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

Introduction

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 www.abovetheinfluence.com, 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.

Conclusion

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.

REFERENCES:
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. http://www.cfah.org/hbns/getDocument.cfm?documentID=1796.
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. http://www.abovetheinfluence.com.
9. “Lungs”. The Ads. Washington, DC: Above the Influence, National Youth Anti-Drug Media Campaign. http://www.abovetheinfluence.com.
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. http://www.abovetheinfluence.com.
13. “Try Football”. The Ads. Washington, DC: Above the Influence, National Youth Anti-Drug Media Campaign. http://www.abovetheinfluence.com.
14. “T-shirts”. The Ads. Washington, DC: Above the Influence, National Youth Anti-Drug Media Campaign. http://www.abovetheinfluence.com.
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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.
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18. “Walk Yourself”. The Ads. Washington, DC: Above the Influence, National Youth Anti-Drug Media Campaign. http://www.abovetheinfluence.com.

“Just Say No”: Why One of the Largest Prevention Campaigns was Destined to Fail- John H. Murphy

Anti-drug campaigns have been a prominent part of American culture since the early 1980’s and the introduction of the “War on Drugs”. Most of these initiatives have not done well in regards to curbing adolescent drug use. One of the worst campaigns was the Reagan initiated “Just Say No” initiative. Created in the 1992, the campaign sought to abolish drug use through concept of empowering young people by making them realize they had the power to not do drugs, improve their self-esteem, and thus their lives. Unfortunately, this proved to be quite untrue. This particular initiative failed for a multitude of reasons, with some of the most prominent being that it was based on a flawed model of behavior, actually increased drug use by making it appear prevalent, and because of the fact that drug use and culture are embedded in corporate America.

The “Just Say No” campaign’s failure was, in large part, due to the fact that it was created using an outdated and flawed model for behavior: The Health Belief Model. One of the most important issues with the HBM is the fact that it is based on individual level, rational decision making (1). The very name of the campaign implies that the person confronted with the decision as to whether or not to use drugs, has the ability to make the rational decision to not do so. Obviously, this is untrue, as so many young people engage in drug use. If the healthy, logical decision to not do drugs was so simple, this would not be the case. This issue is also important in regards to the concept of intention leading directly to behavior, which is something else that the HBM assumes. By making this assumption, HBM ignores the fact that many other factors (environmental, social, etc.) can influence the outcome of the intention to do something (1).

The second issue with the HBM is that it fails to acknowledge the role that social factors play in health behavior and decision making (2). These factors, along with environmental, SES, etc cannot be ignored because, for many young people, the desire to not do drugs may pale in comparison to the desire to fit in with their peers, be accepted by larger social groups, or feel supported. Simply, it is often much too intimidating to “just say no.”

The HBM is also flawed in its definition of choice and how people weigh the options. In the HBM, it is assumed that people weigh the pros and cons of a behavior as strictly black and white. That is to say that a behavior that is negative, will be negative for everyone, as was noted in recent litigation against Big Tobacco:

“To me it’s like any other form of pleasure, whether it’s jogging, drinking beer or smoking cigarettes. If it provides a benefit to the person...in the eyes of the beholder, if it makes that person feel better about himself or herself,... There is a benefit, otherwise you would not sell the number of cigarettes that we sell every year...” (3).

Clearly, the benefit of a particular behavior is something that is unique to the individual and assuming that behavior is all or nothing fails to acknowledge this very important aspect of human psychology.

The final problem with the HBM is that it assumes that all human behaviors are in concert. That is to say that the intention to not do drugs will fall in line with all other intentions, such as the desire to do well in school. This was a major issue in the “Just Say No” campaign and many others after it. In multiple advertisements, young people who did not say no were depicted as being losers with no desire to, often, do well in school. This demonstrated the immediate and assumed link between the two. For example, while most people don’t want to be overweight, it does not mean that they don’t want to eat cheeseburgers, as noted in, “health beliefs compete with an individual's other beliefs and attitudes” (4).

The “Just Say No” campaign actually made more kids do drugs. By disseminating advertisements and interventions that showed drug use as prevalent, the campaign was showing teens that drug use was a common behavior, engaged in by many. This, when linked with the desire to be part of a group, which is incredibly strong because it feeds natural instincts: comfort, support, protection, love, etc., may have increased drug use. This was demonstrated in a study published in the Journal of Consulting and Clinical Psychology in 1999. The researchers found that the “Just Say No” and DARE campaigns not only did not decrease teen drug use, but that they actually led to an increase. They concluded that this was to the fact that the campaigns made drugs seem very prevalent and they also showed young people engaging in the illicit behavior. In turn, teens may have seen people their age engaging in an activity shown to be prevalent. Because of the desire to fit in, this combination could have led to increased usage rates (5). Recently, another study, to be published next month in the American Journal of Public Health, came to the same conclusion:

“Our basic hypothesis is that the more kids saw these ads, the more they came to believe that lots of other kids were using marijuana,” Hornik said. “And the more they came to believe that other kids were using marijuana, the more they became more interested in using it themselves” (6).

In the same study, researchers showed that as the number of ads seen per month increased, so did marijuana use. For teens that saw 12 or less ads per month, 82% reported no drug use. This number dropped by 6% with teens who saw over 12 and continued along this path as the number increased (6).

All of this is not to say that saturating the market with the messages that are trying to be conveyed is ill-advised. On the contrary, models, such as the diffusion of innovations theory, demonstrate the importance of doing just that. Otherwise, how else can one hope to reach the target audience with any effectiveness? However, the message that is being conveyed must be relevant to that audience. If it is not, it may have the opposite effect and actually reinforce the negative behavior. The “Just Say No” campaign is not alone in having a so called “boomerang” effect (6). The safe sex initiative of the mid 1980’s and 1990’s that was intended to improve safe sex behavior in MSM had just the same effect. The initiative sought to educate men about the dangers of unprotected sex by reinforcing the highly negative consequences of contracting HIV. This initially worked well because of the high levels of fear regarding the disease in the population. However, as treatment and subsequently life span for those with HIV improved, the effectiveness of the campaign began to crumble. In fact, by the mid 1990’s, increased rates of unsafe sex were being reported in MSM. Researchers believe that this was due to the fact that the fear based tactics of the message was no longer relevant to the intended audience. These men no longer viewed HIV as a death sentence and actually reported having “treatment optimism”. Also, because these men were repeatedly being told “you MUST always have safe sex”, many of them viewed not doing so as an act of rebellion (7). This is very similar to the effect of the “Just Say No” campaign. The message was not relevant, even laughable to many teens, and for some, the act of doing drugs was an act of anti-conformity and rebellion.

Because of these findings, it seems appropriate that in order to combat teen drug use, campaigns should focus on young people who aren’t doing drugs. The “truth” campaign is an example of an initiative that sought to target its intended audience in just this way. The researchers for the “truth” campaign discovered that “youth’s reason for using tobacco had everything to do with emotion and nothing to do with rational decision making.” After discovering this and marketing the “truth” campaign as a brand of rebellion in Florida, tobacco use by teens in the state dropped 7.4% in the first 30 days (8).

The third and some could argue most difficult issue to resolve, reason for the failure of the “Just Say No” campaign is the fact that drug use, especially marijuana, is embedded in corporate America. Corporations make “decisions about the production, pricing, distribution, and promotion of their products and political efforts to create an environment favorable for their business” (9). At its most basic level, it is a “how can we make the most money possible, regardless of the means” mentality. Because of this, young people are perpetually provided positive reinforcement for the use of illegal drugs by corporations and people that they view to be cool or even role models. Hollywood is the perfect example. Shows such as Entourage display people smoking Marijuana on a daily basis and being no worse for the wear. The show also happens to be predominantly viewed by 18-30 year old men, who are also the heaviest users of pot. It is not hard to decide which one, Entourage or a “Just Say No” ad, a young man would rather watch and what their association, negative or positive, would be with marijuana. Clothing is another example. Walk into any Pacific Sunwear and it won’t be hard to find hoodies, hats, and belts emblazoned with pot leaves. These shows and articles of clothing are viewed as much cooler than anti-drug ads, and are also used as a form of rebellion by, again, demonstrating anti-conformity.

The demographic that corporations target is also of importance. Multiple studies have shown that people who have low SES have greater risk for negative health behaviors such as, smoking cigarettes, alcoholism, drug use, and unsafe sex (10,11). These facts are no secret to corporations. For many businesses, these population groups are a prime target for their products. For example, the media outlet BET and clothing store Urban Behavior’s target demographic are African-American men between 18-30 years old. It is not unusual to see many of their products (music videos, shows, hats, shirts) displaying many references to the positive aspects of drug use: you will get women, wealth, friends, etc. Tobacco marketing is a prime example of corporations doing just the same thing. Studies have shown that neighborhoods with low SES have higher tobacco marketing saturation rates because there will be a larger proportion of smokers and possible smokers in those neighborhoods (12).

Recently, large corporations (Merck, Firestone) have been found to have been aware the negative health effects of their products, but continued distribution because of the high profit margins, and even “conducted extensive public relations and lobbying campaigns to try to maximize financial returns” (9). While these specific instances are extreme, they are not unlike the Hollywood executive producing a show glorifying drug use. They know exactly what effect it will have on the viewer, because they have put the time and money into the research. In contrast, the “Just Say No” campaign was based around a single, cheesy catchphrase: just don’t do it. This is no match for the huge influence corporate America has on behavior. Businesses employ hundreds of marketers, advertisers, and psychologists to determine what factors influence the choices of consumers. Corporations then take the wealth of information learned through their research and are able to create products and then market, distribute, and price them in a manner that elicits a strong, positive, and often subconscious reaction from the targeted group (13).

To alleviate the negative impact of corporate practices the glorify drug use, it will be necessary, not to create new, stronger anti-drug campaigns, but rather, provide consumers with adequate knowledge about the negative health impacts of drug use while protecting the young and especially vulnerable groups, increase penalties for disseminating pro-drug products, and increase health and policy spending to level the playing field (9). Otherwise, huge corporations, such as film and TV studios and clothing manufactures will always be able to out spend health campaigns while marketing their product in a manner that creates the perception of coolness by the consumer.

In hindsight, it is not surprising that the “Just Say No” campaign was unable to deter adolescent drug use. The entire campaign was based on a model of behavior that reduces decision making and behavior to an individual cost v. benefit analysis. It also saturated media outlets, schools, etc with a message that showed drug use as something prevalent in young people, which may have actually increased usage rates. The fact that drug culture is something that is so highly embedded in American culture and business also played a significant role in undermining this and many other campaigns. In order to reduce teen drug use, it will be important for initiatives to use the message as a brand that assumes no rational thinking and takes into account the many pressures young people face.

The “Just Say No” campaign was inherently flawed and destined to fail because of its creators unwillingness to accept or unawareness of the fact that adolescent drug use is more than a simple yes or no decision, should be displayed as an act of the minority rather than the majority, and that drug culture is highly rooted in the practices and products of corporate America. In order to reduce teen drug use, it is imperative that each of these issues be incorporated into future campaigns. If the multi-factor causes of drug use are not acknowledged, anti-drug campaigns will continue to have little effect.

One of the greatest flaws of the “Just Say No” campaign was its utilization of an already outdated model of behavior, the Health Belief Model. In order to construct an intervention that would not be inherently flawed, the core issues of the HBM must be addressed. For instance, the HBM assumes health behavior is based on rational, logical decision behavior (1,2). A successful campaign and intervention would have to utilize a model that does not make this assumption, thus enabling it to account for the extreme variation in similar groups of people in regards to health choices. For example, models such as the Diffusion of Innovations Theory make no mention of logic or rational being the basis for decision making. By doing so, such a model would allow campaign creators to construct an intervention that would acknowledge the, in many cases, complete lack of logic that human decision making is based upon.

The second major flaw of the HBM that must be addressed is the lack of inclusion of social factors as playing a major role as determinants of health behavior and decision making. For example, the HBM assumes that intention leads directly to behavior (2). Obviously, this is often untrue when put into the context of a real-life scenario. For example, many heroin addicts intend not to use again, but often they do, and sometimes for lengthy periods of time, all the while intending each hit to be the last. By addressing the importance of environmental, social, economic, and cultural factors in regards to health behavior, an anti-drug campaign would have a much greater chance of addressing the multi-factor causes of drug use. It is crucial that things such as social acceptance, peer pressure, and SES play a major role in the construct of the model being utilized (1,2).

One of the greatest challenges in creating a successful health campaign is the marketing strategy. In the 1980’s and ‘90’s, the “Just Say No” campaign portrayed illicit drug use as being prevalent in adolescent society. In doing so, the initiative normalized drug use and may have even led to increased usage rates (5,6). In order to avoid this phenomenon, an anti-drug campaign must take the opposite approach. Drug use and the desire to avoid using should be marketed as the norm. Teens need to see that the benefits, maturity, acceptance, and happiness that their peers have enjoyed and gained through other activities. Drug use should be shown as an outlier behavior that few teens engage in. By doing so, the campaign would be able to market drug use a socially unacceptable and taboo. This is in direct contrast with the “Just Say No” campaign which, by failing to engage in such a marketing campaign, may have demonstrated that a lack of drug use would be viewed as social suicide in adolescent groups. An example of just such a marketing campaign is the “Truth” initiative in which smoking is portrayed as being the activity of the minority and thus viewed as a negative behavior. By doing this, the campaign was able to show non-smokers as the non-conformist group rebelling against “Big Tobacco” (8). This is an important point. For many young people, adolescent years are difficult and many feel a need to rebel against their parent, society, etc. Often, drugs are the perfect outlet for this angst. A successful anti-drug campaign needs to account for these emotional needs in youth and demonstrate just that: a lack of drug use is a form of rebellion through strong and individual (a.k.a non-conformist) thinking and decision making.

All of this being said, it is still important, just as in the “Just Say No” campaign, that the market (TV, radio, popular culture, etc.) is saturated with the message. The flaw of this tactic with said campaign was not the actual high level of disbursement of the message, but rather the message that was being dispersed. While the “Just Say No” campaign failed, in part, because it normalized drug use, which led to a “boomerang” effect, it is still important to do the same, but with a relevant message normalizing a lack of dug use (6). Just as in the Diffusion of Innovation Theory, it is crucial that the early stages of the campaign are marked by high recognition of the message. Adolescents must encounter large “doses” of the alternate campaign, one in which positive, socially accepted alternatives to drug use are displayed. By doing so, teens will begin to desire the same acceptance, hope, love, and self-efficacy that is being demonstrated by their peers in the campaign.

The third obstacle and, by far, the most difficult to address is the effect that corporate America and their practices has on the youth of this country. As noted previously, organizations and industries, such as Hollywood and clothing manufacturers, spend billions of dollars each year researching the psychological factors that influence consumer’s decisions (9,10,13). By doing so, these organizations are able to create and market items that play into the subconscious desires of their target audience. For example, television shows and movies, such as Entourage and Blow, portray drug culture as a positive in many ways. The individuals highlighted in these pieces are shown to be flashy, wealthy, surrounded by women and, possibly most importantly, happy (9,10,13). When young people are constantly surrounded by messages extolling how drug use will lead friends, wealth, and happiness, it is no surprise that these fictitious messages begin to become reality to them. It is analogous to the idea that the more a person hears or tells a lie, the more it becomes a truth. While seeing such a message at a low rate may not influence behavior or influence choice, when constantly surrounded by the message, even though it may be rationally false, it can become incredibly difficult for it not to begin to shape a persons perception of the path to success.

The first step to changing these practices is through an increase in policy and public health spending. If this nation is to reduce drug use, it is imperative that politicians pass legislation prohibiting the rampant dissemination of the positive aspects of drug culture and allow public health organizations access to adequate levels of funding, so that they may compete with multi-billion dollar corporations. This legislation must also be multi-pronged. Because so many industries utilize drug culture as a means for amassing wealth, it will be necessary to target all. There must be regulations on the content that is permissible for the youth of the country. This is a very thing line to walk because blanket regulation is not possible, nor it should be. One of the hallmarks of this country is held in the First Amendment of the Constitution and the right to free speech. This must never be infringed upon. However, our citizens and politicians can demand that the distribution of such products can no longer go, so completely, unchecked. For example, to purchase clothing with drug references people under the age of 18 should have to have an adults consent to do so. To view certain shows with ratings acknowledging drug use and references, parents must take a more active role and “lock” these programs. In order to achieve the latter, high levels of marketing must be done to make parents aware of particular shows and movies. Simply showing parents in a commercial putting “parental controls” in place on their television is not enough because many parents are unaware of what to block. Because of this, a majority of the content that could be detrimental to their children slips through.

One of the most important keys to the success of a future anti-drug campaign, and any public health campaign, is that our public health organizations must begin to utilize the social and psychological sciences to a much greater degree. Organizations employ sociologists and psychologists to determine the social trends, individual desires, and needs of youth. By doing so, these organizations create products that are appealing to adolescents ¹³. How can public health practitioners hope to achieve similar results without employing the same methods? By including them in the construction of an anti-drug campaign, public health organizations would be able to tap into the same inherent, group level drivers of behavior. The result would be interventions that youth would find appealing and identify with. The “Just Say No” campaign is the perfect example of an initiative that failed to do this and because of this failure, their simple, catch-phrase message quickly became laughable to teens (5).

Finally, incentives must be created to drive corporations to create more health friendly products and services. Currently, organization’s financial gains often come at the expense of the health of lower class citizens. Corporations spend millions of dollars marketing their unhealthy products to groups in low SES areas of the country (10,11). For example, because of the higher rates of smoking and possible smokers in low SES areas, tobacco companies heavily market in those areas and also market products, such as menthol cigarettes, that are consumed at higher rates by those groups (12). In order to push corporations from producing and marketing unhealthy products to consumers, legislation must be passed that creates financial incentives to do so. For example, tax breaks for organizations that use and produce environmentally and health friendly products could be implemented. The situation is analogous to the current energy crisis. Because of the large financial gains of oil, organizations are unwilling to seek out alternative sources of energy, unless there are financial incentives, often tax breaks, to do so. By implementing a similar sense of urgency and benefit for corporations, a shift from an emphasis on health harming products to those that improve population health could be created.

It is unlikely that drug use will ever be completely removed from society, but an increase in use is possible. However, this will only be possible if policy and campaign creators are willing to look at the multi-dimensional factors that lead to drug use. Illicit drug use, especially in youth, can no longer be simply viewed as an activity for social deviants. Drug use occurs in all groups and for a variety of reasons, none of which is rational decision to begin using. Policy and funds, just as with any public health issue, must seek to attack the issue from a multitude of angles. For example, treating homelessness by simply removing people from the streets is not effective. They must also be provided with mental health and drug counseling, sustainable employment, food, etc. Just as with homelessness, drug abusers become as such because of a variety of reasons and need a variety of support outlets to regain sobriety and maintain it.

REFERENCES:

1. Rosenstock, Irwin. Historical Origins of the Health Behavior Model: University of Michigan School of Public Health. Health Education Monographs Vol. 2, No. 4, 1974.

2. Salazar, Mary Kathryn. Comparison of Four Behavioral Theories: A Literature Review. AAOHN Journal, Vol. 39, No. 3, 1991.

3. Horrigan EA Jr. Liggett Group. Broin v. Philip Morris Companies Inc. : Circuit Court of the Eleventh Judicial Circuit, in and for Dade County, Florida, 1994:114

4. http://msucares.com/health/health/appa1.htm

5. http://www.time.com/time/nation/article/0,8599,99564,00.html

6. http://www.thecontemplation.com/?p=2016

7. Hart, G.J. Williamson, L.M. Increase in HIV Sexual Risk Behavior in homosexual men in Scotland, 1996-2002: Prevention Failure? MRC Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow G12 8RZ, UK.

8. Hicks, JJ. The Strategy Behind Florida’s “truth” Campaign. Tobacco Control 2001; 10:3-5.

9. Freudenberg, Nicholas. Galea, Sandro. The Impact of Corporate Practices on Health: Implications for Health Policy. Journal of Public Health Policy. 2008.

10. Lantz, P. Lynch, J. House, J, et al. Socioeconomic Disparities in Health Change in a Longitudinal Study of US Adults: The Role of Health-Risk Behaviors. Social Science Medicine 2001; 53.

11. Lu, Ning. Samuels, Michael. Wilson, Richard. SES Differences in Health: How Much Do Health Behaviors and Health Insurance Coverage Account For? Journal of Health Care for the Poor and Underserved. 15. 2004: 618-630

12. http://tobaccocontrol.bmj.com/cgi/content/full/11/suppl_2/ii71

13. http://www.corporationsandhealth.org/chron.php

Critique of the Partnership for a Drug Free America Television Ad Campaign & A Potential Alternative Intervention - Christian Pulcini

Introduction

Throughout the latter half of the 20^th century and continuing into the 21^st, public health interventions aimed at reducing illicit drug use among youths and adolescents have been fundamentally flawed in their reasoning and strategies behind the interventions. The over-reliance on traditional public health models to help structure interventions, such as the health belief model and theory of reasoned action, have steered public health professionals and organizations concerned with illicit drug use away from their original goals.

Partnership for a Drug-Free America

No example is more prominent and memorable than the Partnership for a Drug Free America’s commercial campaign, which has targeted illicit drug use over the past 30 years. Although the Partnership touts it successes by citing an overall decline in drug use over the past 30 years, it fails to acknowledge that drug use reached its peak in the late-1990s years after its most well-known and widely distributed television advertisement “This is drugs. Now this is your brain on drugs. Any questions?”.[1]

The answer to this advertisement in the context of structuring successful public health intervention is most certainly “yes”. In fact, this advertisement can offer insight into the fundamental questions of why did the Partnership’s early interventions fail? And why will their advertisements aimed at preventing illicit drug use continue to fail to reach the youths and adolescents of the United States if they refuse to alter the structure and foundation behind their interventions? By exploring and questioning the earlier advertisements and mass media campaigns by the Partnership for a Drug-Free America within a more broad social science construct, one can achieve a better sense of the answers to these questions.

The Nature of Drug Use & Missed Social Science Cues by the Partnership for a Drug-Free America

The Partnership for a Drug-Free America has consistently employed more traditional health behavior models in constructing their market-based interventions. More specifically, “This is drugs. This is your brain on drugs. Any questions?” is an excellent example of a health belief model-based intervention. What is interesting about the reasoning behind this intervention is that the Partnership appears to completely ignore the multiple behavioral factors that influence drug use, and also fails to recognize the inadequacy of the health belief model in predicting complex behaviors. By reviewing psychological theory over the past thirty years in parallel with the foundations of the health belief model, one may attain a better understanding of why the Partnership for a Drug-Free America initially produced ineffective advertisements and why they continue to do so today.

When the first mass media campaign was launched by the Partnership for a Drug Free America, psychological theory held (as evidenced by the DSM-IV & ICD-10) that drug use is a largely atheoretical disease which can be classified by a traditional medical model conceptualization.[2] Many argued against this reductionist view of the illness however, as they felt it could not be classified under a single disease and instead involved multiple factors which could not be accurately defined.[3] As early as the mid-1980s, the psychological theory behind drug use began to shift to support the latter opinion and reject the more traditional classification of drug use. Psychologists found that the relationship between behavior and drug use is not easily categorized, and cannot be defined by a set of agreed upon variables.[4] More recently, psychologists have agreed that drug use is a multi-dimensional behavior that can be influenced by various factors including genetics, biology, environment, socio-cultural factors, and the biochemistry of the substance itself. The exact formula that leads an individual to use drugs is largely unknown, and could be any combination of the factors listed above.⁴ Modern psychopathology recognizes that physicians, sociologists, behavior-oriented researchers, and other scientists and social scientists that study drug use all produce different theories and interventions based on their discipline.[5] Therefore, although mainstream psychological theory failed to recognize the complexity of the behavior involved with drug use in the 1970s, it certainly has come to agree with other social sciences that drug use is not a behavior that can necessarily be predicted.

Although the health belief model has several limitations, the one that is most relevant to the psychological theory presented above (in the context of evaluating the Partnership’s intervention campaign) is that the health belief model has repeatedly been shown to be a poor predictor of complex behavior.[6] Why then would the Partnership utilize the health belief model in their marketing campaign to address drug use? Although the answer to this question is difficult to answer without input from the Partnership for a Drug-Free America, it can be postulated that the Partnership has consistently failed to incorporate social science theory into their interventions and consequently has failed to capture their target audience. They instead decided to adopt the health belief model as a common model to predict health behavior, not evaluating the efficacy of the model in predicting complex behaviors. Although the Partnership may not be held accountable for their failure to recognize drug use as a complex behavior when they initially produced their interventions (because mainstream psychological theory had not decided until the mid-1980s drug use was a complex behavior), their failure to adapt to new social science theories and abandon the health belief model in constructing illicit drug use interventions cannot be excused for at least the last 20 years.

Marketing Campaign or Just Another Public Health Intervention?

In addition to the failure of the Partnership for a Drug-Free America to recognize that the health belief model cannot readily predict complex health behaviors, they also failed to incorporate more modern marketing theories in their interventions that are generally a better predictor of behavior. The Partnership claims they that are the pioneers who successfully breached the long-existing gap between public health and mass media, but they do not recognize that their advertisements fall short in addressing the problem of illicit drug use among youths because the foundation which produced their memorable yet ineffective messages was wrongly applied.[7]

This once again leads us back to a discussion of the health belief model and its limitations. The health belief model hypothesizes that behavior is based on individual, rational decisions which are not influenced by social or environmental factors. Besides the fact that these characteristics also support the first argument presented above, they also display that the Partnership was largely unaware of the components of a successful marketing campaign based on marketing theory. Marketing theory, almost in direct opposition to the health belief model, is a homogenous approach which concentrates on influencing the behavior of large portions of a population as opposed to individual idiosyncrasies.[8] The pattern that marketing theory follows to achieve this goal is as follows:

• First, they present to the group of people something they want, need, or desire.
• Second, they offer a promise that their product can fulfill the consumer’s newly discovered demand.
• Third, an image is given that reinforces the goals of the audience.
• Lastly, support must be offered to show how the promise will be delivered.[9]

If the marketing theory model explained above is compared to the Partnership’s health-belief model based intervention “This is drugs. This is your brain on drugs. Any questions?”, the distinctions and argument become much clearer. The first step in the marketing theory, which appeals to a groups wants, needs, and/or desires, is successfully addressed in the intervention. No teenager or adult wants their brain to be fried by drugs. It is unclear whether or not they are attempting to address a rational individual, which would indicate a health-belief model based intervention, or a group of people who are predictably irrational (marketing theory). Either way, it is safe to assume that any individual or group regardless of rationality would not want their brain fried by drugs. In terms of the first portion of the marketing theory, the intervention does appear to be successful. This also appears to be the case with the third component, as the strong, memorable image does reinforce the goal of the audience.

If the 2^nd and 4^th elements of marketing theory are discussed within the context of the intervention, one is able to realize that these are the crucial steps within marketing theory that are missing. In the television advertisement, there is no promise or proof that shows an individuals brain will be fried if they use drugs. Teenagers watching the commercial interventions who are considering using drugs may dismiss the strong imagery based on the lack of a promise, and make the assumption that the claim within the commercial is false. Logically the last component of the marketing theory cannot be addressed if the 2^nd is not produced, which indicates that no support is offered by the Partnership which proves the adverse effects of drug use.

Overall, the “This is drugs. This is your brain on drugs. Any questions?” intervention does incorporate elements of marketing theory. It appears as if the Partnership however, when they attempted to merge mass media and public health, was largely unsuccessful in bridging the gap between public health and mass media because they picked up on parts of marketing theory and put it into a health belief model context. Instead, the Partnership should have fully utilized marketing theory as a better predictor of complex behaviors and dismissed the health belief model entirely. By incorporating marketing theory components into the a health belief model based intervention, the Partnership falls short of its goal and the commercial simply becomes another failed attempt to prevent illicit drug use among youths.

Later Intervention: Change or Just the Same?

It is important to mention that the Partnership, after their initial commercial campaign, decided to modify “This is drugs. This is your brain on drugs. Any questions?” commercial campaign to incorporate other public health based behavior models. It is unknown whether the Partnership viewed the early campaign as a failure and decided to change, or whether they felt they could strengthen their already successful campaign to combat illicit drug use among youths. Regardless, it appears as if the Partnership did strengthen their newest mass media product, but still fell short of obtaining the goal because of their reliance on the traditional health behavior models.

The revamping of the 1980s Partnership for a Drug Free America anti-narcotics commercial in the late 1990s features a woman with a frying pan, who smashes an egg after declaring “this is your brain, now this is your brain after you snort heroin”.[10] She continues to destroy the entire kitchen with the pan stating “And this is what your family goes through, and your friends, etc., etc.”.[11] The intervention attempts to portray the outcome expectancies for the viewer(s), perceived social approval, and to strengthen the feelings of the viewer(s) towards the outcomes. These are all important components of the theory of reasoned action, a model similar to the health belief model which integrates outcome expectancies, perceived social approval, and different attitudes and beliefs towards the behavior.[12]

Although interventions based on the theory of reasoned action have more potential than the health belief model to be successful in predicting behaviors surrounding the use of illicit drugs, the Partnership once again fell short in fully recognizing the nature of the problem. Even more so than the original commercial campaign; this commercial relies on those youths considering illicit drug use to be able to make a rational, planned decision. It also does not provide any explanation of the disconnect between intentions and behavior. In other words, impulse behavior is not accounted for within the theory of reasoned action. For example, the contents of the commercial assume that before using drugs the teenager is going to be in a rational mindset to ask questions such as: what is this drug going to do to my brain? How is it going to effect my family and friends? How am I going to feel about myself if I do the drugs?. Several surveys of teens agree, including ones published by the Partnership for a Drug Free America, that drug use is usually not pre-meditated and the decision to use drugs is based on their immediate availability.[13] Teens in these surveys also overwhelmingly agree that they know any kind of drug use is bad (89%), but what is interesting is that over 18% of students nationally are engaging in illicit drug use (alone) according to the Youth Risk Behavior Survey.[14] It is obvious that the decision to use drugs is often not rational, planned, or intended, but instead is based on the disconnect between intention and behavior, which the theory of reasoned action fails to address.

Even though social sciences have a difficult time agreeing on the exact components of the behavior which encompass drug use, they all agree that the decision to engage in the behavior is often not planned, rational, and intended.[15] The partnership does make a better attempt at addressing illicit drug use among youths in their second campaign, but still falls short in assessing the nature of drug use and consequently fails in constructing a successful intervention.

Conclusion: Flaws that Need to be Addressed

The Partnership for a Drug Free America should be applauded for their persistence in attempting to curb illicit drug use among youths from the latter half of the 20^th century until present. But as what often occurs with public health interventions, persistence with the wrong framework and structure leads to continued failure. The Partnership’s over-reliance on traditional health behavior models, such as the health belief model and theory of reasoned action, and their failure to apply marketing principles to a marketing campaign have led to 30 years of misled advertisements, wasted public dollars, and ineffective efforts. Until the Partnership is able to incorporate modern social science theory into their interventions, their efforts are doomed to continuously fall short in reaching out to the youths of America.

Introduction to an Alternative Intervention

Given the fundamental flaws in the Partnership for a Drug Free America’s commercial intervention, it provides a significant opportunity to suggest an alternate intervention which addresses each of the previously addressed flaws and may serve as a guide for a future successful intervention aimed at preventing the use of illicit drug among teens. By creating a commercial based on marketing theory (instead of the traditional health behavior models) which addresses the limitations of the Partnership’s current campaign, more teens at risk of using drugs will be reached if the proposed intervention is implemented.

The Intervention: “Fate” & Positive Choices

To truly understand the context of the proposed intervention, it is imperative to give a short background of the television advertisement it is based upon. A recent commercial by Nike (entitled “Fate), which shows very brief clips of two notable football players, LaDainian Tomlinson and Troy Polamalu, developing into the excellent players they are today is an solid foundation for a public health intervention.[16] As the original commercial displays how these two players were born to be excellent football players, a public health intervention could also portray the same idea. The commercial shows images of the players as children and adolescents, running to class with books in their arms, running up stairs, etc. to portray that they not only worked hard, but were also destined to do what they have done. Nike’s Vice President states “The beauty of this ad is it reminds us of how much hard work, sacrifice, and yes, fate it takes to make it to the top of the sport of football”.[17] The commercial finishes with a dramatic clash of the two players in an actual game.

A public health intervention aimed at keeping adolescents off drugs could use the marketing theory strategies utilized in the Nike commercial. First, the commercial would begin exactly the same; with two athletes born and excelling from youth to adolescence. At this point, the public health intervention would deviate from the actual commercial. It would show one of the players working hard and the other player experimenting with marijuana around high school age. Both players would still be shown at big name colleges, one displayed as scoring a touchdown and the other player who had experimented with drugs as not living up to his potential. It would show them after the game, one getting high fives with people all around him encouraging him, with the other using some sort of illicit drug(s). The last shot would be the football player who worked hard scoring a touchdown on a NFL team, and the drug user in a secluded room alone using drugs. The final message would be “What fate gives, drugs can take away”, in which the famous successful football player (ideally LaDainian Tomlinson because of his clean record and respect he receives from in and out of the NFL) would deliver the message to keep consistent with the Nike message and to directly influence the youth of the United States.

Although the exact representations in the commercial may be improved upon by marketing experts, the basic idea and message of the commercial could be effective according to marketing theory. This intervention could also be extended to other public health interventions (ex. Teen pregnancy) and sports (ex. Women’s basketball) to potentially influence a wider audience.

A Better Predictor of Complex Behavior: An Intervention with Potential

The first fundamental flaw in the Partnership’s commercial campaign is their use of the health belief model, which has repeatedly been shown to be a poor predictor of complex behavior.[18] The proposed commercial intervention, which is based on marketing theory, more accurately recognizes that behaviors surrounding drug use are often complex and cannot be predicted utilizing traditional health behavior models. In fact, one of the strengths of marketing theory is that it accounts for behavior(s) of individuals being dynamic.[19] The commercial involving two football players does not assume that each individual watching makes independent decisions regarding drug use, but instead it attempts to influence the decisions’ of a group of individuals (causing herd mentality) who are considering and/or exposed to drug use. More specifically, the advertisement forces a group of teens to consider the consequences of drug use, but also reinforces the idea that drug use is not acceptable among a group of individuals (NFL players) who teens often aspire to be.

The proposed campaign could be more successful because it does not attempt to simplify behaviors surrounding of drug use. Instead, it realizes that drug use among teens has multiple contributing factors, and does not attempt to address these multiple factors with a model that does not lend itself to doing so. As a result, the intervention based on marketing theory has the potential to be more successful than the original ad campaign in predicting and/or preventing drug use among a large faction of teens who aspire to be NFL football players.

Applying Marketing Theory to Construct a Successful Intervention

In addition to the failure of the Partnership for a Drug-Free America to recognize that their intervention, based on the health belief model, cannot readily predict complex health behaviors, they also failed to incorporate more modern marketing theories in their interventions (which are generally a better predictor of behavior). The proposed intervention however utilizes marketing theory to construct an intervention which has the potential to reach out to teens and more effectively prevent drug use.

Marketing theory, almost in direct opposition to the health belief model, is a homogenous approach which concentrates on influencing the behavior of large portions of a population as opposed to individual idiosyncrasies.[20] The pattern that marketing theory follows to achieve this goal is as follows:

• First, they present to the group of people something they want, need, or desire.
• Second, they offer a promise that their product can fulfill the consumer’s newly discovered demand.
• Third, an image is given that reinforces the goals of the audience.
• Lastly, support must be offered to show how the promise will be delivered.[21]

In regards to how the proposed intervention relates to marketing theory, the goal of the commercial is to tap into the viewer’s desire to become a professional football player (as researched for the original commercial). The promise of the advertisement is that it is possible for those who are naturally gifted to become NFL players, but not for those who use drugs and do not work hard. Ultimately it draws comparisons to the two individuals’ choices, where the one football player chooses to use his natural talent while the other chooses to throw it all away. The supports are the images of the players growing up and making choices, and the apparent success and failure of each player is how the promise will be fulfilled. It is important to note that the commercial also incorporates the social aspect of using drugs and how using drugs can have adverse consequences on relationships.

Therefore, although the Partnership for a Drug Free America does incorporate some aspects of marketing theory, the new ad campaign has the potential to be more successful because it accurately reflects all components of marketing theory instead of just two of them. Teens will be able to see through the players’ choices that the promise of the consequences of using drugs will be fulfilled, and will consequently make better choices when presented with the opportunity to use illicit drugs.

Rational or Predictably Irrational? A Better Model to Prevent Drug Use Among Teens

The third limitation of the Partnership’s drug ad campaign occurred after they had revamped their original campaign. The “revamping” involved using the health belief model to construct an intervention, with the new commercial implementing components of the theory of reasoned action. Although the theory of reasoned action has more potential than the health belief model to be successful in predicting behaviors surrounding the use of illicit drugs, the Partnership once again fell short in fully recognizing the nature of the problem as the new commercial relies on those youths considering illicit drug use to be able to make rational, planned decisions.

Because the recommended ad campaign is based on marketing theory, it does not assume that a teen is going to be able to make a rational, planned decision when considering drug use. Instead, it postulates that behavior is predictably irrational.[22] The proposed intervention exposes a group of teens to an idea and promise that if they decide to use drugs, then they will not be able to succeed in athletics regardless of inherent ability. This could potentially be a much stronger motivator, as teens would see a promise of something they aspire to be fulfilled in the new intervention, whereas in the original intervention no promise is fulfilled.

These components of the proposed intervention strongly support the need for the Partnership to realize that decisions involving drug use are often not planned and rational, but instead are impulsive and irrational. The proposed intervention targets a group of individuals who aspire to be athletes, as opposed to the Partnership’s campaign which fails to address the aspirations and desires of its viewers. Although the proposed marketing campaign may need several commercials to address the different desires and aspirations of different groups of teens, this model has been shown a much more effective predictor of behavior.

Conclusion

Even though the Partnership for a Drug Free America has consistently failed to incorporate social science theory into their interventions, more specifically marketing theory, there is still hope for the Partnership to construct a potentially successful ad campaign in the future. By implementing the proposed intervention, using the Nike “Fate” commercial as a model, many of the fundamental flaws in the Partnership’s original and revamped campaign would be addressed. As a result, the prevention of teen drug use in the United States through commercial ad campaigns would become a reality, and thousands of teens would be able to fulfill their aspirations and desires by choosing not to use drugs.

References

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[1] Partnership for a Drug Free America. Case Studies About the Effectiveness of the Partnership’s Media-Based Educational Campaigns. September 2006. Available at http://www.drugfree.org/Portal/DrugIssue/News/campaign_effectiveness. Accessed Thursday, November 13th, 2008.

[2] Parents. The Anti Drug. Rockville, MD. Natinoal Youth Anti-Drug Media Campaign. http://www.theantidrug.com/drug_info/prescription_tips.asp. Accessed November 13th, 2008.

[3] Pattison, E. M., Sobell, M. B., & Sobell, L. C.. Emerging concepts of alcohol dependence, New York: Springer. 1977. p. 58-63.

[4] Shaffer H.J., Neuhaus Jr. C. Testing Hypotheses: An Approach for the Assessment of Addictive Behaviors. 1985. p. 87-103.

[5] Maddux J., Winstead B. Psychopathology: A Foundation for a New Understanding. 2005. p. 308.

[6] Becker MH, ed. The health belief model and personal health behavior. Health Educ Monogr. 1974;2:Entire Issue.

[7] Partnership for a Drug Free America. Case Studies About the Effectiveness of the Partnership’s Media-Based Educational Campaigns. September 2006. Available at http://www.drugfree.org/Portal/DrugIssue/News/campaign_effectiveness. Accessed Thursday, November 13th, 2008.

[8] Austin EW, Pinkleton BE. Strategic Public Relations Management. Lawrence Earlbaum Associates, Inc., New Jersey. 2001. p. 284.

[9] Siegel M, Siegel LD. Marketing Public Health. 2004. p. 57-58.

[10] Partnership for a Drug Free America. Available at http://www.drugfree.org/Portal/About/NewsReleases/Fried_Egg_Message. Accessed October 2nd, 2008.

[11] Partnership for a Drug Free America. Available at http://www.drugfree.org/Portal/About/NewsReleases/Fried_Egg_Message. Accessed October 2nd, 2008.

[12] Fishbein M, Azjen I. Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research. Reading, MA: Addison-Wesley; 1975.

[13] Partnership for a Drug Free America. Partnership Attitude Tracking Survey. 2003. Available at http://www.whitehousedrugpolicy.gov/publications/pats/final_rpt.pdf. Accessed on Tuesday, November 20^th, 2008.

[14] Youth Risk Behavior Surveillance – United States 2007. MMWR. June 6^th, 2008. Vol. 57. No. SS-4. Available at http://www.cdc.gov/healthyyouth/yrbs/pdf/yrbss07_mmwr.pdf. Accessed on Tuesday, November 20^th, 2008.

[15] Shaffer H.J., Neuhaus Jr. C. Testing Hypotheses: An Approach for the Assessment of Addictive Behaviors. 1985. p. 87-103.

[16] Nike Corporation. “Fate” Available at http://www.nikebiz.com/media/pr/2008/10/09_Fate.html. Accessed Tuesday, October 22nd, 2008.

[17] IBID.

[18] Becker MH, ed. The health belief model and personal health behavior. Health Educ Monogr. 1974;2:Entire Issue.

[19] Siegel M, Siegel LD. Marketing Public Health. 2004. p. 57-58, 204.

[20] Austin EW, Pinkleton BE. Strategic Public Relations Management. Lawrence Earlbaum Associates, Inc., New Jersey. 2001. p. 284.

[21] Siegel M, Siegel LD. Marketing Public Health. 2004. p. 57-58.

[22] Ibid.