Knowledge is Power: Government Funded Abstinence-Only Programs Omit Crucial Information on Sexual Health -Diana Theriault

“Vows of abstinence break more easily than latex condoms (1).” Yet America is still taught to abstain from sex. Education is important. How can anyone make an informed decision when much of the information is not provided? Abstinence-only education is ineffective at preventing many teens from engaging in sex before marriage and only hurts those who do have sex without the knowledge of how to do so safely.
When you think of the word sex, what comes to mind? For many there is a negative connotation that comes along with that word. In America, people don’t talk about sex openly. We keep that part of our lives a secret. It is almost like you have to hide it. Sex should be a topic that everyone is comfortable talking about. This is the first step in having a safe and healthy sexuality. Communication is key in this area. If the only thing we tell the children of America is, “don’t do it,” then what happens if and when they do? Are we just supposed to say, “I told you not to?” No. We should be promoting abstinence, but saying “in the event you do have sex, here is how to protect yourself.” Because when it is all said and done, teenagers are going to have sex whether or not you tell them to.
The data shows that people do have sex before marriage. “The average age of first intercourse is 16.9 for boys and 17.4 for girls (2).” Yet the “average age of first marriage continues to rise. for women the average age is 25.6 and for men it is 27.5 in 2007 (3).” This is a major drawback of these types of programs. We can see that the programs don’t work, that people are still having sex anyway, and many are just ignorant to the way contraception works and how it can protect them. Still, abstinence-only education is valuable right? The following studies show otherwise.
Abstinence-Only Education: More harmful than helpful?
If you think about it, almost everything that we engage in, such as driving a car, jumping on a trampoline, smoking cigarettes, taking prescriptions, swimming in pools and many more, have safety guidelines to abide by. Also in case of an emergency, there are steps to take to prevent any further harm. But why is it that when it comes to sex, we fail to teach those safety guidelines? It’s like throwing someone in the driver’s seat of a car and saying go! If you don’t know how to drive, you don’t know the rules of the road, how to be safe and what to do incase of an emergency, do you really want that person to be behind the wheel? I surely don’t. “In 2005, 37.2 percent of sexually active high school students and 44.6 percent of sexually active twelfth grade students did not use a condom during their last sexual intercourse (4).” Many of them ‘got behind that wheel’ without learning about safety. Unprotected sex can lead to unintended pregnancies and sexually transmitted infections which can lead to other complications. Even more distressing is that, “One-quarter of sexually active adolescents nationwide have an STD, and many STDs are lifelong viral infections with no cure (4).”
A survey from the Kaiser Family Foundation found that young adults want to learn. “They want to know more about how to use condoms, how to recognize the signs of STD and HIV infection, what STD and HIV testing involves, and where they can get tested. They also want more instruction on communicating effectively with partners about sensitive sexual concerns and relationship issues (5).”
Abstinence-only education programs have been funded by the government for many years, however, comprehensive sex education programs have suffered from new restrictions on what can be taught to receive funding. Essentially any program that teaches about contraception has been limited in the funding they can receive under the Bush administration. This allows for more programs that refuse to teach about contraception and safety. If teens want to learn about safety and healthy sexual relationships, shouldn’t we give them guidance?
A study done following over 2000 students from elementary school to middle school and through high school that had abstinence-only education failed to prove that this education is valuable. The study found that there was no difference between those who participated in abstinence-only education versus those who did not. This study confirmed what other studies have already shown. "The most effective programs are those that say abstinence is the best choice but birth control and protection are also worth knowing about (6)." Yet abstinence is still funded heavily by the government. I like the way one woman, Martha Kempner, put it when she said,”Abstinence-only was an experiment and it failed (6)." Failed experiments should not be continued and especially not funded with tax payers dollars.
These programs have not taught our kids properly. Some adolescents even believe they are being safe by using contraception, but they may be using it in correctly. I believe that this proves the point: “One in five young people believe that birth control pills offer protection from STDs and HIV/AIDS. The same amount of people believe that condoms are not effective in preventing the transmission of STDs and HIV/AIDS (5).” If people believe they are protecting themselves or that using condoms won’t protect them from contracting diseases this is a serious misconception. The lack of knowledge about sexual behavior and protection is astounding. I do believe that abstinence is an important thing to teach the young people of America. Children need to develop feelings of self-confidence, independence, and all in all, just grow and mature to make these complicated sexual decisions. But abstinence taught alone leaves people with the knowledge of the dangers of sex but no way to prevent the dangerous consequences.
Not only do these programs fail to educate, but they give out false and misleading information. A report put out by the House of Representatives actually proves that 80% of the curriculum guarantees to contain false, misleading, or distorted information about reproductive health. This false information includes the effectiveness of contraceptives, the risks of abortion, and even scientific errors such as the number of chromosomes that an individual has (7). These things are important. Everyone should know the true facts. How can you make an important judgement like this without having all of the correct information? The same report states that, “youth who pledge abstinence are significantly less likely to make informed choices about precautions when they do have sex (7).”
Community Influence on the Development of Sexuality
Abstinence-only programs teach an ideological view. We set the bar very high when we expect everyone to abstain from sex until marriage. Although this may prevent a few sexual encounters out-of-wedlock, it certainly does not apply to everyone. As kids, we are taught values and morals to live by. As we get older, we discover our own morals and values that we wish to live by. However, when society pushes virginity as the only option, it makes it seem like sex is a bad thing. Therefore, if you have sex, you are bad. This can have social and emotional implications.
Abstinence-only education is an example of the Health Belief Model applied in practice. The Health Belief Model is a theory that suggests that an individual will make a rational decision based on perceived benefits weighed against perceived barriers. It also implies that if a person feels susceptible and that the consequence is severe enough, a person would take action to avoid that behavior (8). Abstinence-only educators believe that if one is taught the severity of consequences and how easily susceptible they are to pregnancy and disease that everyone will abstain. They portray it in such a way that the barriers greatly outweigh the benefits. Even the governments definition of abstinence-only education includes “teaching the social, psychological, and health gains to be realized by abstaining from sexual activity its exclusive purpose (4).” They are trying to prove the benefits of abstinence. These benefits are real, however, we know that decisions are not only based on the individual level alone and so these benefits may not be as important as the beliefs of others for example.
“ ASRH (Adolescent Sexual and Reproductive Health) programming should be approached from an ecological perspective, with the belief that individual behaviors and decisions are not made or practiced in a vacuum, and that social norms and institutions often determine the choices available to most individuals (9).”
There is a large factor of social influence that abstinence only programs come along with. Social norms stereotype men and women as well as heterosexual and homosexuals into different categories. These stereotypes portray “girls as naturally chaste and boys as constantly struggling to control their rampant sexuality and raging hormones (10).” Sexist views put gender roles on men and women. In education like this these stereotypes are taught as facts. The are biological sciences that makes men and women act differently towards sex. This teaches women that if they do express desires and wish to talk about sex, they may be found as promiscuous where men are just generally curious because they have testosterone and it is natural for them to feel these desires (10). This conservative thinking heeds much guilt for women and leaves both sexes uneducated about safety and communication among adolescents. Although gender stereotypes have an enormous impact on teens, stigmas of sexual orientation have an even greater impact. Abstinence-only education programs do not even bring up the subject of homosexuality. This is deliberately left out because programs like these are actually “required by the federal funding guidelines to instruct students that heterosexual marriage is the ‘expected standard’ (10).” Since gay marriage is not recognized nationally in the United States as legal, it is easy to see why the government would leave this discussion out of the program. Because how can you stay abstinent until marriage if you can’t even get married? And we already know that sex out-of-wedlock can be a burden on society so those who do not follow the ‘expected standard’ must also be a burden, right? That is what these programs teach us. It almost allows for discrimination and increases homophobic beliefs which is not right. In society today, everyone should be treated equal regardless of gender, sexual orientation or any other differences we have between us.
As we can see, society and our surrounding communities can greatly influence our views and what we consider social norms. We must adopt a culture open to communication and discussing all sexualities. Teaching teens about contraceptive options, physical differences between men and women, and sexual orientation does not encourage adolescents to go explore what they just learned. We are just providing the facts and allowing them to make an informed decision on their sexuality and bringing about safe options while doing so.
A Violation of Basic Human Rights
Abstinence-only education fails to allow access to basic health information. To educate our children we must provide the full spectrum of options and information. When you hear questions like: “You can’t get pregnant the first time right? Isn’t everyone having sex? Can you get pregnant if you use birth control (11)?,” you know there is much more that teens have to learn before having sex. A person who is in the contemplating stages of having sex should first know their beliefs and feelings about sex. If they feel that they are ready then the next question to ask would be “in what kind of sexual relationship would sexual involvement be comfortable or OK for me (12)?” And when someone is ready to have sexual intercourse they need to be prepared for all of the consequences with that decision including emotional feelings. If kids are not taught the full spectrum of sexual responsibility they can not make informed decisions. Leaving information out or distorting truthful information is harmful to all. Health information should be freely provided and true. By giving out wrong information, these programs are violating our human right to education and information about sexual health.
“Individuals who lack information about sexual and reproductive health care thus also lack the ability to protect themselves from STIs, including HIV/AIDS, and unplanned pregnancy (10).” It is everyone’s right to seek out truthful information. This is why it is not only important for educators to teach the facts, but for parents to divulge all pertinent information as well. Most teens are influenced by many factors when making decisions about health. Parents, peers, and school education are at the top of the list for influencing children on sex. If your peers are taught the same as you, then they are most likely going to base their decisions on the same information you received which does not promote anything but continued misinformation. However, if parents step in, they may be able to influence the child and teach them the right things. Many adults however do not know everything about sex. Even the parent has the right to information and education. That is why it is up to the educators who are supposed to have up to date information on sex and sexual consequences to teach the future of America. Children only learn what they are taught, that is why it is our job to teach, and their right to learn health education.
“Major human rights documents discourage states from limiting access to contraceptives, and other means of maintaining sexual and reproductive health, from censoring, withholding, or intentionally misrepresenting health-related information, including sexual education, as well as from preventing people’s participation in health-related matters, or allowing third parties to do so (10).”
Abstinence-only education violates these rights which has a negative effect mostly on those who do not receive the knowledge. It puts those who do have sex at greater risk for health consequences that they do not even know about, or for that matter, how to prevent negative health effects and unintended pregnancies. Abstinence only education violates the rights of all humans, but has an even greater potential risk in LGBT (lesbian, gay, bi-sexual, and transgendered) individuals and their families by failing to provide “useful and appropriate sexual health information (10).” Men who have sex with men have the highest risk for developing HIV/AIDS (13). These statistics need to be known. Even for those who do not consider themselves gay when they are younger, may realize later in life that they are homosexual or bisexual and should have the facts on both homosexual and heterosexual encounters.
Final Thoughts on Abstinence-Only Education Programs
“The communities should provide access to education about sexual health and responsible sexual behavior that is thorough, wide-ranging, begins early, and continues throughout the lifespan” (14). Such education should give them knowledge about pregnancy, STD's, contraceptives and responsible choices. Abstinence-only education cannot provide this comprehensive education. It should be taught as part of an education program but not as the only program.
A New Perspective
“Comprehensive sex education teaches about abstinence as the best method for avoiding STIs and unintended pregnancy, but also teaches about condoms and contraception to reduce the risk of unintended pregnancy and of infection with STIs, including HIV. It also teaches interpersonal and communication skills and helps young people explore their own values, goals, and options (15).” This type of sex education is important for teenagers to get the full spectrum of knowledge on this topic. Comprehensive sex education have been proven to work (16). Mandates prohibiting educating the youth about the benefits of condoms and contraception make these programs ineligible for federal funding (17). Teens need to learn about all aspects of sexual health to protect them from the dangers of infection and pregnancy. This is something that abstinence-only education cannot provide.
Does Comprehensive Sex Education Provide Benefits?
A concern of many with comprehensive sex education is that it will encourage teenagers to want to have sex at a younger age than they would have had they had abstinence-only education. Research however shows that this is not the case. “Evaluations of comprehensive sex education and HIV/ STI prevention programs show that they do not increase rates of sexual initiation, do not lower the age at which youth initiate sex, and do not increase the frequency of sex or the number of sex partners among sexually active youth (15).” Knowing that these programs do not have an influence on increasing sexual activity of teenagers, we can say that they are not harmful. How though do these programs provide a benefit?
Findings put out by the National Campaign to Prevent Teen and Unplanned Pregnancy, stated that almost all of the comprehensive sex education programs they evaluated had a positive effect on the behavior of teenagers. “In particular, they improved factors such as knowledge about risks and consequences of pregnancy and STD; values and attitudes about having sex and using condoms or contraception; perception of peer norms about sex and contraception; confidence in the ability to say ‘no’ to unwanted sex...communication with parents or other adults about these topics.(18).” Comprehensive sex education is teaching teenagers responsibility, giving them confidence and teaching self-esteem. Not only this but this education is teaching them about risks and prevention. The APA stated, “Based on over 15 years of research, the evidence shows that comprehensive sexuality education programs for youth that encourage abstinence, promote appropriate condom use, and teach sexual communication skills reduce HIV-risk behavior and also delay the onset of sexual intercourse(19).” With all of the evidence shown, it is clear that comprehensive sex education has many benefits and proves to be the superior method to teach teenagers about sexuality.
Influence on Development of Sexuality
Comprehensive education also plays off of the Health Belief Model, although it includes other tools to educate as well. “Rather than trying to deter or frighten young people away from having sex, effective sex education includes work on attitudes and beliefs, coupled with skills development, that enables young people to choose whether or not to have a sexual relationship taking into account the potential risks of any sexual activity (20).” Teenagers need the opportunity to form their own opinions on this subject matter. Have they been taught the consequences of their actions? Have they been taught how to handle such consequences? Do they know where to get support? If one does become pregnant, do they know all the options? Are they emotionally prepared for such consequences? Also, can they communicate with parents and other adults from whom they are educated? There are so many more questions that need to be asked and answered pertaining to sex and the development of sexuality. These questions cannot be answered in an abstinence-only classroom. “Programs designed to prevent pregnancy need to give young women information about pregnancy and opportunities to discuss the topic so that they form opinions. Furthermore, programs should emphasize positive attitudes toward contraception, because effective contraceptive use is shaped by such attitudes and is strongly associated with reduction of pregnancy risk (21).”
Pregnancy is not the only topic discussed in comprehensive sex education. Sexual development, such as physiological, anatomical and emotional changes in puberty are also discussed. For this education to be comprehensive in all aspects it must also include discussions on healthy relationships. “In terms of information about relationships they need to know about what kinds of relationships there are, about love and commitment, marriage and partnership and the law relating to sexual behavior and relationships as well as the range of religious and cultural views on sex and sexuality and sexual diversity (20).” Like I said before, teenagers are going to have sex whether you tell them to or not. Given the tools, teenagers will make the right choice for themselves, and learn about their own sexuality armed with knowledge on how to be safe. The right attitudes and beliefs on sexuality and the known dangers of what sex can be without protection being taught to teenagers is great. Abstinence-only education may be able to provide these things. However, comprehensive sex education goes beyond the concepts in the Health Belief model and brings in the tools needed to develop a healthy sexuality and be safe when engaging in these activities.
Right to Information and a Right to Equality
America has always prided itself on freedom. We are the land of the free. Though many people do not feel this way. Shouldn’t all Americans have the right to decide if and when they want to engage in sexual activity? Abstinence-only education teaches teenagers that this is not a right. One must not engage in such activities until marriage. Well if one doesn’t have that right, than can’t they choose with whom they would like to engage in this activity with? According to abstinence-only education, that too is not a right. By definition marriage is between a man and a woman (22). Which leaves lesbian, gay. bisexual and transgendered teens to believe they do not have the same rights. So if one cannot decide with whom, or when to have sexual encounters, than at least the information on how to be protected and have safe sex is given, right? Wrong again. Contraceptives and other methods of protection are not taught in abstinence-only education programs because teenagers shouldn’t be having sex anyway (23). So when a teenager gets older and maybe does wait until marriage to have sex, do they know how to protect themselves? If never given the information to learn how to fully prepare for sex and the consequences that come with it, physically and emotionally, than no matter how old you get you still are not prepared. Comprehensive sex education prepares you for all of what is to come. You are given the knowledge and information needed to make the right decisions, so when it comes down to it, you can decide if, when and with whom you want to engage in sexual activity with knowing how to stay protected when that decision comes. “State parties must ensure that children have the ability to acquire the knowledge and skills to protect themselves and others as they begin to express their sexuality (23).” These are the rights and freedoms Americans are entitled to.
Culminating Thoughts
Given all of the information about abstinence-only education programs and comprehensive sex education programs, one is clearly able to see the benefits that comprehensive education provides over abstinence-only education. I believe that abstinence is necessary to teach and to instill core values and morals in teenagers. I also believe though that teenagers are rebellious in nature and because they are told not to do something they are more apt to do so. So when educating teens about sex, one should also be taught about contraceptives and how to respect one another’s choices. Whether those choices are to have sex or not, or whom they may choose as a partner, or even how to handle the event of an unintended pregnancy. Developing their own attitudes and beliefs about sexuality is essential. With comprehensive education, one can make an educated decision and learn about sexuality. Comprehensive sex education should be available to all teenagers, it is a right of Americans. Therefore, comprehensive sex education should be funded by the government instead of abstinence-only education. It is important that the children of America have the freedom to make their own choices when it comes to sexuality and they should be guided on how to make the right choices.
REFERENCES
1. Elders, Joycelyn M. “Vows of Abstinence Break More Easily Than Latex Condoms.” Rethinking Schools Online. 2002. Milwaukee, WI. 20 November 2008 <http://www.rethinkingschools.org/sex/elders.shtml>.
2. Guttmacher Instutute. In Their Own Right: Addressing the Sexual and Reproductive Health Needs of American Men. 2002.
3. U.S.Census Bureau. Estimated Median Age at First Marriage, by Sex: 1890 to the Present. 2007.
4. Trenholm C. et al. Impact of Four Title V Section 510 Abstinence Education Programs. Final Report. Princeton: Mathematica Policy Research; 2007. http://www.mathematica-mpr.com/publications/pdfs/impactabstinence.pdf
5. The Henry J. Kaiser Family Foundation. (2003). National Survey of Adolescents and Young Adults: Sexual Health Knowledge and Experiences. http://www.kff.org/youthhivstds/upload/National-Survey-of-Adolescents-and-Young-Adults.pdf
6. Stepp, Laura Sessions. “Study Casts Doubt on Abstinence-Only Programs.” Washington Post. April 14, 2007. http://www.washingtonpost.com/wp-dyn/content/article/2007/04/13/AR2007041301003.html
7. UNITED STATES HOUSE OF REPRESENTATIVES COMMITTEE ON GOVERNMENT REFORM — MINORITY STAFF SPECIAL INVESTIGATIONS DIVISION. “The Content of Federally Funded Abstinence-Only Education Programs: Prepared for Rep. Henry A. Waxman.” December 2004. http://oversight.house.gov/documents/20041201102153-50247.pdf
8. Rosenstock, I. M. (1974). Historical Origins of the Health Belief Model. Health Education Monographs. Vol. 2, No. 4. 328 – 335.
9. Community Pathways to Improved Adolescent Sexual and Reproductive Health: A Conceptual Framework and Suggested Out come Indicators. December 2007. Washington, DC and New York, NY: Inter-Agency Working Group (IAWG) on the Role of Community Involvement in ASRH. http://www.advocatesforyouth.org/publications/iawg.pdf
10. Kay J.K., Jackson A. Sex, Lies and Stereotypes. How Abstinence-Only Programs Harm Women and Girls. Legal Momentum; 2008
11. “Facts & Stats.” The National Campaign To Prevent Teen Pregnancy. 2002. Washington, D.C. 20 November 2008. <http://www.teenpregnancy.org/resources/teens/facts/default.asp>
12. “Sexual Responsibility.” Olin Health Center. 2002. Michigan State University, MI. <http://www.healthed.msu.edu/fact/sexual_responsibility_1.shtml>
13. Centers for Disease Control and Prevention. “A Glance at HIV/AIDS among Men Who Have Sex with Men.” January 2006.
14. “The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior: At a Glance: Vision for the Future.” U.S. Department of Health & Human Services. July 2004. Washington, D.C. <http://www.surgeongeneral.gov/library/sexualhealth/glancetable.htm>
15. Advocates for Youth. “Sex Education Programs: Definitions & Point-by Point Comparison.” Accessed on December 6, 2008. http://www.advocatesforyouth.org/rrr/definitions.pdf
16. Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2001.
17. American Foundation for AIDS Research. Assessing the Efficacy of Abstinence-Only Programs for HIV Prevention among Young People. [Issue Brief, no. 2] Washington, DC: Author, 2005.
18. Kirby D, Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases, Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy, 2007, p. 4, Accessed Dec. 6, 2008. http://www.thenationalcampaign.org/EA2007/EA2007_full.pdf
19. American Psychological Association (APA). (Feb. 2005). “Comprehensive Sex Education is More Effective at Stopping the Spread of HIV Infection.” Accessed December 8, 2008. http://www.apa.org/releases/sexeducation.html
20. Avert: AVERTing HIV and AIDS.“Sex Education that Works.” Accessed on December 8, 2008. http://www.avert.org/sexedu.htm
21. Perspectives on Sexual and Reproductive Health, Vol. 36, No. 6, Findings from Add Health (Nov. - Dec., 2004), pp. 248-257 http://www.jstor.org/stable/1520257 Accessed Dec. 10, 2008
22. "Marriage." Merriam-Webster Online Dictionary. 2008.Merriam-Webster Online. Accessed December 10, 2008 <http://www.merriam-webster.com/dictionary/marriage>
23. Santelli, John S., MD, MPH, Schleifer, Rebecca, JD, MPH, and Lande, Lila J., MPH. “Abstinence and U.S. Abstinence-Only Education Policies: Ethical and Human Rights Concerns.” Accessed on December 10, 2008. http://www.protectchoice.org/downloads/Reproductive%20Justice%20Briefing%20Book.pdf

Connecticut “Make Healthy Fish Choices” Campaign-Amanda DeLoureiro

On October 16, 2008, the Connecticut Department of Public Health and the Connecticut Food Association began publicizing a statewide campaign entitled “Make Healthy Fish Choices” (1). This campaign is geared towards women and children, and its purpose is to educate people about the health benefits and dangers of consuming different varieties of local and store-bought fish (1). This has involved the publication in English and Spanish of take-home cards entitled “Healthy Fish Choices for You and Your Family”, which are being distributed in participating supermarkets and grocery stores statewide (1). The cards contain information specific to pregnant women, nursing women, women of child-bearing age, and young children about the health merits and dangers of eating fish, and suggestions about how often different types of fish should be consumed (2).
Problems of the “Make Health Fish Choices” Campaign
The “Make Healthy Fish Choices” campaign is a clear example of an intervention that follows the Health Belief Model. This model is based on the idea that an individual’s perceptions regarding health behavior are rational, and an intervention can be used to alter the attitudes of the individual (3). This particular health behavior intervention focuses on changing how individuals view their perceived susceptibility, or the degree to which they think they are at risk of getting sick from the toxins found in many fish (4- 37). There are three main problems with this type of an intervention based on the Health Belief Model, in addition to a major problem with how the issue of fish contamination is being framed through this campaign. First, this intervention focuses on individual-level decision-making, and does not take into account the fact that there are environmental factors that can also affect decisions that people make about the consumption of fish (4-38). Secondly, this campaign assumes that everyone in Connecticut will have equal access to the information provided in the guides, which is untrue because of the large segment of the population that is not literate in English or Spanish, and will not understand all of the vocabulary presented in the document (4-38). Thirdly, this intervention assumes that those affected by the campaign will make rational decisions about their consumption of fish, and in doing so discounts the impact of cultural norms on choices regarding fish consumption (4-38). Lastly, this campaign frames the issue of contaminated fish in such a way that it ignores the root cause of this problem, pollution, and instead focuses on what the consumer can do to decrease the health risks associated with consuming this fish. The “Make Healthy Fish Choices” campaign should have done two major things differently: 1) it should have been modeled after a different type of health model that was more community-based, in order to address the influence of outside impacts like culture on behavior, and 2) it should have framed the issue in such a way as to address the root causes of fish contamination in Connecticut.
Individual-level decision-making ignores outside influences on behavior
A major problem with the “Make Healthy Fish Choices” intervention is that it is targeted at the individual, and was not developed to address social and environmental influences on behavior related to health. This campaign involved only a handout that was read by an individual person, instead of a more community-based effort that would address outside influences on diet, such as cultural norms. The focus on the individual person that is used in this campaign, like the example set forth in other interventions based on the ideas of individual-level models like the Health Belief Model and the Theory of Reasoned Action, reflects the value that North American and Western European cultures place on individualism (5). These societies are very focused on the concept that individuals have complete control over their behavior and decision-making, and in doing so tend to overstate the influence of personal behavior on health (5). Most of the original behavioral health models were built on various assumptions, such as 1) the individual is the key decision maker, 2) individuals value good health and will change their behavior in order to attain positive health outcomes, and 3) cognitive predisposition, like beliefs, attitudes, and perceptions, are a major driving force of health behavior (6-5). All of these assumptions are not inherently correct, because they ignore other influences that may impact individual decision-making and make people choose unhealthy habits, like consuming large amounts of contaminated fish. This intervention ignores the extent to which pre-existing beliefs, attitudes, and perceptions regarding fish consumption may counteract the information being put forth in the pamphlet.
In recent decades, researchers have begun to question the validity of relying solely on health behavior models that are based on individual-level decision-making in achieving substantive and sustainable changes to health behavior (6-6). It is thought that many individual-level models, like the Health Belief Model, do not lead to large-scale behavioral change because they are focused on changing the behavior of individuals. More recently developed models have focused on community-based campaigns, through which it is hopeful that norms within an entire community of people will be changed to encourage more healthy behaviors (6-6). Whereas the “Make Healthy Fish Choices” campaign focuses on changing individual perceptions of the health risks involved with fish consumption, community-based initiatives would prioritize changing the perception of an entire population regarding these health risks. Instead of focusing solely on the individual, health behavior campaigns should recognize the impact that factors like community, living and working conditions, and socioeconomic, cultural, and environmental impacts have on decisions people make about their health (5). It is doubtful that this intervention, based on the Health Belief Model, will be adequate to initiate widespread behavioral change in this case because the change for which the campaign is advocating ignores contextual meanings that are entrenched in group qualities, for example cultural practices, skills, and languages (3). Instead, the campaign would have been wise to take into account the outside influences that can significantly impact the choices that people make regarding fish consumption.
Lack of access of information to low literacy populations
Another major problem with this campaign is that the information about healthy consumption of fish is only offered in the form of a written handout. There are two major problems with this document that may inhibit access to the information provided: 1) it is available in only English and Spanish and 2) it makes use of scientific vocabulary. The availability in only two languages is of concern because in Connecticut, 12.9% of the population is foreign born and this number is predicted to rise in the coming decades (7). The large proportion of immigrants contributes greatly to the percentage of the adult population of Connecticut that is not literate in English. In 2001, 16% of Connecticut’s adult population was in the lowest of five literacy levels, which means that this group of people will be unable to understand the information as it is currently being presented (8). This segment of the population will not fully comprehend the suggestions being made, nor are they apt to know the different types of fish that are listed.
Populations with low literacy face various problems properly understanding health risks, including inadequate comprehension of available health education material, social networks that are not well-informed regarding health problems, and inadequate access to health services (9). A previous intervention geared at addressing the health needs of low literacy populations designed a book which promoted understanding through color coding, graphic symbols, simple language, and clear type (9). The “Make Healthy Fish Choices” intervention did not follow this example, and instead presented health-related information using extensive vocabulary, including words like “PCBs” and “omega-3 fatty acids”, in a manner that was not very clear (2). Low levels of literacy in a large proportion of Connecticut’s population, coupled with low understanding of scientific concepts, means that this intervention provides information in a way that many Connecticut residents will not fully comprehend.
Assumes people will make rational decisions without considering cultural practices
Another major problem with the “Make Healthy Fish Choices” campaign is that it assumes that people will make rational decisions without considering other factors that may have a significant impact on fish consumption, such as cultural practices. The Health Belief Model is known to ignore these outside impacts and instead focus on affecting how the individual makes decisions related to health (4). However, there are many groups of immigrants in Connecticut whose diet is composed of a large quantity of fish that may not, even given the information, choose to change their dietary habits. For example, between 2000 and 2006, the Brazilian population of Connecticut grew 82%, from 10,379 to 18,871 (7). Due to its large coastline, vast rivers, and the influence of Portuguese conquistadors who brought their dietary practices to the new world, the diet of many Brazilians includes a large amount of fish (10). Although the diet of this population may be altered due to the influence of living in the United States, diets of particularly the new immigrants cannot be expected to change dramatically with an individual-based intervention like the “Make Healthy Fish Choices” campaign. This intervention provides information that goes against the Brazilian’s cultural norms of consuming large quantities of fish, and yet it is questionable whether this information will be strong enough to change people’s perception of the health risks related to consuming fish. Many immigrant populations, particularly recent immigrants, tend to live in communities that have large populations of others from their country, as well as markets with food from their country. In order to change dietary norms for groups such as this, it would be necessary to create an intervention to address an entire population of people like the recent Brazilian immigrants.
Downstream approach that ignores the cause of the pollution
Another key problem with the “Make Healthy Fish Choices Campaign” is that it focuses on providing information to fish consumers about the dangers of fish consumption, instead of framing the issue in such a way that it places blame on the companies that contribute to the pollution of Connecticut’s fish. In Connecticut, 75% of fish samples taken have mercury levels that exceed the safe limit for women (0.13 ppm), with an average of 0.42 ppm (11). Sampling in Connecticut waters of specific fish species, such as smallmouth bass and certain predator fish, have found that 100% of fish exceed the safe mercury levels for women (11). Much of this mercury comes from businesses along the rivers of Connecticut, such as power plants. In order to reduce mercury pollution in the rivers of Connecticut, the state passed a law in 2003 that limited emissions to 0.6 pounds of mercury per trillion Btu, or 90% efficiency (11). However, the pollutants in Connecticut rivers do not originate solely in the state of Connecticut, as the Connecticut River estuary includes parts of the states of Massachusetts, Vermont, and New Hampshire.
The intervention as it currently stands does not address the underlying causes of pollution of fish from sources like coal fired power plants, and instead focuses on putting the responsibility of healthy fish consumption on the individual consumer. Institutional framing is the way that public health practitioners can social construct risk (12). In this case, the issue should be framed in such a way that people see the corporations from throughout New England that they are polluting their fish and their water as an enemy, so that they become angry with this group and hopefully work to initiate change. The Connecticut Department of Public Health should make use of the frame-alignment process, which involves linking individuals and social movement organizations with the same set of interests, values, and beliefs (12). In framing the issue in this way, the department could help to initiate a movement for change that would ultimately affect all people who consume fish from the waters of Connecticut.
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Alternative intervention
An appropriate alternative intervention will need to address the problems associated with the Health Belief Model, as well as the root cause of water pollution that is resulting in the contamination of fish. The proposed intervention would provide educational programming to people throughout Connecticut, which would teach them about the dangers of consuming certain types and amounts of fish, and also about the causes of water and subsequent fish contamination. The education programs would be advertised in and provided in local libraries, schools, and religious organizations, in order to reach a large segment of the population. The information would need to be provided in such a way that it addresses the needs of individual communities, consequently there would be a need for flexibility so that each presentation of the information would be designed for people of different backgrounds and cultures. The intervention would also provide people with a form to send to their government representatives about the environmental hazards associated with water pollution and its effects on fish. It is hopeful that this would cause a significant change in policy, and encourage the government to properly address the root cause of fish contamination.
This intervention would address the major problems associated with the Health Belief Model that have been previously outlined. Firstly, it is a community-based intervention that is aimed at changing the behavior of a population, not specific individuals. Secondly, the intervention would educate low-literacy groups of people because the information would be provided verbally. Finally, this intervention would address the need for information to be presented in a culturally sensitive manner, by altering the presentation to speak to the cultural dietary norms of each represented population.
It is also hopeful that, by providing information about the causes of water pollution, and by giving people forms to send to their representatives, they will bond together in order to fight major contributors to water pollution. This intervention would be much more successful than the “Make Healthy Fish Choices” campaign because it 1) deals with the problems associated with the Health Belief Model and 2) properly frames the issue in such a way that the root cause of fish contamination is addressed.
Group-level intervention addresses outside influences on behavior
One major problem with the “Make Healthy Fish Choices” intervention is that it focuses on changing the behavior of individual people and ignores the influence of groups on behavior. Some of the more recently developed behavioral theories have emphasized that groups are different than simply a collection of individuals, and that groups of individuals can be affected at the same time (13). One example of how the emphasis in social behavior models has been altered to address the needs of groups is seen in the Social Expectations Theory, which states that people act in mass based on the prevailing social norms (13). Thus, interventions based in the Social Expectations Theory attempt to alter the social norms of an entire group of people (13). For example, an intervention in Finland that made smoking in the workplace illegal was found to be successful at changing social norms, so that non-smoking at work is now seen as normal behavior in this nation (14).
The proposed intervention can be similarly productive because it addresses behavior change at the level of the community instead of at the level of the individual by having members of a population learn about and discuss the causes and implications of fish contamination. It is hopeful that, though discussions in the education programs and follow-up conversations with their peers, citizens of Connecticut will come to see the consumption of reduced amounts of fish as a societal norm.
Provides information to low literacy populations
Another major problem with the “Make Healthy Fish Choices” campaign is that it assumes that people will have equal access to the information provided in the pamphlets, when in reality low literacy populations will be unable to adequately understand the suggestions being put forth. One study of functionally illiterate populations made the suggestion that preexisting health literature should be extensively reviewed by assessing readability and comprehensibility, editing written material, and evaluating the effectiveness of less complex written documents (15). The researchers found changing the educational intervention so that used less complex language and an easy to read format made it more effective in addressing the needs of low literacy readers (15).
The proposed intervention goes even further than the previous example, as it properly addresses the difficulties in comprehension associated with low literacy populations by educating people through verbal presentations. These presentations will be made in different languages depending on the needs of individual populations, and will provide universal access to the information to all people who attend the education sessions.
Considers cultural practices
Another problem with the “Make Healthy Fish Choices” campaign is that it assumes that an individual’s intention to reduce fish consumption, as a result of an educational intervention, will actually result in behavior change. However, this ignores the impact that cultural norms have on diet, such as the example of Brazilian immigrants discussed in a previous section. The proposed intervention addresses the needs of people of very different cultures by encouraging public health professionals to be flexible in how material is presented based on the needs of varying communities. The results of a previous study that looked at the effects of socio-cultural factors on food selection practices suggest that in order to provide information about food in a culturally sensitive manner, public health professionals need to 1) incorporate cultural information into education approaches, and 2) incorporate the entire household in educational programs (16).
The proposed intervention is designed in a way that will be sensitive to the dietary norms of different cultural groups, even recent immigrant populations, by including cultural information in the programming and by encouraging all members of a household to attend. For example, if public health practitioners wanted to address fish consumption in the growing Brazilian population in Hartford, they might teach people how to incorporate other types of meat into recipes that traditionally have fish. In this way, the behavior of a population that has distinct cultural norms regarding food can be changed by encouraging slightly altered behavior that is sensitive to that population.
Addresses cause of pollution
The final strength of the new intervention is that it deals with the issues associated with the consumption of contaminated fish by addressing the root cause of this problem, which is water pollution from industrial waste. It does this by giving participants of the education programs the opportunity to fill out a form to be sent to their governmental representative, which would outline the problem and the changes that would be necessary to reduce fish contamination. This method makes use of framing theory, which states that an issue can be seen from many perspectives and can be viewed as having implications for many considerations (17). Interventions of this kind use framing to reorient how people think about a certain issue (17). Framing theory has been successful in many public health interventions, the most notable being the anti-tobacco Truth campaign. This intervention frames tobacco smoking in such a way that it encourages young smokers to have anti-industry attitudes towards producers of cigarettes (18). A study in 2004 found statistically significant increases in anti-industry attitudes among youth since the Truth campaign was introduced (18).
The proposed intervention is similar to the Truth campaign in that it encourages the general public to speak out against producers of fish pollutants. It frames the issue in such a way that contaminated fish are not simply a food that they should avoid, but also a problem that they can work to prevent.
Conclusion
The “Make Healthy Fish Choices” campaign of informational handouts regarding the benefits and health risks related to fish consumption is not efficient in relaying this information to the general public of Connecticut. This intervention, which is based on the Health Belief Model, is poor because it is based on an individual-level model of decision-making, ignores problems that people may face in accessing the information, and assumes that citizens will make rational decisions about fish consumption once provided with information. Additionally, this intervention ignores the root cause of the need for the campaign, which is water pollution, and instead focuses on changing consumer behaviors.
In order to be a more effective intervention, the Connecticut Department of Public Health needs a campaign that addresses the significant problems associated with the Health Belief Model in a way that encourages Connecticut residents from all backgrounds to want change from corporations polluting local bodies of water. The proposed intervention would address the flaws of the existing campaign by creating a community-based initiative to address the needs of Connecticut’s diverse population in a linguistically and culturally sensitive manner, while also addressing the underlying cause of the fish pollution.
Works Cited
(1) Connecticut Department of Public Health. Connecticut’s Fish Consumption Advisory and the Safe Eating of Fish Caught in Connecticut. 7 Nov 2008. http://www.ct.gov/dph/cwp/view.asp?a=3140&q=387460&dphNav_GID=1828&d phPNavCtr=#47464.
(2) Connecticut Department of Public Health. State Health Department “Reels-In” Fish Eaters. 16 Oct 2008. http://www.ct.gov/dph/cwp/view.asp?A=3294&Q=425142.
(3) Thomas, Linda W. A Critical Feminist Perspective of the Health Belief Model: Implications for Nursing Theory, Research, Practice, and Education. Journal of Professionalism 1995; 11(4): 246-252.
(4) Edberg, Mark. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Boston: Jones and Bartlett Publishers, 2007.
(5) Marks, David F. Health Psychology in Context. Journal of Health Psychology 1996; 1(1): 7-21.
(6) DiClemente, R., Corsby and R., Kealer, M., Eds. Emerging Theories in Health Promotion Practice and Research. San Francisco: Jossey-Bass, 2002.
(7) Mejia, Rafael and Canny, Priscilla. Immigration in Connecticut: A Growing Opportunity. Connecticut Voices for Children. Oct 2007.
(8) Gelb, Jennifer. Summary of Connecticut Plan for Adult Education and Family Literacy. OLR Research Report. 16 February, 2001.
http://www.cga.ct.gov/2001/rpt/olr/htm/2001-r-0198.htm.
(9) Berger, David, Moira Inkelas, Sonya Myhre, and Alanna, Mishler. Developing Health Education Materials for Inner-City Low Literacy Parents. Public Health Reports 1994; 109(2): 168-172.
(10) Fish, Warren R. Changing Food Use Patterns in Brazil. Luso-Brazilian Review 1978; 15(1): 69-89.
(11) US Public Research Group Education Fund. Reel Danger: Power Plant Mercury Pollution and the Fish We Eat. Aug 2004.
(12) Zavestoski, Stephen, Kate Agnello, Frank Mignano, and Francine Darroch. Issue Framing and Citizen Apathy Toward Local Environmental Contamination. Sociological Forum 2004; 19(2): 255-283.
(13) Siegel, Michael. SB 721 Class Lecture. 9 October 2008.
(14) Heloma, Antero and Jaakkola, Maritta S. Four-year follow-up of smoke exposure, attitudes and smoking behavior following enactment of Finland’s national smoke- free work-place law. Addiction 2003; 98: 1111-1117.
(15) Horner, Sharon D, Dawn Surratt and Sarah Juliusson. Improving Readability of Patient Education Materials. Journal of Community Health Nursing 2000; 17(1): 15- 23.
(16) Gittelsohn, Joel and Vastine, Amy E. Sociocultural and Household Factors Impacting on the Selection, Allocation and Consumption of Animal Source Foods: Current Knowledge and Application. Constraints on Animal Source Food Consumption 2003; 4036S-4041S.
(17) Chong, Dennis and Druckman, James N. Framing Theory. Annual Review of Political Science 2007; 10: 103-126. (18) Thrasher, JF, J Niederdeppe, MC Farrelly, KC Davis, KM Ribisl, and ML Haviland. The impact of anti-tobacco industry prevention message in tobacco producing regions: evidence from the US truth campaign. Tobacco Control 2004; 13: 283-288.

“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.