Challenging Dogma - Fall 2008

Wednesday, December 17, 2008

Why Teens Couldn’t Live Above the Influence: Ineffectiveness of the National Youth Media Campaign to Prevent Substance Abuse in Teens-Chau Tran


In 1998, Congress created and funded the National Youth Media Campaign led by the Office of National Drug Control Policy (ONDCP) in an effort to prevent and reduce drug use among youth. After five years and over $1.2 billion worth of media interventions and public relations efforts, evaluations by Westat Inc. and the University of Pennsylvania found the campaign ineffective in reducing youth drug use despite achieving high levels of media exposure (16, 7). More troubling was that evidence from University of Pennsylvania suggested the opposite: a possible increase in intended drug use among youth exposed to the campaign ads (7). As a result of the campaign’s ineffectiveness in both preventing initiation and curtailing current drug use, the U.S. Government Accountability Office has suggested reducing funds to the campaign until the ONDCP could provide evidence of an effective campaign (16). The ONDCP responded to these findings by noting that the campaign has undergone major changes by adjusting its advertisement messages to improve its effectiveness (4). The most current campaign, “Above the Influence,” based on elements of a combination of theories such as the theory of reasoned action and the social learning theory, may prove to be just as fruitless as their previous efforts.

The basic premise of the theory of reasoned action (TRA) is that behavioral intent is based on an individual’s attitudes about a behavior and their perception of the social norms associated with that behavior (5). Moreover the theory maintains that an individual’s intent will likely translate into behavior (5). Attitudes about a behavior are based on the individual’s expectation of the health-related outcome, and how strongly the individual feels about that outcome, while perception of social norms is believed to be a product of the individual’s belief of what others would think about the behavior and how important it is for that individual to conform to what others think (5). The theory of reasoned action assumes a rational thought process and that attitudes and social norms are weighted by each individual and then factored into the individual’s intention to do the behavior.

Social learning theory (SLT) is founded on the idea that individuals interact with their immediate environment (1). It is through this interaction that individuals learn by observing or modeling a certain behavior (1). Modeling a health behavior is thought to rely on four main components: 1. the ability to bring attention to the modeled behavior by making the behavior more attractive or the person doing the behavior more relatable to the observer, 2. the ability to aid in the retention of the modeled behavior through images and verbal descriptions, 3. the ability to allow for reproduction of the behavior through converting symbolic representations into the action, and 4. the observer must have a positive motivating factor in order to emulate the behavior (1).

Despite a well-intentioned effort to implement these theories as a way to prevent and curb drug use in the youth population, this campaign fails in several aspects. In many of its advertisements, it fails to recognize the limitations of the theory of reasoned action by assuming youth will make intended and calculated drug use/initiation decisions. Although the advertisements are regularly based on elements of the social learning theory, the models are hardly relatable to how youth think to impact behavior. Moreover, the campaign neglects and inappropriately addresses various social variables that may impact a large number of youth. Lastly, mixed messages from the campaign may both confuse and deter youth from adopting the intended behavior.

a. The Theory of Reasoned Action and misleading assumptions of adolescent attitudes and behavior.
In an effort to employ the theory of reasoned action, the National Youth Media Campaign created print ads such as “Lungs” which depict artwork of a lung in which two true/false questions are written on them asking, “ True or False, 1. When you smoke a joint you inhale four times as much tar as a cigarette, 2. A teenage marijuana user is twice as likely to drop out of school than a non-user. Answer: True, now get all the facts. Live above the influence” (9). Ads such as “Lungs” are targeting the adolescent expectations of the health and educational outcomes of smoking marijuana in an effort to change attitudes of the behavior. The idea is that by changing attitudes about the behavior, the ad would change the intention to perform the behavior and thus directly change the behavior itself (5). More over, by telling the adolescent to “Live above the influence,” ads are telling teens to neglect social norms and not smoke marijuana.

Ads employing the TRA such as “Lungs” make a few assumptions about adolescent attitudes and behavior. First, even if the ad was successful, as a limitation of the TRA, it assumes that intention will ultimately lead to behavior. While this may be true in theory, many of us may have similarly intended to do something but ended up not accomplishing our intended task due to a variety of factors. Psychological studies on adolescent deviant behaviors such as substance abuse add to this difficulty of accomplishing an intended behavior by suggesting common underlying causes in adolescent behavior such as difficulty in regulating negative emotions, emotionally driven behaviors during adolescence, poor impulse control, and sensation seeking behaviors (3). This inability for many teens to regulate emotions is noted to lead to emotional avoidance coping in which the teen avoids unpleasant feelings by further engaging in risky, sensation seeking behaviors that could temporarily alleviate these feelings (3).

Secondly, print ads such as “Lungs” assumes that factors such as the amount of tar or educational status are important enough for a teen to change their attitude towards marijuana. For example, if a teen’s family has positive perceptions of drug use, or if education or health is not important to a teen’s social network, it may be difficult for the teen to find issues such as health or education important enough to change attitudes about drug use. Moreover, although some teens may find these topics of value, there could be multiple factors in a young person’s life that play a larger role in decision-making, or that can overshadow the issues of health and education such as socioeconomic factors or family structure (11, 17). For example, recent studies have suggested that influential individuals such as siblings, cousins, and parents in the home and their views on drug use can determine marijuana use among teens (11, 17). Drug use can also serve a variety of different functions across different groups and subgroups of teens as ways to cope with a variety of environmental stressors such as poverty, oppression, or violence (17).

b. Social Learning Theory- using the wrong models
Although the campaign utilizes elements of social learning theory, many of the advertisements depict characters or situations that may be difficult for teens to relate to. One of the first components of social learning theory is to be able to bring attention to the modeled behavior or person doing the behavior so that it is attractive and relatable to the targeted observer. Television ads such as “Walk Yourself” or “Football” depict cartoon characters and/or situations that could never happen.

In “Walk Yourself” a cartoon boy is lying down smoking marijuana and his cartoon dog enters the room. The boy asks the dog, “Can’t you walk yourself?” while the dog walking away responds, “You disappoint me” (18). Neither the cartoon depiction nor the scenario of a dog talking to you exemplifies any real life situation that a teen may relate to or understand. By the ad’s inability to engage the viewer, any subsequent messages may be overlooked or scoffed at by the audience. Moreover, in this ad, the boy is happily smoking in his room and benefits by not having to do a chore with the only consequence of his dog being disappointed. What kind of message does this send to youth? That smoking may be beneficial because you don’t have to do your chores and the worst that can happen is that your dog tells you he/she is disappointed in you?

In “ Try Football,” a cartoon boy tells another cartoon boy walking his dog, “I smoke to impress the ladies”(13). The boy with the dog responds while walking away, “Try football.” The message here is “Football is an alternative to help get the ladies.” Although still well intentioned, the ad is still depicting cartoon characters and an unlikely conversation between two teens. Moreover, adolescents may not be swayed by this ad because although it offers an alternative, it does not show or prove the idea that football is any better than smoking marijuana.

c. Failure to address differences.

Addressing Cultural/Ethnic Differences
Despite ads that appear to be targeting non-white minority youth, the campaign may still be far from addressing ethnic/racial/cultural differences among the adolescent population. Searching through, some ads such as “Huggin the Block” and “Sent” seemed to be targeted towards African-American and Hispanic youth. “Huggin the Block” portrays an African-American girl as the narrator who raps about a boy named Trey who smokes marijuana and does nothing all day except sit on the steps with his friends (8). In “Sent,” a Hispanic young girl picks up the phone and says, “Hey girl, que pasa? My weekend was crazy, what I can remember” (12). She continues talking to her friend and finds out that an embarrassing picture was sent to all her friends from her “crazy weekend” (12). The scene ends with another girl flaunting a phone image to her circle of friends and a teen boy looking up at her from his phone in disapproval (12).

Although the campaign recognized the differences in racial and ethnic groups by creating ads that were intended to target African American, and Hispanic audiences, these ads only scratched the surface of creating a culturally sensitive intervention. According to Resniscow, et al. in the Journal of Community Psychology, cultural sensitivity consists of two dimensions, surface and deep structure (11). Surface structure is explained as matching an intervention to social and behavioral elements of the targeted population by using the people, places, foods, music, clothing familiar to that population (11). Surface structure is considered necessary for an intervention but is only a prerequisite, as it will only determine how receptive a population is to a message or intervention (11). Deep structure is noted as the factor that will impact an intervention and is explained as understanding how cultural, social, psychological, environmental, and historical factors affect a target population (11). With these elements in mind, one can try to understand how a population understands and perceives the problem and how a variation of these factors influences their behaviors. For example, it is noted that compared to Caucasians, African-Americans experience a greater number of stressful events, experience different types of stressors, and use different coping mechanisms to stressful events (11). The two ads “Huggin the Block” and “Sent,” failed to address any deep structure factors while only addressing a few surface structure elements such as inclusion of the people, clothing, music, and a bit of the language. Merely identifying ethnic/ racial/cultural differences and addressing surface structure may not be enough, in a complex problem such as teen drug use. It may require tailoring of interventions to address deep structures in a diverse adolescent population.

Addressing, gay, bisexual, lesbian differences
Another social factor that the campaign entirely fails to address are differences in lesbian, gay, and bisexual in adolescents, their cultural and social systems, and/or environmental stressors. Recent studies have shown that both prevalence and odds of lesbian, gay and bisexual youth substance abuse is higher than their heterosexual peers (10, 15). In a study, looking at bisexual young women compared to their heterosexual peers, it was found that bisexual young women were more likely to be solitary users, have pro-drug beliefs, and lower refusal efficacy, perceived greater parental approval, and had more exposure to substance using peers (15). These studies suggest that failure of the National Youth Media to address the right audiences in a culturally understanding and sensitive way may be a factor in its inability to prevent and curb drug usage among adolescents.

d. The “Boomerang Effect”- Reactance Theory

Another failure of the National Youth Media Campaign lies within its own slogan “Live Above the Influence.” While many of its ads such as “T-shirts” seem to be sending the message of being free, independent, and making one’s own choices, by constantly telling teens what to do to “Live above the influence” can be perceived as hypocritical and impinging the teen’s freedom to make one’s own choices (14). A possible consequence of these mixed messages could result in what is called reactance among teens that could prevent youth from adopting the intended behavior or even doing the opposite of the intended behavior coined the “Boomerang Effect” (2).The reactance theory derived from psychology posits that when individuals perceive that their freedom is threatened or restricted, they will emotionally react by directly contradicting the threat to regain or retain their behavioral freedoms (2). Reactance can also cause someone to adopt a stronger attitude towards the threatened behavior as well as increase resistance to future persuasion (2).

Florida’s successful “truth” campaign in 1998 understood this theory well. It found through interviews with youth, that they disliked anti-tobacco efforts that passed judgment on tobacco users and disliked even more so being told what to do (6). Yet, the National Youth Media Campaign continues to send hypocritical messages to youth who may be reacting to being told what to do.


The National Youth Media Campaign has the potential to improve the health and safety of many adolescents by preventing and curtailing substance abuse among this population. By understanding and getting into the minds of youth, the campaign can target interventions that address barriers, attitudes, and the true causes of behavior. Using more attractive and relatable models that teens would want and be inspired to emulate may help to bring attention and motivate teens to model the desired behaviors. Moreover, the adolescent population is a diverse population with different patterns of use, prevalence of use, and environmental and social factors that contribute to substance abuse. Although tailoring ads to different teen populations may be complex, such an intervention may be needed in solving such a complex problem. Finally, by carefully examining how a message is conveyed to the adolescent population, the campaign may be able to both capture the trust and attention of the adolescent population instead of deterring or pushing them in the opposite direction. By critically examining the flaws in their campaign and making a true effort to adjust them, the campaign can make a large impact in the lives of many teens.

An Intervention

Through the examination of the various flaws of the National Youth Media campaign, we may be able to construct an intervention that could better impact the teen drug decisions and outcomes. Accounting for these various flaws, the following four-pronged intervention is suggested as an improvement upon the current campaign. The first component of the intervention involves going beyond the focus group by accounting for various social, psychological, and developmental factors using field research and immersing interviewers into the world of various groups of adolescents. The second component of this intervention involves using an element of social learning theory, which involves winning the target population’s attention, and desire to emulate behavior using celebrities and real-life situations in ads. The third component of the intervention accounts for deep structure elements in ads targeting various groups and subgroups of teens. The last component of this intervention is to develop a message that keeps in mind the effects of psychological reactance in order prevent mixed messages towards teens on drug behavior.
The first component of this multilayered approach is to address various barriers to behavior such as psychological, developmental, and social factors that play a role in drug use through field research and directly talking to groups of teens representative of the target audience. Although the National Drug Youth Media Campaign used focus groups in their to better understand the target population, it may have been difficult to understand how these various factors, and their complexities truly influence teens without observing them within the context of their social environment (16). A possible component of the “truth” campaign’s success may have been contributed to the implementation of qualitative field research going beyond the interaction in a focus group (6). Interviewers in the “truth” campaign were dispersed into various youth environment and were made to act similar to their peers in order to build trust when gathering information (6). By immersing interviewers into the youth environment and gaining their trust, we may be able to receive a more complete understanding of how teens think and the complex factors that influence teen drug use decisions. Another goal of doing field research and talking to various groups of teens is to also understand the various differences across ethnic/racial/cultural groups and provide an opportunity to focus on deep structure elements such as how various cultural, social, psychological, environmental, and historical factors affect various groups and subgroups of teens (11).

This component of the intervention addresses a major limitation of the Theory of Reasoned Action (TRA) employed in many of the National Youth Media Campaign ads, which assumes that intention would directly lead to behavior. The previous ads neglected to account for factors that can cause behavior to deviate from intention such as psychological and emotional development (3). Moreover, while many of the ads illustrate the negative educational and health effects of smoking marijuana, studies have shown that there exist various social factors that may be relevant to address in anti-drug interventions (11,17). Evidence of these various factors as barriers to behavior suggest that merely addressing individual negative health and educational effects of drug use as shown in “Lungs” may be limiting and require a more critical examination. Moreover, evidence of the differences in psychological, historical, and cultural, barriers across different teen groups illustrates the complexity of the problem (11). By examining a fuller spectrum of barriers, differences, and groups, we could then account for and tailor ads and interventions that address these factors.

The next component of the intervention involves using popular celebrity teens in print and television ads portrayed in real-life situations that adolescents may face with drug use. This may be a better use of social learning theory because the people and situations may be more attractive and understandable to the adolescent viewer (1). The use of popular celebrity teens that many adolescents may already want emulate may better bring attention to the modeled behavior as well make the modeled behavior seem more attractive to the viewers. Unlike talking to a dog in “Walk Yourself,” using real life situations that adolescents encounter may increase the receptiveness of the ad because it pertains to something that they know and understand (1, 18). Moreover, using real-life situations may allow adolescents to more easily reproduce and emulate the desired behavior as described by social learning theory (1). Another important component of social learning theory is that observer must have a positive motivating factor in order to emulate the behavior (1). In “Walk Yourself,” the cartoon boy smoking marijuana avoided having to complete a chore with very little negative consequences besides the disappointment of his dog, which could be seen by many teens as a positive outcome (18). It may be important to note that using celebrities and real life situations may be ineffective if it fails to send the right message to the audience.

The third approach to this intervention is to not only target ads towrds different groups of teens of different cultures, ethnicities, races, and sexual orientations, but use ads that make a better attempt at addressing the deep structure elements of these groups. Although it may difficult to tailor ads to each group, it may be necessary and more effective than creating ads that inadequately address, or do not address these issues at all. Understanding deep structure elements such as the psychological, historical, social, environmental, and cultural context of each group can be accomplished through the first component of this intervention using field research (11). An example of an ad that might tailor to deep structure elements of a group may be to account for point used earlier of African-Americans experiencing a greater number of stressful events, different types of events, and different ways to cope (11). Using this historical, social, and psychological understanding one could create an ad that mirrors the types of stressful events that African American youth experience and identify a more positive coping mechanism that may be more understandable and acceptable for African American youth.

The last component of this intervention seeks to change the message of the campaign to decrease mixed messages as well avoid psychological reactance. The message can be tailored more towards sending a message promoting individual choice and self-efficacy instead of telling youth that they should not smoke and live above the influence. By understanding the idea behind psychological reactance and examining the approach of the “truth” campaign, sending a message that inspires and encourages youth towards the wanted behavior rather than telling youth what to do may be important to note in order to avoid deterring teens from the campaign (2, 6).

Although the current campaign has been very successful in achieving high amounts of media exposure, its various flaws limit and according to data, may prevent the campaign from achieving its goal in decreasing national adolescent drug use (16). Recognizing that achieving high exposure may do little to affect change, the proposed intervention seeks to improve upon the various flaws of the current campaign while maintaining this high exposure. By examining the various factors that affect youth decisions, we may be better able to develop interventions that address these elements. Using more attractive models in situations that adolescents can understand may help achieve more attention and desires to emulate modeled behavior. Tailoring ads to different cultural, ethnic, and racial groups by addressing deep structure elements although difficult may be key in approaching such a complex problem. Lastly, by creating a positive message that avoids a psychological reactance among teens, we may be better able to capture not only the attention but also the motivation of youth to establish the targeted behavior.

1. Bandura, A. Social Learning Theory. New York: General Learning Press, 1977.
2. Brehm, J. A theory of psychological reactance. New York: Academic Press, 1966.
3. Cooper, M. L., Wood, P. K., & Orcutt, H. K. Personality and the predisposition to engage in risky or problem behaviors during adolescence. Journal of Personality and Social Psychology 2003; 84(2):390-410.
4. Dotinga, R. Study: Federal Anti-Drug Campaign Didn’t Work.Washington, DC: Center for the Advancement of Health, 2008.
5. Edberg, M. Individual Health Behavior Theories (pp. 35-49). In: Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers, 2007.
6. Hicks, JJ. The strategy behind Florida’s “truth” campaign. Tobacco Control 2001; 10:3-5.
7. Hornik, R., et al. Effects of the National Youth Anti-Drug Media Campaign on Youths. American Journal of Public Health 2008; 98: 1-8.
8. “Huggin the Block”. The Ads. Washington, DC: Above the Influence, National Youth Anti-Drug Media Campaign.
9. “Lungs”. The Ads. Washington, DC: Above the Influence, National Youth Anti-Drug Media Campaign.
10. Marshal, M. P., Friedman, M. S., Stall, R., King, K. M., Miles, J., Gold, M. A., et al. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction, 103(4), 546-556.
11. Resnicow, K., et al. Cultural Sensitivity in Substance Abuse Prevention. Journal of Community Psychology 2000; 28:271-290.
12. “Sent”. The Ads. Washington, DC: Above the Influence, National Youth Anti-Drug Media Campaign.
13. “Try Football”. The Ads. Washington, DC: Above the Influence, National Youth Anti-Drug Media Campaign.
14. “T-shirts”. The Ads. Washington, DC: Above the Influence, National Youth Anti-Drug Media Campaign.
15. Tucker, J. Ellickson, P., & Klein, D. Understanding Differences in Substance Use Among Bisexual and Heterosexual Young Women. Women’s Health Issues 2008; 18:387-398.
16. United States Government Accountability Office. Contractor’s National Evaluation Did Not Find That the Youth Anti-Drug Media Campaign Was Effective in Reducing Youth Drug Use. Washington, DC:GAO 06-818, 2006.
17. Wagner, K. D., Ritt-Olson, A., Soto, D. W., & Unger, J. B. Variation in family structure among urban adolescents and its effects on drug use. Substance use & Misuse 2008; 43(7): 936-951.
18. “Walk Yourself”. The Ads. Washington, DC: Above the Influence, National Youth Anti-Drug Media Campaign.

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