth by the DOE, the main ingredients of these pita chips are not nutrient-rich. Regular consumption of whole grains and whole grain products, as opposed to refined grain products, has been associated with reduced risks of various types of cardiovascular diseases (7). Whole grains naturally contain phytochemicals and antioxidants that work synergistically to create health benefits, and these synergistic effects cannot be replicated or recreated by simply enriching refined grains with the vitamins that are known to be lost during the grain-refining process.

Many homemade baked goods can be very nutritious. While many of the approved snacks on the DOE’s list contain a combination of whole and refined grains, children cannot sell homemade 100% whole wheat bread or rolls under A-812, even if the whole wheat bread or whole wheat rolls did meet the DOE’s required nutritional profile. Homemade banana bread is also not permitted, even if whole wheat flour, healthy oils, such as olive oil, and bananas, a fruit that naturally contains protective antioxidants and phytochemicals, are used. Many health benefits have been attributed to olive oil. Olive oil is said to reduce risk factors of coronary heart disease, have protective effects against various cancers, modify immune and inflammatory responses, and contain many healthy phytochemicals including polyphenolic compounds (8). In addition, bananas and fresh fruits and vegetables naturally contain antioxidants and phytochemicals, and it has been found that the total antioxidant activity from these foods comes from the combination of phytochemicals (9). One antioxidant cannot replace the combination of phytochemicals naturally found in fruits and vegetables to produce health benefits, because it is the additive synergistic effects of phytochemical activity that are responsible for these antioxidant and anticancer activities. The collaborative effects of phytochemicals naturally found in foods cannot be replicated by simply enriching or fortifying snacks, because there are many compounds in food that remain to be identified. The health benefits found in foods naturally high in antioxidants and phytochemicals cannot be found in processed food products that do not contain these nutritious ingredients, even if the Brown Sugar Cinnamon Pop-Tarts are fortified with niacin, thiamin, iron, riboflavin, folic acid, vitamin A, and vitamin B6 (10). Although an individual may believe a packaged snack contains fruit, the actual amount of fruit in the product may be considerably less than he or she may have initially believed. For example, even though an individual might expect to have some fruit from a Nutri-Grains Blackberry Cereal Bar, a product which is approved by the NYC’s DOE, blackberries are actually the fourth ingredient in the cereal bar filling (11). The first three ingredients of the cereal bar filling in order are high fructose corn syrup, corn syrup, and glycerin. While any fresh fruits and vegetables are allowed to be sold during bake sales, teaching students and parents learning how to incorporate these healthy foods into baked goods, rather than letting the manufacturers do the work, is important and can be very educational.

A-812 Hinders Proximal Processes and Child Development

A-812 hinders proximal processes and child development according to the Ecological Systems Theory. Two main propositions define the Ecological Systems Theory. Proposition I states that human development takes place throughout life through processes of increasingly more complex reciprocal interactions between active, evolving human organisms and the persons, objects, and symbols in its immediate environment (12). For interactions to be effective, they need to be mostly on a regular basis over long periods of time. These continual forms of interactions in the immediate environment are known as proximal processes. A corollary to Proposition I is that the developmental power of proximal processes is enhanced during circumstances in which the persons involved have developed strong emotional attachments to one other. Meanwhile, Proposition II states that the form, power, content, and direction of the proximal processes affecting development vary steadily as a combined function of the characteristics of the developing person, the immediate and remote environment, and the nature of the developmental outcomes under consideration.

In the ecological model, the developing individual is also influenced by five successive systems, with each system contained within the next (13). The microsystem includes the setting in which an individual lives, while the mesosystem involves connections between two or more settings which both involve the developing individual. The exosystem includes two or more contexts, at least one of which does not contain the developing individual but which influences the individual. Macrosystems involve the culture in which the developing individual lives, and the chronosystem involves change or consistency in the developing individual and their environment over time.

Child development can thus be hindered if only packaged snacks are typically allowed at school bake sales. As indicated by the Ecological Systems Model, children are most affected by proximal processes, close relationships, and factors in their immediate environment (13). This has implications in school bake sales, especially if children are baking homemade goods with their parents. Cooking is becoming a lost art in the United States, and children increase their development, cooking ability, and ability to interact with others if they have more complex interactions with other people, such as by cooking with their parents. Furthermore, as indicated in Proposition I, these interactions are enhanced when these interactions occur regularly. If PTA bake sales with non-approved goods can only occur once a month, the interaction and experience of the child cooking with his or her parent is rather infrequent, particularly if a parent is busy at one month and cannot cook with the child until the next month. This infrequency decreases the amount of interaction the child has with the parent and can thus hinder a child’s development.
Foods that children make with their parents are more meaningful than packaged food items. For instance, home-baking is important in relation to a child’s culture, a part of the macrosystem (13). A student may get more from a cooking experience with a parent if the food that they are making has a familial and cultural background. Helen Martineau-Kraus, a parent from New York City, used to make mini-spanakopitas, a pastry characteristic of Greece, with her two daughters for their school bake sales (17). Under A-812, homemade spanakopitas can only be sold at the exceptional PTA bake sale once a month. According to the Ecological Systems Theory, a child would learn much more from making and selling a homemade treat that is characteristic of their family and culture, which has much more meaning as compared to a retail packaged item. Meanwhile, the corollary to Proposition I notes the importance of strong emotional attachments in relation to proximal processes and individual development (12). While a child’s relationship to a General Mills Strawberry Team Cheerios Cereal Bar may involve a television commercial, the emotional attachment between a child and parent is much stronger and more meaningful. In effect, learning how to cook a healthful, homemade baked good with a parent increases a child’s development much more than reselling a packaged food item provided by a manufacturer. In addition to hindering proximal processes and child development, A-812 is disempowering.

A-812 Disempowers Children

Regulation A-812 disempowers children by preventing them to sell homemade goods at school bake sales during the school day. Empowerment is “the process of gaining influence over events and outcomes of importance to an individual or group” (14). At the individual level, empowerment refers to a process in which individuals gain control and mastery over their lives, and a critical understanding of their environment (15). The empowerment theory predicts that participating in decision making can enhance an individual’s feeling of empowerment, and that empowered individuals are more likely to participate in community organizations and activities (16).

Various studies explore the Empowerment Theory in more depth. In a study performed by Prestby and colleagues, it was found that organization empowerment may be linked to person-environment fit through their research of the connection between incentive management and organization activity (16). Organizations that have shared decision making, open leadership, and communal projects may be empowered by individuals motivated by factors including social ties, skill building, and helping others (16). In 1990, Chavis and Wandersman proposed that the sense of community is important in the development of personal control and participation, and found that a sense of community had a direct effect on an individual’s level of involvement in a neighborhood association (16). Chavis and Wandersman also suggested a reciprocal relationship between “a sense of community and participation and a sense of personal power and participation” (16).

The DOE’s restriction of only being able to sell foods from their approved list disempowers children from being able to decide what goes into the foods sold at school bake sales. Yes, students can submit a retail package with a nutritional label, ingredient list, and allergen list if they want the proposed, packaged food to be reviewed by a chef and nutritionist to be added onto the approved list (2). However, limiting children to only selling foods that they did not make themselves removes is disempowering, decreases their sense of control, and leads to decreased feelings of community and motivation.

Experiences from several parents emphasize the importance of community and empowering children through school bake sales. By contributing homemade goods to bake sales in the past, students and parents felt a sense of community. Helen Martineau-Kraus, a parent in East Village, New York, stated “Everybody contributes, everybody feels more like they are part of the school community. They try things that other people have baked. In such a big city it’s really nice to have that small community feeling” (17). In addition, these bake sales are often used as fundraisers. Geraldine Neary, a parent at the Renaissance Charter School in Jackson Heights, Queens, NY, said her school’s weekly bake sales, which made around $200-$300, made enough money to send eleven students to Mexico last year (17). School bake sales are important in bringing students, parents, and the school staff together. Again, allowing children to sell only foods that appear in an approved food list restricts their feeling of empowerment, feelings of organization responsibility, and likelihood to participate in community activities.

Conclusion

There are better ways to promote health and reduce obesity in school and school bake sales than by preventing children from selling homemade goods at school bake sales. Homemade goods should be allowed in school bake sales during the school day, because they can provide nutritious options that processed foods do not offer. Baking homemade goods fosters the development of the child. In addition, allowing children to sell homemade goods at school bake sales empowers the children and promotes the feeling of community.

The New York City 2010 Draft Wellness Policy does include goals for nutrition education and promotion (4). For example, SchoolFood is a program that will work with and partner with the New York City Public Schools and the community. Partnership meetings will include discussions of nutrition-related topics and the school food service program, and invited participants can include students, a school administrator, a parent coordinator, the school nurse, and the SchoolFood manager (4). Meanwhile, the Office of Fitness and Health Education will address “nutrition education in professional development trainings for the Department’s recommended comprehensive health curricula, HealthTeacher (for grades K-5) and HealthSmart (for grades 6-12)” (4). The DOE encourages schools to promote parents’ efforts to provide a healthy diet and regular physical activity for their children as well. According to the 2010 Draft Wellness Policy, schools can offer healthy-eating seminars for parents, send home nutrition information, post nutrition advice on school websites, and provide nutrition analyses of school menus (4).

Although the 2010 Draft Wellness Policy does address nutrition education and promotion by educating staff and promoting parental awareness of nutritional food choices, selling homemade goods at school bake sales during the school day should be viewed as an educational opportunity for the children, parents, and school staff in regards to nutrition. Instead of preventing children from selling homemade goods at bake sales, children and parents should be educated about ways to incorporate healthy ingredients into their cooking and homemade treats, such as by substituting shortening, which may contain trans fats, with healthier options, such as olive oil. Instead of using refined white flour, students and parents can be taught that whole wheat flour is more wholesome and contains more health benefits than white flour, and that whole wheat flour can be a complete or partial substitute for white flour in recipes. When educating parents and children about the importance of fruits and vegetables in the diet, recipes and creative ideas to incorporate fruits and vegetables in baked goods can be recommended, such as by incorporating raisins in baked cookies or breads.

Homemade goods can meet specified nutritional guidelines as much as manufactured food can. For a food to be accepted on the approved foods list, the food item must be available in single serve packages and meet a specific nutritional profile (2). Instead of disempowering students by preventing them from selling homemade goods, students and parents should instead be given the resources to not only learn how to make food that is more nutritionally sound, but also be given the resources that will help them to evaluate whether their foods meet recommended dietary guidelines. There are even free recipe analyzers online, such as CalorieCount.com’s Recipe Analyzer, where individuals can enter the ingredients in a recipe to create a nutrition label of the food. After generating a nutrition label, students can revise the recipe if necessary, or keep the recipe if it meets the nutrition standards set forth by the DOE. Subsequently, children can divide the homemade goods into individual portions, and provide ingredient lists and nutrition labels when selling homemade goods at bake sales.

The new nutritional standards set forth for products sold in New York City schools should can seen as a way to educate the students and parents about what they eat and make at home, and not as a way to disempower children and by restricting them to sell retail and processed products at school. Children and parents are able to make nutritionally sound food just as well as any manufacturer can. After all, what’s life without a little dessert?



References
1. Regulation of the Chancellor. Competitive Foods - A-812. New York City, NY: New York City Department of Education, 2010.
2. Office of SchoolFood. Nutritional Guidelines for Products Sold in Schools. New York City, NY: New York City Department of Education, 2010.
3. New York City Department of Education. General Programs/Services and Other Information – Wellness Policy. New York City, NY: New York City Department of Education, 2010. http://schools.nyc.gov/Offices/Health/GenProgServ/Wellness. htm.
4. The New York City Department of Education. Draft: The New York City Department of Education Wellness Policies on Physical Activity and Nutrition - January 2010. New York City, NY: New York City Department of Education, 2010.
5. Ogden C., et al. Prevalence of overweight and obesity in the United States, 1999-2004. Journal of the American Medical Association 2006; 295(13):1549-1555.
6. Stacy's Pita Chips. Our Products. Dallas, TX: Stacy’s Pita Chips. http://www. stacyssnacks.com/#/?page=products.
7. Liu, R. Whole grain phytochemicals and health. Journal of Cereal Science 2007; 46:207-219.
8. Stark, A. and Madar, Z. Olive Oil as a Functional Food: Epidemiology and Nutritional Approaches. Nutrition Reviews 2002; 60(6):170-176.
9. Liu, R. Potential synergy of phytochemicals in cancer prevention: mechanism of action. The Journal of Nutrition 2004; 134:3479S-3485S.
10. Kellogg’s. Kellogg's Pop-Tarts 20% DV Fiber Frosted Brown Sugar Cinnamon toaster pastries. Battle Creek, MI: Kellog’s. http://www2.kelloggs.com/Product/ ProductDetail.aspx?brand=202&product=11011&cat=poptarts.
11. Kellogg's. Kellogg's Nutri-Grain Cereal Bars Blackberry. Battle Creek, MI: Kellog’s. http://www.nutri-grain.com/ProductDetail.aspx?product=12270.
12. Bronfenbrenner, U. Ecological Systems Theory (pp. 129-133). In: Kazdin, A, ed. Encyclopedia of Psychology, Volume 3. Washington, D.C.: American Psychological Association, 2000.
13. Bronfenbrenner, U. Ecological Models of Human Development (pp. 37-43). Reprinted in: Gauvain, M. and Cole, M. Readings on the development of children, 2nd Ed. NY: Freeman, 1993.
14. Foster-Fishman, P., et al. Empirical support for the critical assumptions of empowerment theory. American Journal of Community Psychology 1998; 26(4):507-536.
15. Zimmerman, M., et al. Further explorations in empowerment theory: an empirical analysis of psychological empowerment. American Journal of Community Psychology 1992; 20(6):707-727.
16. Zimmerman, M., et al. Taking aim on Empowerment research: on the distinction between individual and psychological conceptions. American Journal of Community Psychology 1990; 18(1):169-176.
17. Kershaw, S. Taking the Bake out of Bake Sale. NY: The New York Times. http:// www.nytimes.com/2010/03/17/dining/17bakesale.html

A Critique of Why the "Are You Pouring on the Pounds?" Campaign Will Not Prevent Weight Gain -Kate Sullivan

Introduction

Soda, Gatorade, lemonade and ice tea. Refreshing drinks or dangerous drinks? What do these drinks have in common? Tons of sugar. These non-nutritive beverages are wreaking havoc on the weight of millions of Americans. What used to be an occasional treat has turned into a basic food group.
“Gross”, “disgusting”, “I can’t look at it” were comments made by passengers on the New York City subway system late last year (3). What these people were commenting on was a new public health campaign organized by the New York City Department of Health and Mental Hygiene (NYCDHMH), called “Are You Pouring on the Pounds?” The posters placed in the subway system show a soda or other beverage being poured out of a can or bottle into a cup and as the liquid reaches the cup, it turns into yellow globs of fat riddled with blood vessels. The department wanted a shocking campaign to catch people’s attention by focusing on the hazards of sugar-sweetened beverage consumption and to increase people’s awareness of how soft drinks contribute to weight gain and eventually to obesity (1). The campaign was short and focused. It ran for three months at the end of 2009. The message accompanying this image exclaims “Don’t drink yourself fat.” (1) NYCDHMH spent three years and $277,000 researching and developing this campaign.
The New York City Department of Health and Mental Hygiene was stirred to action because of studies showing connection between health problems and sugar-sweetened beverage consumption. To understand the SSBs consumption habits of its citizens, the health department conducted a survey. The 2007 Community Health Survey found that among adult New Yorkers, two million adults drink at least one SSB each day for a caloric intake of 250 calories (1). Serving sizes have increased and with that, increased consumption of empty calories. The department is looking to raise awareness of its citizens through the “Are You Pouring on the Pounds?” campaign about the hazards of SSBs. They are recommending substituting water, seltzer or low fat milk as alternatives (1).
It may be common knowledge that too many calories consumed leads to weight gain. SSBs have played a special role in the rising obesity rates is adults and children. From 1977 to 2001 the consumption of SSBs increased by 135% (7). Besides the infiltration of sodas into the American diet, SSBs also take the form of teas, sports drinks and fruit-based juices. SSBs all contain large amount of sugar. The calories contained in SSBs are empty calories and provide little nutritional value. When people drink SSBs, rarely do they take into account the extra calories. A randomized, double-blind study was conducted by Raben et al to compare the effect of calorically sweetened beverages with that of diet beverages (8). The study showed that the calories from SSBs did not replace food calories, but were additional calories to the diet (8). Those participants who were given the caloric sweetened beverages gained weight during the study and those who drank diet beverages did not (8). This is why the New York City Department of Health and Mental Hygiene is trying to decrease SSBs consumption.
Articles about the campaign are plentiful. Journalists from The New York Times, The Daily News and the British Broadcasting Corporation discussed the effectiveness of the “shock” campaign and interviewed various people. Opinions were mixed. Some people interviewed felt that this kind of campaign would work, others thought it wouldn’t. Many websites and blogs discussed the merits of the campaign (4). Claire Prentice, writing for the BBC News, interviewed a mother and daughter who were riding on the subway. The daughter was quoted as saying “gross” and the mother claimed that she never realized the amount of sugar in SSBs (3). Prentice spoke with a NY psychologist, Jonathan Alpert. He supports the shocking advertising and claims that in makes people think about what they are putting in their bodies. On the flip side, an advertising expert, George Parker, was critical of the campaign. He warned that it might backfire because the image is so gruesome people will turn away before the whole message is absorbed (3). The New York Times interviewed Cathy Nonas, director of Physical Activity and Nutrition programs. She said that the campaign was definitely going for shock value. She also said that the campaign was tested on focus groups and the “graphic in-your-face” approach would work (2). In the Daily News, Adam Lisberg spoke with Associate Commissioner Geoff Cowley. Cowley claimed that “being ‘positive and encouraging’ is not always useful in getting people to change behavior, sometimes you have to get into people’s faces to get attention (4).”
The New York City Department of Health and Mental Hygiene is not the first health department to raise awareness of the link between SSB consumption and obesity. During the summer of 2008, the Bay Area Nutrition and Physical Activity Collaboration in the San Francisco area conducted a campaign called “Soda Free Summer.” The idea behind this campaign was to get people to pledge not to drink soda over the course of a summer. The tools of this campaign included log books, pledge cards and wrist bands which were designed to keep the participants engaged through out the summer (5). Another campaign, called the global “Dump Soft Drinks” campaign is an international effort to improve children’s health and diet around the world. The campaign has succeeded in persuading Coke and Pepsi to provide more healthy alternatives at school vending machines is the Unites States and European Union (6).
There are three flaws in the “Are You Pouring on the Pounds?” campaign. The first flaw is that the campaign relies on the Health Belief model. This traditional model puts the onus on the individual to make a change. It relies on rational thought processes and planned behavior. The second flaw is that the campaign used fear to get the message across to the target audience. The third flaw is that the campaign targeted the proximal causes of SSB consumption.

Critique 1
“Are You Pouring on the Pounds?” is a campaign geared towards the individual. The NYCDHMH is asking each citizen of New York City to reconsider his/her SSB habit and substitute water, seltzer, or low-fat milk. This campaign is modeled on the Health Belief Model which is a traditional health behavior model. It is based on the motivation of the individual to adopt healthy behaviors and is comprised of several factors: perceived susceptibility, perceived severity, perceived benefits of an action and perceived barriers to taking that action (9).
The campaign is geared towards the individual: “Don’t drink yourself fat” (1); it is based on rational thought: “I will stop drinking SSBs now”; and it is planned behavior: “Next time I choose a beverage, I will drink water or milk.” The perceived benefits are less chance of obesity. The perceived susceptibility and severity is whether or not the individual believes that drinking any amount of SSBs will cause them to gain weight and to what extent will they become over weight and suffer health consequences if they don’t follow the health advice of the campaign. The perceived barriers to reducing SSBs consumption may be price of other beverages (fruit drink and soda are cheaper than milk); convenience (most SSBs do not need to be refrigerated while milk requires refrigeration) and water may not be appealing (SSBs are tasty and enjoyable, and therefore hard to give up). People may not be willing to spend money on bottled water but also may feel that tap water in their home is not good for them. Water fountains are not well maintained, many are broken, in disrepair or they look unhygienic so people are unwilling to drink from them.
Because this campaign is based on rational and planned behavior of the individual, it fails to take into account the irrationality of the individual. The campaign has created an expectation that if a person continues to drinking SSBs, he/she will become obese and have health problems. This campaign tries to educate individuals on the hazards of drinking SSBs and gives healthy alternatives, but it does not acknowledge that individuals really like SSBs and do not want to give them up; people “own” their SSB consumption.
The campaign is asking the individual to make a decision regarding beverage choice. If the individual does not follow the recommendation, something bad will happen: the individual will gain weight. The campaign is over estimating the ability of any one person, on their own, to make a change and gives no long term support to the individual.
Self-control is also an issue in this campaign. Whenever one wants to give up something, there are always others around who are doing the behavior. It’s hard to say no to soda when your best friend is drinking it. The individual faces added pressure about beverage choice because not only is drinking SSBs socially acceptable, people have been lead to believe through incessant advertising, that SSBs will make you socially acceptable.
The developers of this campaign used the Health Belief Model when they developed this campaign but fell into the “EZ program structure illusion.”(9). The message it provides “SSBs turns to fat” and people should stop drinking it for the sake of their health seems simple enough but the campaign fails to take into account expectation, ownership, framing of core values, context and self-control.

Intervention 1
Juxtaposed to the Health Belief Model with its emphasis on the individual is the Ecological Model for Health Promotion which recognizes that behavior is complex and there are many “factors” involved. The factors involved in this model are intrapersonal factors, interpersonal factors, institutional factors, community factors and public policy (10). The Ecological Model for Health Promotion recognizes that a range of strategies are necessary in health promotion activities (10).
One can understand the desire of the New York City Department of Health and Mental Hygiene to want to reach as many people as possible throughout the city. Putting the ads in the subway system would logically reach a lot of people in a short amount of time. Although their intentions were good, they wasted their money. The ads are catchy, and have a good tag line but are soon forgotten once the individual leaves the subway.
New York City Department of Health and Mental Hygiene would have been wise to target a community in which SSBs consumption is the highest. According to a survey conducted by the NYCDHMH, the Bronx had the highest consumption rates of all the boroughs surveyed (11). The ecological model says that intervening at the individual level is not enough. The community should be part of the intervention: “the purpose of an ecological model is to focus attention on the environmental causes of behavior and to identify environmental interventions” (10).
The Soda Free Summer campaign would have been a good model for New York City to use in the Bronx. The Bay Area Nutrition and Physical Activity Collaborative used an inter-disciplinary approach to reduce SSB consumption. “The soda free summer campaign consisted of a variety of activities to reach residents in the six San Francisco Bay area counties.” (5) The campaign involved the individual by distributing pledge card and logs to track progress through out the summer. The completed pledge cards could be turned in and entered into a raffle to win a prize. Promotional material was distributed to remind people of the program. Wrist bands were distributed to the participants that helped maintain a sense of community: “you are not alone in your endeavor”. Workshops were offered to educate participants on the sugar content of beverages and the health risks associated with sugar consumption. Community factors were applied to the program: school districts, public health departments, community groups, clinics and hospitals assisted in the campaign through a variety of outreach channels. Public policy factors were employed. Political leadership was engaged in the campaign (5). By using aspects of the ecological model, the campaign was a success: 47% of the participants reported a decrease in their soda consumption as a result of the campaign (5).
Money may have been a factor but if the New York City Department of Health and Mental Hygiene had used this model to target a particular community such as the Bronx, they might have made an impact by reducing this type of beverage consumption on the community with the highest consumption level of SSBs. This could then have been used as a model for other communities throughout New York.

Critique 2
The New York City Department of Health and Mental Hygiene framed their campaign with fear. The fear in this campaign is weight gain from drinking SSBs. “Fear appeals are persuasive messages designed to scare people by describing the terrible thing that will happen to them if they do not do what the message recommends” (12). Whether a message is rejected or not depends on the level of threat as well as the level of efficacy, i.e. the ability to do something about it. (12).
Many public health campaigns have used fear to motivate individuals to change their behavior. For example, the drug-resistance campaign that used a frying egg to simulate how a person’s brain looks on drugs used fear to change people’s behavior (12). Fear models such as the Extended Parallel Process Model (EPPM) use the elements of fear appeal as the basis of their model (12). There are four important components to the fear appeal process: fear, threat, efficacy and outcome variables (12).
A fear appeal can be explained by examining the content of the fear appeal, (gory pictures of crash victims) or fear appeals can be explained by the reaction of the target audience. The target audience can give self-reported levels of fear or instruments can be used to measure the physiological state of the target audience. The fear appeal targeted to the audience in this campaign is that if you drink soda, you will gain weight and have health problems (12). Fear is a negative emotion and has been described by various researchers as anxiety, concern, worry or physiological arousal (12). In this campaign, the fear of weight gain may cause anxiety. Since the campaign does display a glob of fat riddled with blood vessels, negative emotions are aroused and the images in the campaign are labeled as ‘gross” (3). Threat is an external stimulus variable that exists whether a person knows it or not (12). Threats are categorized based on severity of threat (12). In this campaign, the threat can be categorized as the severity of the weight gain and extent of health problems. A person may gain a couple of pounds or hundreds of pounds; have few health problems or many. Efficacy is the targeted audience’s ability to perform the recommended response (12). In this campaign, efficacy is the ability of the target audience to reduce the amount of SSBs in their diet. In the fear appeal, the researcher is looking for message acceptance as an outcome. The outcome does not always lead to message acceptance. Sometimes avoidance and reactance are the outcome (12). The outcome of the campaign is the actual response of the target audience to the message. The target audience may reduce consumption of SSBs, therefore the message was accepted. There may be no change in consumption habits in which case the message was avoided. The worst outcome would be an increase of consumption in defiance of the message, indicating the message had the opposite effect.
Although the campaign fits into the EPPM and this model can explain how the target audience will react to the fear appeal, researchers don’t know how effective fear campaigns are. “Beck and Frankel (1981) noted that the parallel process model is the most broad of the fear appeal theories and although virtually untestable, offers a nice frame work in which to further theorize (12).”
If the EMMP provides a framework, other researchers have explored reinforcement in relation to fear appeal. The effective use of fear is when fear is coupled with reinforcement; this is called “response- fear offset pairing (13).” An example of the type of situation that uses “response-fear offset pairing” is the pairing of seatbelt use with an outcome. Seatbelt-use campaigns have tried to get the target audience to use seatbelts. The underlying message of wearing seatbelts is that if you don’t wear seatbelts, you could die. Even though this could happen, the likelihood of it happening is very small, so the target audience rejects the message. When seatbelt-use messages are reinforced with laws that allow police to ticket and fine non-seatbelt users, the target audience embraces the message and wears seatbelts (13).
This campaign did not use fear successfully. “The use of fear is only likely to work under particular circumstances involving the identification of specific behaviors which successfully reduce the fear aroused (13).” Although the images of fat in a glass are unsettling, the threat of weight gain and the risk of poor health are not strong enough to trigger a change in the target audience because there is no appropriate reinforcement i.e. response-fear offset pairing. A reasonable reinforcement could be a tax added to sugar-sweetened beverages. Increasing the price of SSB would impact the “wallet” of the target audience.
When changing a behavior it is also helpful to see immediate results of the change (13). The target audience may feel that they have been drinking soda for a long time and it has not caused them any harm. Even if the target audience did give up drinking soda, it may be along time before they saw any positive results (weight loss). In addition, it would be impossible to judge if in fact the target audience was able to avoid poor health outcomes from reducing SSB consumption. Researchers recognize that health promotion should not be the removal of unhealthy behaviors but of the reinforcing of healthy behaviors (13). The overall message of “Are You Pouring on the Pound?” is a fear-invoking message dictating the decrease of SSB consumption instead of a positive message encouraging consumption of water or milk.

Intervention 2
The New York City Department of Health and Mental Hygiene should take some cues on promoting healthy beverage choices from the “got milk?” campaign. The campaign used humor and what the advertisers called a milk deprivation strategy (14).
For years drinking milk was promoted as “the key to good health”. Dairy advertising, public relations efforts and the government worked together to encourage milk consumption. For a while the idea of good health from drinking milk worked. But in the 1990s due to other beverage choices made available to consumers, milk consumption declined. SSBs were fun to drink; their packaging was colorful and had innovative designs. This was in contrast to milk which was packaged in boring cardboard cartons and plastic jugs (14). In order to increase sales of milk, the California Milk Processor Board hired a San Francisco ad agency to create a new campaign. “Got milk?” campaign became one of the 1990s most popular and critically acclaimed advertising campaigns (14).”
Money aside (the advertising agency had a $23 million per year budget) the advertisements were effective because they appealed to a core value that was something other than health. Although many people surveyed thought of milk as a compliment to certain foods, the advertising team decided not to sell milk as a complement to those foods (14). Instead, the ad agency used a milk deprivation strategy mixed with humor. The television ads showed people put in silly situations where milk was not available. For example, one commercial showed a man going to heaven and there were chocolate chip cookies everywhere. As he ate the cookies, he grabbed carton after carton of milk, and they were all empty. He began to wonder if he was in heaven after all. This helped to sell milk because the commercials were humorous and people could relate to that feeling of being without milk when it was needed it most (14).
What the New York City Department of Health and Mental Hygiene could have done to “sell” water was use a deprivation strategy. The campaign could reach the target audience by portraying people performing strenuous activities and then not having the most thirst quenching beverage available: water. Posters with an image of someone in the dessert seeing a mirage of water, but not being able to reach it might have portrayed a water deprivation scenario. Making the image enjoyable and positive would have a greater impact than showing an image that is disturbing and negative.

Critique 3
“Are You Pouring on the Pounds?” addresses the proximal causes of weight gain. It maintains that if you drink soda and other soft drinks you, the individual, will gain weight. Telling the individual to cut back on SSB consumption is futile in light of marketing tactics, availability, social norms and policies. Beverage companies target children and teens in their advertising campaigns. For example, the Sprite “Obey Your Thirst” campaign featured rap artists and basketball players combined with “playful cynicism” to create a brand that became popular with urban youth (14). The availability of alternatives such as water fountains is not taken into consideration. The campaign doesn’t take into account the wide availability of SSBs. Everything is geared towards making drinking beverages easy. There are reminders every where that you too can be carrying a beverage. SSB are available everywhere: in corner stores, vending machines, grocery stores, and street vendors. The fact that people bring their drinks where ever they go is not addressed. There are very few places where it is not acceptable to carry around a beverage. Schools allow students to have drinks in class. Cars have beverage cadies as do strollers and shopping carts. SSBs are portable, inexpensive and do not spoil if not refrigerated.
SSBs are served to the youngest members of society, usually in the form of fruit juices. At an early age, children are given juice during the day are snack or meal time. They are conditioned at an early age that sweetened beverages are normal. The Federal Government endorses the consumption of sweet beverages (juices) because there is concern that young children are not getting an adequate amount of fruit in their diet. The Dietary Guidelines for Americans recommends fruit juice consumption by children (15). Since SSBs are a normal part of every day life from early on, asking people to give up SSBs is not practical.
People are taught from early on that sugar-sweetened beverages are a normal part of their diet. This is further reinforced by the wide-spread availability and social acceptance of SSBs. SSBs are ingrained in the American diet. It is unrealistic to expect people to change their behavior when even the government is encouraging people to drink SSBs.

Intervention 3
Efforts to reduce SSB might be better addressed at the distal level. From a rational point of view, the individual has control to a certain extent but people are not rational. Putting policies in place such as requiring beverage manufacturers to make some labeling changes and even levying a tax on sugar-sweetened beverages would go along way in changing people’s relationship to SSBs.
Sugar-sweetened beverages are packaged and bottled in various configurations. Some juices are packages in colorful cartoon featuring favorite cartoon characters. Each juice box represents one serving. The box is around 6-8 ounces and may have a calorie content of 100 calories. This is a reasonably sized portion and represents the small end of the scale for size. Many SSBs are available in 2 liter or ½ gallon-sized bottles. These SSBs contain numerous servings. Most people would agree that this size is not a single serving size and would adequately serve a number of people. This represents the large end of the scale. In between the juice box and the 2 liter bottle is a landscape of bottles of various sizes and shapes. Are the bottles in between single serving containers or are they multiple serving bottles? Even though the 20 ounce soda bottle claims that it contains 2.5 servings, how many people are really going to share that bottle? In actuality, the 20 ounce bottle is one serving. Even if a smaller size beverage is available, it is not priced as favorably as the larger size so one may feel a little “ripped off” buying it. Larger sizes are considered a “value” because they are cheaper per unit measure. Buying in bulk is cheaper on the wallet but drinking in bulk carries the hidden cost of weight gain.
Bottlers have been getting better about labeling their bottles. They may still consider that the 20 oz bottle provides 2.5 serving, but some bottlers are also putting the calorie content of the entire bottle on the nutrition label as well as the calories “per serving”. This type of labeling was recommended by the FDA’s Obesity Working Group “encourage manufacturers immediately to take advantage of the flexibility in current regulations on serving sizes and label as a single-serving those food packages where the entire content of the package can reasonably be consumed at a single-eating occasion. For example, a 20 oz bottle of soda that currently states 110 calories per serving and 2.5 servings per bottle could be labeled as containing 275 calories per bottle.”(16) Not all bottlers are doing this but consistent labeling of the calorie content of the bottle will help consumers make better choices.
Another way to reduce SSB consumption from a distal vantage point that has caused a lot of controversy is taxing SSBs. Public health groups advise taxing SSBs would lead to decreased consumption and subsequently reduced health problems. Many consumer groups see taxes as regressive, affecting poorer people disproportionately (17). On the other hand, poorer people have greater health problems related to a nutrient-poor diet and would benefit from reducing the consumption of sugar-sweetened beverages (17). According to Brownell and Frieden, the best way to implement the tax is to use an excise tax (17). This type of tax structure taxes a fixed cost per ounce at the manufacturing level. This cost would be passed on to the consumer and it would be seen as the true purchase price of the beverage (17). The sales tax, on the other hand, is added on to the beverage at time of purchase. At this point the consumer has already made their choice or feels obligated to pay since they are already at the cash register (17).
According to Brownell et al, taxing SSBs would reduce the amount of consumption because of “price elasticity” which is described as consumption shift caused by price (18). The price elasticity for all soft drinks is the range of -0.8 to -1.0 (18). This means a decrease in consumption from 8-10% if there was an 8-10% increase in price of the beverage. Consumers would switch to diet beverages (which would not be taxed) if their favorite SSB becomes too expensive, or perhaps to a smaller size container if available (18).
Reducing consumption of SSBs through taxation would in turn lower risks of obesity, diabetes and other diseases. The tax money raised could go to obesity prevention programs geared towards children and teens.

Conclusion
The New York City Department of Health and Mental Hygiene sponsored a campaign that was geared towards getting people to change their sugar-sweetened beverage habit. The campaign focused on the individual instead of looking at the larger community, it used fear instead of positive reinforcement and it targeted the proximal causes of weight gain instead of looking at distal causes. One New Yorker said it well, “They look kind of lame (the posters). We’re bombarded with so many messages and these don’t stand out (3).” Unfortunately, the message may not be heeded and New York City will likely have wasted taxpayer money.


References
1 New York City Department of Health and Mental Hygiene. Are You Pouring on the Pounds? Health Bulletin, 2009.
2 Chan, Sewell. “New Targets in the Fat Fight: Soda and Juice.” New York Times. 01 September 2009. Web. 02 April 2010.
3 Prentice, Claire. “Anti-obesity as shocks New Yorkers.” BBC News. 07 October 2009. Web. 31 March 2010. http://news.bbc.co.uk/go/pr/fr/-/2/hi/americas/8281203.stm.
4 Lisberg, Adam. “Controversial new subway billboards show human fat being poured out of soft drink bottles.” Daily News. 21 August 2009. Web. 02 April 2010.
5 Bay Area Nutrition and Physical Activity Collaborative. Getting the Soda Free Message. San Francisco, CA: Bay Area Nutrition and Physical Activity Collaborative. 2009. www.banpac.org.
6 Center for Science in the Public Interest, International Association of Consumer Food Organizations. Global Dump Soft Drinks campaign. Web. 02 April 2010. http://dumpsoftdrinks.org/index.html.
7 Malik, Vasanti S, Schulze, Matthias B., Hu, Frank B. Intake of sugar-sweetened beverages and weight gain: a systematic review. American Journal of Clinical Nutrition 2006; 84: 274-88.
8 Bray, George A., Nielsen, Samara Joy, Popkin, Barry M. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. American Journal of Clinical Nutrition 2004; 79: 537-43.
9 Individual health behavior theories (chapter 4). In: Edberg M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers, 2007, pp. 35-49.
10 McLeroy, Kenneth R., Bibeau, Daniel, Steckler, Allan, Glanz, Karen. An Ecological Perspective on Health Promotion Programs. Health Education Quarterly. 1988; 15(4): 351-377.
11 New York City Department of Health and Mental Hygiene. Are You Pouring on the Pounds? Press Release # 057-09. http://www.nyc.gov/html/pr057-09.shtml. 31 August 2009. Web. 09 April 2010.
12 Witte, Kim. Putting the fear back into fear appeals: the extended parallel process model. Communication Monographs, 1992; 59: 329-349.
13 Job, R.F. Soames. Effective and Ineffective Use of Fear in Health Promotion Campaigns. American Journal of Public Health, 1988; 78(2): 163-167.
14 Holt, Douglas B. Got milk? Advertising Educational Foundation. 2002. Web. 08 April 2010. http://www.aef.com.
15 United Stated Department of Agriculture. Is Fruit Juice Dangerous for Children? Washington, DC: Center for Nutrition Policy and Promotion. March 1997.
16 Food and Drug Administration. Calories Count: Report of the Working Group on Obesity. Obesity Working Group. 2004. Web. 15 April 2010. http://www.fda.gov/food/labelingnutrition/reportsresearch/ucm081696.htm.
17 Brownell, Kelly D., Frieden, Thomas R. Ounces of Prevention-The Public Case for Taxes on Sugared Beverages. New England Journal of Medicine 2009; 360(18): 1805-1808.
18 Brownell, Kelly D. et al. The Public Health and Economic Benefits of Taxing Sugar-sweetened Beverages. New England Journal of Medicine 2009; 361(16): 1599-1605.

Abstinence Has a Ring to It, But Is It the Answer? A Critique of the Silver Ring Thing Campaign– Christine Vanderheiden

Introduction

Let's talk about sex for now to the people at home or in the crowd
It keeps coming up anyhow
Don't decoy, avoid, or make void the topic
Cuz that ain't gonna stop it
-Salt ‘n’ Pepa (1)

Let’s talk about sex. As lyrically stated in the early 90’s song, “Let’s Talk About Sex”, Salt ‘n’ Pepa revealed the taboo subject of sex to the media. Acknowledging that teenagers have, and will, have sex is realistic. Providing said teenagers with information regarding sexual safety is smart. With nearly half of fifteen to nineteen year olds sexually active in the U.S., it would be irresponsible not to teach teenagers about safe sex (2). As it turns out, that is exactly what abstinence campaigns, such as the Silver Ring Thing, are promoting.
The Silver Ring Thing is a movement toward abstinence. This movement is aimed at Christian teens across the country and in England to encourage chastity by using Christian teachings and morals to avoid sex until marriage (3). This campaign does not promote the teachings of safe sex; in fact, it asserts that teaching safe sex is wrong, as it encourages teenagers to have sex before marriage (3). The Silver Ring Thing uses youth oriented methods to deliver their message to teen audiences. They travel to a number of different cities where they have seminars and shows including talks, lessons, sketches, and music. Teenagers follow these shows, take an abstinence pledge, and pay $12 for an abstinence pack, which includes a Bible, Abstinence Bible, and a silver ring. The ring, contains a verse from the Bible, “God wants you to be holy, so you should keep clear of all sexual sin. Then each of you will control your body and live in holiness and honour.” –Thessalonians 4:3-4 (3). This is a religious-based program with only one goal in mind; to stop all individuals from having sex before marriage.
A 2002 study done by the National Survey of Family Growth, asked 40,000 people ages 15-44 about their sexual behavior. Of those interviewed, 95% reported that they had had premarital sex. That leaves 5% of people who had abstained from sex until marriage (4). Also, studies have shown that adolescents who take virginity pledges are no less sexually active than those who do not take pledges (5). In fact, one study done by Columba University showed that of 12,000 teens aged 12-18, 88% of pledgers had sex before marriage (6). It is obvious that either the abstinence program is not as effective as it is meant to be or that it is unrealistic to believe that people will choose to abstain from sex until marriage.
Abstinence is the only sure protection against STDs and unwanted pregnancy, but with so many sexually active individuals, is it realistic? The above-mentioned study showed that while 88% of the pledgers had sex within two years of making the pledge, they also had similar rates of STDs and were less likely to use contraception (6). With the abstinence-only teachings, the use of contraceptives is not encouraged or taught. How does that make sense knowing that about 95% of people will engage in sexual activity before sex? Is depriving information regarding sexual safety really part of the plan to ultimately prevent STDs and unwanted pregnancy? Is this not the goal of abstinence teaching?
These questions may be addressed directly to the government, whose spending for abstinence-only programs has increased significantly over the past decade. Funding increased from $73 million a year in 2001 to $204 million in 2008. That is a total of $1.5 billion in federal money (7). These programs teach abstinence only methods and completely disregard actual safety information concerning contraceptives. Cecile Richards of Planned Parenthood stated that abstinence-only education was "an experiment gone awry. We spent $1.5 billion and can't point to a single study that says this helps. If it doesn't help, why fund it?" (7).
Critique 1: Societal Influence
Denny Pattyn, president and founder of Silver Ring Thing, discusses the main goal in his campaign in video highlighting entitled, “Get It On.” Pattyn explains that what they are trying to do is create a culture shift in America where abstinence becomes the norm again, instead of the exception (8). He asks two important questions to pastors; “Do you have an abstinence program that you use in your church and is it working?” He notes that if there is a current program, “it does not seem to be working all that well because teenagers continue to get hammered by a culture that is dead set on getting them to be sexually active” (8).
It is socially acceptable for people to have sex before marriage. It is a personal choice that takes into account individual’s morals and perceptions of social norms. Both are important and influential in making decisions, as social norms are a primary determinant of behavior. A big part in what causes attitudes and behavior and how they are spread is the social network theory. A social network is any social relationship that one may have, such as a friendship, a kinship, common beliefs, sexual relationships, etc (9). These networks play a critical role in determining values of society and actions taken as a result of those values. As you will see later, the United States shows to have different values and, as a result, different sexual outcomes as compared to other countries used in the study.
One study found that adolescents considered abstinence to be “not so much a health choice, or even a moral choice, as a stage of life that was naturally followed by a sexually active life stage.” Also found in the study, “’Readiness’ for sex also appeared to play a role in a survey that investigated young women’s reasons for having or not having sexual intercourse; beliefs and values were cited as reasons for not only abstaining from sex, but also engaging in sexual activity.” (10). Teens have certain values about sex and do not view it as a negative choice. Not only teens, but Gloucester Superintendent, Christopher Farmer, was forced to take a hard look at the problem of teen pregnancy, and even he realized that, “abstinence is one course of action, [but] we recognize that in the real world that doesn’t always happen.” (11). Society understands the reality of sex before marriage, so why should we follow a campaign that fights that?
In fact, creating a negative connotation about sex may actually be more harmful than helpful. In the article titled, “Can More Progress Be Made? Teenage Sexual and Reproductive Behavior in Developed Countries,” five countries, Sweden, France, Great Britain, Canada, and the U.S., were studied regarding sexual behavior. Out of the five countries, the U.S. showed higher levels of adolescent pregnancy, less contraceptive use, and higher prevalence of infection and STDs than the other countries. This article showed how positive attitudes about sexuality and clear expectations for behavior in sexual relationships contribute to responsible sexual behavior (12). In countries such as France and Sweden, sexuality is seen as normal and positive, and the expectation is that sex will take place in a committed relationship (not necessarily marriage), and those involved will use protection (12). In the U.S., adults are more concerned about whether young people are having sex and close relationships are viewed as worrisome because they may lead to intercourse. Talk about contraception is avoided for fear that such discussion may lead to sexual activity (12). This negative attitude reflects poorly on the country and is most likely to blame for such high pregnancy and STD rates.
Having positive values and intentions regarding sexual activity is important. This critique is not merely putting down the value of abstinence, but it is pointing out reality. It is easy to flip through your Abstinence Bible, slip on a ring and pledge not to have sex before marriage. But is it easy to ignore the human instinct of sexual desire? What about a night alone with your boyfriend/girlfriend, when the atmosphere is just perfect to get a little closer to each other? What about the hot state?
The Silver Ring Thing completely disregards the Illusion of Control Theory and Restraint Bias. The Illusion of Control theory illustrates that people believe that they have more control than they actually have once they decide to do something. Similarly, restraint Bias is the tendency to overestimate one's ability to show restraint in the face of temptation (13). People tend to believe that if they choose something, they have more control over it. If a teenager chooses to be abstinent, they do so in a cold state, where people most likely overestimate their sense of control. However, in a hot state, you have a much more realistic idea of control, and you may have less than you think. Self-restraint may not be enough to fight the influence of society and sexual instinct, and that is something this campaign needs to tackle.
Critique 2: Promoting to a Small Target Market
One clear criticism is that this campaign has pigeonholed itself to appeal to a small population of unwed individuals. What about those who are not religious? What about the population of gay/lesbian teens? What about those who are already sexually active?
According to statistics of 15-44 year old sexually active, unmarried individuals, this campaign only applies to about 5% of the population. This is also assuming that those 5% are Christian following the teachings of God. This religious aspect of the campaign is also stated in the Mission of the Silver Ring Thing, “How can a student give their life to God if they are giving their body to someone else? Think about it… They can’t. You can’t move in two directions at once, yet every week our students are falling into the traps of a sex-obsessed culture.” (14). In this program, teens are taught to understand that abstinence until marriage is God’s plan. What about teens who do not believe in God? What about teens who do not live the lifestyle of God’s teachings?
Approximately 2-5% of adolescents around the country describe themselves has being homosexual. Another 4% are unsure in high school. A national survey of approximately 1,700 college students found that 48% of self-identified gay and bisexual college students became aware of their sexual preference in high school, while 26% found their true sexuality in college. Of these gay, lesbian, bisexual individuals, about 44% of the sexually experienced reported using no use of contraception and about 12% used ineffective methods (15). It is understandable that the Silver Ring Thing wants to avoid sexual behavior by delaying sex until marriage, but how are gays, lesbians, and bisexuals going to follow a program that frowns upon their sexual orientation?
The goal of this campaign is to create a culture shift where abstinence becomes the norm again and not the exception (14). How can you change an entire culture by using such a rigid foundation that is geared toward only a portion of the population? Janet Rosenbaum, of the Johns Hopkins Bloomberg School of Public Health, noted that, “somebody who decides to take a virginity pledge tends to be different from the average American teenager. The pledgers tend to be more religious. They tend to be more conservative. They tend to be less positive about sex.” (16). Also, Rosenbaum noted that pledgers do not seem to be internalizing the pledge because it does not seem to be motivating them to change their behavior.
In studies, she conducted comparing teens that made a purity pledge and teens that had not. Results showed that 82% of pledgers not only retracted their promises, but denied ever having made them (5). This study shows that some teens are giving the purity ring a shot, but most of them are not following through. What is the next step for those who retracted their pledge? What about the teens who do not feel like a purity ring is meant for them at all? This program risks alienating youth by promoting a “one size fits all” image of adolescence that really only matches the true experience of a minority of youth (17 page ii).
This campaign disregards the Marketing Theory and the importance of creating a realistic target market. This theory stresses the importance of identifying and understanding the needs and wants of the target audience, then designing a product to benefit the target audience (18). Research is necessary in finding out what people want, and then market that product to fill the void. In this case, the campaign was designed before assessing the realistic needs and wants of the target audience. If more research had been done, the Silver Ring Thing would have taken into account 95% of unwed people that are already sexually active, or the percentage of gay, lesbian, bisexual individuals, or those who are not religious. These groups would have been factored into the target audience and the product would have been designed for them, as well. With such a small target audience, it is nearly impossible for this campaign to be a success.
Critique 3: Limited Information with Abstinence Only Education
The Silver Ring Thing was created in 1996 as a response to the escalating numbers of teen pregnancies (14). The founders of this program saw the only solution to this problem was abstinence. They saw abstinence as the only way to avoid the “harmful physical and emotional effects of premarital sex.” (14). They recognized that teaching the practices of safe sex and distributing condoms will not ensure the protection from the problems arising from sexual activity (14). So, they do not teach it. Many people see this as a negative approach to solving this issue. Medical professional organizations criticize abstinence for leaving out potentially lifesaving information (19). Abstinence-only programs “are inherently coercive by withholding information needed to make informed choices,” the American Public Health Association said in a statement (19).
In a study comparing the sexual activity of pledgers and non-pledgers, findings showed that both groups are just as likely to engage in premarital sex, but the pledgers are less likely to protect themselves from pregnancy and disease (5). This is because their abstinence-only education does not acknowledge that teens will become sexually active, so they are not taught about contraception or condom use. Discussions of abortion are avoided completely. Information about sexually transmitted diseases and HIV is given strictly as a reason to remain abstinent, instead of to inform teens of the dangers of these diseases and how to use protection against them (17).
Even adults agree that students should be informed as to how to protect themselves. In a survey asking whether or not people who are sexually active should be given information to protect themselves, 84% agreed that they should and 10% thought that telling young people about birth control and sexually transmitted diseases would only encourage them to have sex (17 page 3). Most parents believe that their children need to learn about sex and how to protect themselves. They need to learn about HIV/AIDS and other STDs. They need to learn how to use condoms. They need to learn about how to obtain and use birth control. They need to have homosexuality addressed in sexuality education. (17, page3).
This campaign failed to take into account the Psychological Reactance Theory. This theory suggests that when people feel that their perceived freedom is being threatened, they experience reactance. Reactance is a motivational state that restores the threatened freedom, usually by rebelling (20). Rebellion is expected during teenage years, but this campaign may push teens to rebel even more. To have, or not to have, sex is ultimately the individual’s decision. When a teenager is following a program that is focusing so much on the “Do Not’s” and the “No’s” it is more likely that the individual will feel that their freedom is threatened. Social influence is more successful when it does not threaten freedom (20). This message needs to be delivered in a way that does not seem like teens are being told what to do.
“Like it or not, sexual activity is a reality for teens in America, and it is hard to imagine a school-based intervention which will magically undo the media pressures and natural hormonal urges that young people experience. Facing up to this reality means implementing responsible programming that truly meets the test of science and the real world needs of the youth. “ (17 page 19).
Intervention 1: Create a Value Neutral Approach
One of the biggest problems with abstinence-only education is that it raises concerns for gay and lesbian teens. Not only does abstinence-only education disregard the homosexual population, but it goes so far as creating hostile environment for gay and lesbian teens. Many of these programs stigmatize homosexuality and discriminate against gay and lesbian students (21). In a society that does not allow gays and lesbians to get married, efforts to educate teens about protecting their health are undermined. Some people do not even view same sex relationships an “adequate means of achieving a genuine physical relationship with another human being because this type of ‘union’ is contrary to the laws of nature.” (21). With such hostility toward homosexual relationships, it is obvious that sexual health programs need to address homosexuality in a positive light to have an impact.
An obvious approach to creating a more positive image for sexuality is to create a curriculum in schools that addresses a broader base beliefs and values. SIECUS is an example of a comprehensive school-based sexuality education that respects the diversity of students and understands that students have different values and beliefs (17 p. 14). When dealing with a school wide initiative to end unwanted pregnancy and the spread of STDs, it is important to acknowledge and address all values and beliefs, so that there is not an adverse effect. Effective sexual education should not only address a range of topics, but should be appropriate for all students, regardless of their sexual orientation. It should also encourage health attitudes concerning not only sex, but adolescent growth and development to encourage positive attitudes about gender roles, sexual orientation, dating, marriage, and family. Any religious connotation should be left out of the curriculum, so not to offend anyone or create bias of any information being taught in the school (22).
Intervention 2: Make Contraceptives More Attainable for Teens
The Silver Ring Thing blatantly ignores the use of contraception. The program believes that offering contraception will only encourage sexual behavior. Studies have actually shown that pregnancy and STD rates are lower in countries where contraceptive services are part of an integrated medical plan and easier to obtain. In the U.S., clinic visits and prescriptions are usually costly and difficult to obtain (12). The most important thing for teenagers is to have easy access to information and services, to receive confidential, non judgmental care, and to be able to afford it. While most government funding is going straight to abstinence only education, it should be directed toward encouraging contraceptive use to those teens that are sexually active and unprotected.
The reason why it is so important to provide easily accessible contraception is partly because of the tendency of teens to have optimistic bias (17). Interviews have shown that although young people are concerned about AIDS, they do not perceive themselves to be personally at risk (17). This is mostly due to the fact that they are simply not informed about contraception. Some 21% of teens mistakenly believe that birth control pills are effective in HIV protection (17). There may not be a way around the optimistic bias, but at least teens can protect themselves even though they believe they will not be affected by their behavior.
Statistics show that the majority of sexually experienced teens (74% of females and 82% of males) used contraceptives the first time they had sex (23). At most recent sex, 83% of teen females and 91% of males used contraceptives. These 2002 numbers showed a vast improvement since 1995 when only 71% of teen females and 82% of males had used contraceptives at last sex (23). With emphasis on teaching the use of contraception and making it easily attainable, these statistics should rise, and in effect, the STD and pregnancy statistics should decrease.
Intervention 3: Use Education, not Scare Tactic
There seems to be a concerning disconnect between politicians, teachers, parents, and students regarding their thoughts on sexual education. Politicians are eager to promote abstinence-only education, while teachers, parents and students believe that more information should be taught. An overwhelming 90% of teachers believe that students should be taught more in their sexual education. They believe sexual education should include how to obtain birth control, information about abortion, the correct way to use a condom, and sexual orientation. But, few teachers actually teach what they believe should be taught. One in four teachers are told not to teach grades 7-12 about contraception (24). This is mainly due to state and local policy mandating sexual education and using funding on abstinence only education, rather than comprehensive sexual education. Even if teachers were allowed to cover these topics, about one-third may avoid them due to fear of adverse community reaction (24).
The Silver Ring Thing campaign is promoting a healthy objective, but it is simply not realistic. Abstinence based programs should still be taught in school, but in conjunction with a more comprehensive education. According to a study from the Archives of Pediatrics & Adolescent Medicine, abstinence programs were proven to be more effective in lower grades, such as sixth and seventh (19). It makes sense to focus on abstinence education geared toward younger teens, as they are not as sexually active as older teens. Asking teens to delay sex until they are ready, rather than until they are married, is a more realistic approach and it portrays sex in a more positive light.
Studies have shown that there are lower pregnancy rates in countries that emphasize comprehensive sexuality education. In countries such as Canada, France, Sweden, and Great Britain, comprehensive sexuality education is mandated in schools. These school programs teach the importance of prevention of disease and pregnancy, contraception use, and respect and responsibility with relationships. Programs like this are not funded in the U.S. State and federal funding is directed toward abstinence-only education, but not comprehensive sexual education (12). Teens need to be informed and need to feel like they own their decisions. When they are not given the opportunity to make informed decisions, they will not make informed decisions. Sex should be framed as something they can own and something they can protect, rather than make it a forbidden subject.
Conclusion
The Silver Ring Thing was created to stop unwanted teen pregnancy. Instead, it has stopped the teaching of safe sex to sexually active teens. The purity pledge to God deprives teens of crucial sexual education and knowledge they need to protect themselves. One positive aspect of the campaign was that it may have delayed teens’ first sexual experience by a year or two. But, overall, teens that were taught the importance of abstinence were not told the importance of protection.
It seemed to be that the founder, Mr. Pattyn, was missing the point entirely on preventing unwanted pregnancy and disease. In a world where teenagers share the same religious based values and they are not influenced by society, this program may have been a success. However, they did not take into account their target audience and did not realize the illusion of control that people think they have. People may not make rational decisions all the time, but at least if they are provided with information, they can make informed decisions.

REFERENCES
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5. Janet, Rosenbaum E. "Patient Teenagers? A Comparison of the Sexual Behavior of Virginity Pledgers and Matched Nonpledgers."Pediatrics Official Journal of the American Academy of Pediatrics Vol. 123 No. 1 January 2009, pp. e110-e120 (2008). 29 Dec. 2008. Web. 19 Apr. 2010. http://pediatrics.aappublications.org.ezproxy.bu.edu/cgi/content/full/123/1/e110
6. "How Effective Are Abstinence Pledges?" BBC News. 29 June 2004. Web. 21 Apr. 2010. .
7. Goodman, Ellen. "The Truth about Teens and Sex." Boston.com. The Boston Globe, 3 Jan. 2009. Web. Apr. 2010. 8. "YouTube - Silver Ring Thing GIO Film Promo." YouTube - Broadcast Yourself. Ed. Denny Pattyn. Web. 6 Apr. 2010. .
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10. Masters, Tatiana N., Blair A. Beadnell, Diane M. Morrison, Marilyn J. Hoppe, and Mary R. Gilmore. "The opposite of Sex? Adolescents' Thoughts about Abstinence and Sex, and Their Sexual Behavior."Perspectives on Sexual and Reproductive Health 40.2 (2008): 87-93. EBSCO Host. Web. 22 Apr. 2010. .
11. Jorgensen, Jillian. "Gloucester Teen Lobbies for Sex Education."Boston.com. The Boston Globe, 24 Mar. 2009. Web. 7 Apr. 2010. http://www.boston.com/news/nation/articles/2009/03/24/gloucester_teen_lobbies_for_sex_education/
12. "Can More Progress Be Made? Teenage Sexual and Reproductive Behavior in Developed Countries." The Alan Guttmacher Institute (2001). The Alan Buttmacher Institute New York and Washington. Web. 19 Apr. 2010. .
13. "Illusion of Control." Wikipedia, the Free Encyclopedia. 27 Apr. 2010. Web. 22 Apr. 2010. .
14. GIO Event Leader Guide , Denny Pattyn p. 5-6 .

15. "Fact Sheet: Lesbian, Gay, Bisexual and Transgender Youth Issues." The Body - The Complete HIV/AIDS Resource (April/May 2001). SEXUALITY INFORMATION AND EDUCATION COUNCIL OF THE UNITED STATES. Web. 22 Apr. 2010. .
16. Stein, Rob. "Premarital Abstinence Pledges Ineffective, Study Finds."Washington Post. 29 Dec. 2008. Web. 19 Apr. 2010. .
17. Collins, Chris, Priya Alagiri, Todd Summers, and Stephen F. Morin. "Abstinence Only vs. Comprehensive Sex Education." Diss. AIDS Research Institute University of California, San Francisco, 2002. AIDS Policy Research Center & Center for AIDS Prevention Studies, Mar. 2002. Web. 11 Apr. 2010. .
18. Marketing public health-an opportunity for the public health practitioner (Chapter 6). In: Siegel M, Doner L. Marketing Public Health: Strategies to Promote Social Change (2nd edition). Sudbury, MA: Jones & Bartlett Publishers, Inc., 2007, pp. 127-152. p 330.
19. Landau, Elizabeth. "$250 Million for Abstinence Education Not Evidence-based, Groups Say." CNN Health. CNN, 31 Mar. 2010. Web. 5 Apr. 2010. .
20. Silva PJ. Deflecting reactance: The role of similarity in increasing compliance and reducing resistance. Basic and Applied Social Psychology 2005;27:277-284. p 451.
21. "Helping Teens Make Healthy and Responsible Decisions about Sex."American Civil Liberties Union. 16 June 2008. Web. 22 Apr. 2010. .
22. "Comprehensive Sexual Health & HIV/AIDS Instructions FAQ."California Department of Education. 08 July 2009. Web. 27 Apr. 2010. .
23. "Facts on American Teens' Sexual and Reproductive Health." Guttmacher Institute: Home Page. Jan. 2010. Web. 22 Apr. 2010. .
24. Dailard, Cynthia. "Sex Education: Politicians, Parents, Teachers and Teens." The Guttmacher Report on Public Policy 4.1 (2001). Web. Feb. 2001. .

New York City’s, “Are You Pouring On The Pounds?” Campaign: A Critique based On Psychological Reactance Theory- Tricia Pellizzi

Obesity is a growing concern in the United States. In the United States 68 percent of adults age 20 and older are overweight or obese (BMI greater than 25) (2). In response to the growing rate of obesity in the United States, the New York Department of Health and Mental Hygiene launched an ad in the summer of 2009 targeted at the source of many of the extra calories we consumed on a daily basis: sugary beverages. The department claims that, “On average, Americans now consume 200 to 300 more calories each day than we did 30 years ago. Nearly half of these extra calories come from sugar-sweetened drinks.” (3). The ad recognizes the link between the consumption of sugary beverages and the increased risk of obesity, diabetes, heart disease, stroke, arthritis and cancer (2,3) and warns New Yorkers to cut back, using the tag line; “ Don’t drink yourself fat, cut back on the sugary drinking and go with water, seltzer or low fat milk instead” (3 ). Although the ad has a legitimate source and objective, the ad’s graphic may divert viewer’s eyes before they read the health message. The graphic depicts a hand emptying a soda bottle into a glass; however, it is not soda pouring out of the bottle, it’s fat. Many New Yorkers are opposed to this message, rejecting the “unpleasant image” and “nanny state” the ad represents (8). These powerful emotional reactions can lead to the ultimate backfiring of the Health Departments campaign. Although sugary beverages are a source of many empty calories and are consumed in greater quantities than ever before and therefore are a contributing factor to the growing rates of obesity in the United States (3), the ad’s use of negative, highly directive, overtly persuasive language and improper use of social marketing techniques creates a potential for negative labeling of soda drinkers, and produces high psychological reactance, which can lead to a ‘Boomerang effect’.
Negative Framing and the Potential for Negative Labeling
Labeling is a social process; the label is often not inherent in the behavior that receives it (24). Labeling Theory suggests identity and behavior of certain individuals, usually those seen as deviating from perceived social norms, may be determined or influenced by terms used to describe these individuals. This leads to stereotyping and self-filling prophecy (1). Due to the fact that the ad states that an increasing number of New Yorkers, 2 million according to Health Department researchers, drink sugary beverages daily (3), this ad has the potential to create a stereotype that people who drink soda, or sweetened beverages regularly are ‘fat’, creating a stigma for this group of the population. Research has found that weight related stigmas occur on a variety of levels, including, but not limited to, family, friends, and even health professions, (22) this has great potential to negatively affect emotional functioning as well as provoke negative coping behaviors, which may include overeating or indulging. By negatively effecting emotional functioning, the targeting individual may decrease levels of self-esteem and other psychological stressors that may decrease confidence in their ability to make healthy decisions. This can perpetuate the cycle and create a self-fulfilling prophecy among these individuals (22). There are positive associations between psychological stress and excess body fat accumulations and experiences of unfair treatments lead to increases in abdominal obesity. (24). Clearly an advertisement that intends to positively influence health behaviors should avoid labeling and discrimination of groups to decrease the psychological stress of stigmas that may reinforce negative health behaviors.
Psychological Reactance: Potential for Adverse Reactions/Boomerang Effects
According to the Psychological Reactants Theory, emotions are reactions to threats of personal freedom, which in this case, is the freedom to drink sugary beverages. These emotional reactions often lead to behaviors that restore the freedom perceived to be threatened. Prior to the display of negative reactance the individual must feel the freedom to hold an attitude or belief, or engage in a behavior; in this case sugar sweetened beverages (in moderation or otherwise) is an example of exercising such a freedom. Determinants of the ability to exercise a freedom include; physical ability, wealth, or political regulations that may restrict the exercises of this activity (18,19,20). In this case, anyone can engage in this behavior; however, not everyone who engages in the activity is overweight; many people can enjoy these drinks in moderation without experiencing weight gain. Due to this attempt to manipulate personal freedom by advising against this behavior “individuals may engage in a threatened behavior simply to demonstrate their prerogative to do so” (20).
The attempt of the individual to restore the threatened freedom often results in acting out against recommendations. An example of this can be found in a study investigating the consequences of warnings by Stewart and Martin in 1994, which found that, “[although] empirical research suggests that warning messages increase consumer awareness of potential product hazards…Warnings may produce behavior that is exactly the opposite of that intended by the placement of the warning.” (12) The reaction to threats and acting out in attempts to restore to freedom can also be referred to as ‘The Boomerang Effect,’ which ultimately causes the opposite of the Health Departments intended effect. Not all warnings produce such negative effects; “…effective warnings result in improved awareness of warning information, more accurate perceptions of risk, and enhanced understanding of risk avoidance mechanisms….effective warnings [also] result in the measurable reduction of hazardous behavior.” (11).
According to the Psychological Reactance Theory, “People will react against attempts to control their behavior and eliminate their freedom of choice” (9). The freedom of choice deals with specific, discrete behavioral and attitudinal freedoms that people act upon in everyday life (9). The freedom to choose which beverages you consume on a day-to-day basis definitely fits the mold for exercise of daily behavioral freedom. This attempt to control New Yorkers behavior and thus their freedom, by warning that consuming these beverages will cause you to gain weight is a threat to their freedom; ads that attempt to persuade people to act in a certain way may in fact act in direct opposition in order to exercise their autonomy (9, 26). This theory supports the view that trying to influence peoples’ behaviors by advising against certain choices in this manner may not produce the desired effect of having New Yorkers decrease their consumption of sugary drinks and substitute those beverages with water, seltzer or low fat milk. In a study regarding consumer behavior and psychological reactance, researchers found that, “…the degree that an advertisement …is seen as intending to persuade, there should be reactance arousal and accompanying decrease influence”(9). People don’t like to receive unwanted advice about how they should behave. Warning against unhealthy products may only make them want the product more (15,26).
Adolescents seem to be a population that have an increased sensitivity to psychological reactants (13) and because the NYC Department of Health and Mental Hygiene ad is warning against soda and other sweetened beverages, which of course is popular among adolescents, the message may not be well received and even cause and increase in soda consumption as a result. DeTurck and Goldhaber conducted an experiment in 1991 with a “NO DIVING” warning sign to adolescents. Not only did the researchers find that, “controlling messages such as warning signs with increasing levels of psychological reactance, and as a result, warning signs are less effective with high school students than with middle school students;” is very clearly demonstrated by adolescence in response to warning messages. But also that “…[it] seemed to have a ‘boomerang effect’-caused the opposite than the intended effect” (13).
Due to the profound effect that psychological reactance can have on a variety of populations, Janis Hovland et al., in an article on communication and persuasion, accounted for six possible reasons for high psychological reactance or boomerang effect to a particular message; three of which apply to New York’s ad. The first being when the sender of the message uses counter norm communication the public may react against it; by describing the norm in order to argue against it the sender adds to the receivers knowledge of the norm and heighten conformity. This may be of particular significance with the “Are you pouring on the pounds?” advertisement because the campaign recognizes the daily high consumption of soda and sugar sweetened beverages in New York, and due to this increase the health department needs to intervene. But what the ad could be reinforcing to the public is that everyone drinks soda daily, but we want you to go against societal norms and stop. The second being when, after being influenced by the sender, the receiver becomes sharply aware that he is deviating from the norm, the audience my act in direct opposition to the desired effect. The third being that the boomerang effect may occur when the message produces feelings of aggression or unalleviated emotional arousal (17). This last point may play a significant role in the public reactions to this ad campaign. Viewing the ad or the video may produce many emotions; first and foremost it produces a strong feeling of disgust, which only elevates as the commercial continues, it also may produce anger or frustration in reaction in reaction to being told not to drink soda, or sugar sweetened beverages.
The magnitude of the public’s reaction will vary depending on two important factors. One being how important the consumption of these beverages are to each individual; “ the more important the freedom, the more reactance is generated due to person or impersonal threats” (9), and the other being the mere fact that your freedom to choose these beverages is being threatened, “ the reactance response often entails an overreaction whereby threatened behaviors or attitudes come to be prized more than before.” (9).
Ineffective Use of social marketing techniques
Research has shown that public health practitioners that utilize basic techniques of marketing principles to “sell” their product of health have found much success. Marketing techniques emphasize the importance of selling a product for which there is high demand, “ too often public health practitioners determine the benefits that policy makers and the public ought to want and then attempt to sell these benefits when there is low, or no, demand” (27). New York’s “Are you pouring on the pounds” campaign is attempting to indirectly ‘sell’ weight loss through reducing soda/sugar sweetened beverage consumption. The problem is that the focus of that ad is on the association between soda and ‘fat,’ not the benefits that this reduction can ultimately cause; weight loss, which is an appealing concept for consumers.
Recommendations of the use of marketing techniques in public health campaigns suggest six key objectives to meet when ‘packaging’ a product, New York’s ad violated four of the six objectives. The first violation involved the presentation of evoking visual images that appeal to the target audiences’ core values, rather than appealing to the core values of the population, the image on the New York’s ad evokes strong negative emotions of disgust and aggression (8). The ad also fails to develop a catch phrase that appeals to core values, the catch phrases in this ad a quite negative and potentially stigmatizing. It also does not suggest appropriate metaphors that evoke themes and images that appeal to the core values, Lastly the ad fails to distribute responsibility to society [environment, policy etc], not strictly on the individual. (27)
If we analyze New York’s advertising campaign in terms of the ‘brand’ they are creating for themselves, they identify with the consumer by informing them that their favorite beverage is making them fat. The brand instead should be something the audience can relate and aspire to and should relate back to their core values (27). The problem is that the advertisement is focusing the negative end result of drinking to much soda, rather than the benefits that one receives by cutting down their consumption such as weight control and autonomy, “promise, large promise is the soul of an advertisement (28).
Framing of health issues in a social marketing campaign also influence the outcome of behavior change and overall reaction to health messages; ‘gain-framed’ messages were found to be more effective in promoting prevention than ‘loss-framed’ messages (7). This ad uses a negative frame/ ‘loss-frame,’ insinuating that soda drinkers are ‘fat’, this may both produce a negative or opposite reaction to the desired out come of the campaign as well as create or enforce a stigma that segregates ‘soda drinkers’ from ‘non soda drinkers’ in society (6). In addition, James Price Dillard and Lijiang Shen in their article, On the nature of reactance and its role in persuasive health communication, found that,”…intense, forceful, or dogmatic language may increase the magnitude of reactance (10). The negative angle New York decided to take with this ad, both in terms of language, framing and images clearly increase the psychological reactance of views and therefore increase the potential for a ‘boomerang effect.’
Some theorists believe that campaigns such as this one focus too much attention on targeting individual behavior and not enough on influencing the environment to facilitate the desired behavior change. It is also important for social marketers to anticipate unintended effects of their marketing techniques that would produce adverse reactions (6) The New York City Department of Health & Mental Hygiene did not acknowledge the adverse reactions that having revolting images, targeted at soda and sports drink consumers would have on their ability change their behavior without any help from environmental changes. These changes could include increase availability of non-sweetened beverages, decrease in cost of these alternatives (especially in low income areas), or initiatives on the companies behalf to decrease the amount of sugar in their beverages to facilitate the desired behavior change.
New Intervention: Use Positive Framing and Social Marketing to Reduce Psychological Reactance and Labeling Effects
Due to the flawed design of New York’s “Are you pouring on the pounds?” campaign, alterations can be made to increase the effectiveness of the ad and achieve the desired behavior change of reduce the consumption of sugar sweetened beverages. By addressing the issues of labeling, psychological reactance and social marketing techniques, the ad will produce a more favorable reaction from the public and will be more effective at achieving their goal of reducing the consumption of sugar-sweetened beverages.
Proper use of positive framing techniques and language are useful in decreasing the possibility of negative reactions to health messages and societal stigmas that may be contained within health messages; these alterations will lead to more effective health warnings. A study on the effects of warning and information labels on consumption of full fat reduced fat and no fat products found a similar distinction between reactance and behavior, “people don’t mind being informed about the potentially harmful risk associated with products [but] they don’t like to receive unwanted advice about how they should behave. Warning people about unhealthy products may only make them want the products more” (14). Jensen and Collins explain that offensive, disgusting or fearful advertisements may produce an overreaction of negative reactance in the public due to a phenomenon call “Third Party effect”. This effect is described as the likelihood of people to have an exaggerated complaint or a negative reaction to an advertisement because they believe that other people will be offended (21). This reaction may be due to disgusting images or endorsement of stereotypes in the population. In this case, the disgusting images and stigmatizing negative language presented in both the poster and video presentations of this advertisement, the public may exaggerate their negative reaction because they believe others will be more offended than they are. By removing the stigmatizing language and gruesome images, stigmas can be avoided and messages can be well received.
A positively framed message emphasizes a brands’ advantage or the potential gains to consumers resulting from the purchase or use of the brand or ‘product’, positively framed messages tend to elicit more desirable responses than negatively framed messages (29). Positive messages engage viewers to process the information. (23). Research shows that those who actively process information in an advertisement tend to respond more favorably because active processing involves an acknowledgement of goals or a conscious awareness of the issue or topic (4). Although most social media contains both negative and positive forces within their messages, affecting both simultaneously, increasing positive force and decreasing negative force, should sharply increase compliance, if the if the negative is reduced so much that the positive outweighs it, there is an even greater likelihood the individual will comply with the recommendation (30) This is essential with NY’s ad because the health department is asking the public to reduce or eliminate the consumption of a product that has clearly gained more popularity over the years. “Harvard school of public health recommends that public service messages designed to deter certain behaviors should avoid message executions that evoke negative emotions and rely instead on the upbeat tactics used by advertisers of consumer products (31).
The helpful or interpersonally appealing qualities of the communication will work in the opposite direction of negative reactance. If the freedom (or importance of freedom) were at a low level, the credible and attractive features of the communication would very likely create a net of positive influence (9). Due to the fact that freedom to choose is so crucial in the production of adverse reactance and “Highly explicit, directive language is often viewed as controlling and may contribute to a sense of helpless dependence rather than confident independence” (5), using language which covertly persuasive and ultimately reminds the viewer of their ability to make decisions (5) is an important aspect in decreasing the occurrence of psychological reactance due to overtly persuasive, directive language in many health campaigns. Using language that is concrete tends to be viewed as having expertise and trustworthiness. The new message should also contain “Low-controlling autonomy supportive language appears to be principally associated with positive affective outcomes related to decreased reactance, such as perceptions of fairness, decreased anger, and more favorable judgments of source sociability. (5). An example of a possible headline that fits these new criteria might resemble, “Wanna cut calories? Decreasing soda consumption can save up to 300 calories a day! The choice is yours.”
Another to achieve a type of processing that will engage the attention of our target audience; social marketers have the most success when they identify a solution to a problem the audience is experiencing and offer a solution or a benefit they will value. Appealing to the audience is key and many health professionals struggle with marketing their recommendations in this way (6). One way to make the message more appealing is to increase the attractiveness of the communicator, liking the person delivering the message increases the attention of the audience. Perhaps having a fitness celebrity state the message on the ad, the audience may be more open to receive the message. The elements needed to accomplish this are in place, no one wants to be labeled as ‘fat’ or deal with the co-morbidities of being overweight or obese, and in terms of getting in shape, people tend to want and most results with the least amount of effort. If the lessons learned about the effects of psychological reactance, the elements of positive framing that encourage active processing and avoid stigmatization of groups are applied to New York’s advertisement, the ad will decrease the boomerang effect and overall negative view of the ad which may interfere with the ads effectiveness. Due to the fact that people will react against attempts to control their behavior and eliminate their freedom of choice,”(9) the ad would frame the information to leave the power to choose with the viewer. In addition, appropriate research needs to be done to identify what New Yorkers want, think, feel and do regarding the target behavior (4); drinking sugar-sweetened beverages.
Many argue that too much time is spent attempting to persuade people to change their behaviors and not enough time on developing affordable, accessible products that allow people to solve their problems and realize the aspirations that matter most in their lives and to modify the environment to make it easier and more enticing to adopt the healthy behavior (6). Assuming that weight control is new York is concerned with, and information regarding weight management is what will entice the public, and the health departments wants to attempt change by focusing on decreasing soda consumption, they might want to create regulations or legislation that supports this initiative for example removing soda in school, or making the alternative options (so fat milk, water, and seltzer) more affordable, or easily accessible especially in areas with high soda consumption and low socio-economic status, such as some areas on Brooklyn (3). The health department might want to consider legislative action or at least collaboration with store owners to help with the initiative to help support the effort, perhaps reorganizing their beverage layout to display the preferred beverages and move sweetened beverages to the back or have promotional pricing. Perhaps using the effects of product placement to draw attention to non-sweetened beverages may be another avenue to pursue; although in lower income areas, price will be a more motivating factor to purchase these items.
The incorporation of these techniques will greatly increase the reaction to the New York City Department of Health and Mental Hygiene’s attempt to decrease soda consumption. Their current campaign made use of three techniques that increase the likelihood of adverse reactions rather than behavior change, namely the use of labeling soda/sugar sweetened beverage drinkers as fat, using images and language that produced high reactance, increasing the likelihood of boomerang effects, and finally the improper use of advertising techniques leads to the decrease acceptance for this campaign. By altering the way the information in the ad is presented, the reaction to this ad can be quite positive.
Conclusion
Decreasing consumption of sugar sweetened beverages to remove a large proportion of empty calories from ones diet is beneficial recommendation for the New York City Department Of Health and Mental Hygiene to deliver to its’ residents; however, the advertisements used to send this message may do more harm than good. The negative language and disgusting visuals not only set the stage for labeling and stigmatization but the improper use of social marketing techniques produce such high psychological reactance that the message can actually produce ‘Boomerang effects’. A more successful means of delivering this health message would be to utilize key marketing objectives, which reframe the campaign to appeal to the public core values and motivate the viewer to make healthier beverage choices. The language of the ad should be direct, to maintain credibility of the source, positive, to decrease negative reactance and avoid stigmas and stereotyping, and indirectly persuasive, allowing the viewer to still exercise their own decision-making capabilities. Incorporating these principles into the advertisement will increase the probability of acceptance and behavior change among New Yorkers.
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