Above the Influence, Out of Touch: A Missed Opportunity to Affect Behavior Change on a Scale Broader than Individual Level – Erin Twohig

Introduction

Above the Influence (1) is a national anti-drug and anti-marijuana campaign designed to get kids to avoid starting and to stop doing drugs. The centerpieces of this effort are national television and print ads as well as an associated website. A typical ad for this campaign depicts a teen who “fits in” to a billboard with a range of school scenes but chooses to walk around one depicting using drugs. Although this campaign has some strengths, such as utilizing popular social networking sites to create networks for adolescents who do not use drugs, the premise of the ad campaigns is faulty and perhaps counter-productive from a behavioral science standpoint. The above the influence website describes itself as “this site helps you to be more aware of the influences around you, and [helps] you carefully consider the risks when you're faced with tough decisions.” (2)

            This campaign is educating adolescents about the risks of using drugs and the pro-drug influences they are exposed to. This intervention has been based on the premise that if adolescents are aware of risks associated with drug use then they will be less likely to use drugs, classically based on the Health Belief Model. (3) Notably, this campaign also uses elements of the Theory of Reasoned action, which emphasizes the importance of social norms in making individual level choices. (4)  Although this campaign clearly considered social science theory in the development of this behavior change intervention, there are fatal flaws in the choice and application of theory.

            The fatal flaw in application is that using these theories fail to take into account the extent of non-fact and non-rational motivations to initiate behaviors. Due to this lack of understanding, the campaign provides reasons not to succumb to the influence of peers but does not provide skills that adolescents can use to overcome these influences. Another fatal flaw is that this ad campaign addresses this issue at an individual level, asking kids to individually say no to their friends. It is a difficult task to rebel against one’s own peers. Finally, because it is telling kids to resist peer pressure, it is actually reinforcing the stereo-type that your friends want you to do drugs and that doing drugs is a way to fit in.

 

Overestimating the Rational Nature of Behavior

 

Interventions that have been successful at targeting resistance to peer-pressure to initiate negative health behaviors have not neglected how powerful peer influences are on adolescent behaviors. A different individual behavior change model, Social Learning Theory, recognizes that learning occurs through observation and repetition of behavior. It then takes advantage of this fact to change behavior. (5) This has been successful in interventions where adolescents were taught in seminars to develop the skills to resist peer influence and this “success depends on working with socially interactive groups” (6) This method is powerful because it teaches adolescents within their peer environment, the environment in which they will eventually make the choice to initiate or resist the behavior. In his book, Predictably Irrational, Dan Ariely describes how research shows that despite intentions to choose healthy behaviors in other setting, when actually in a high pressure decision making setting, people have limited ability to predict how they will react. (7) Through practice of skills to avoid smoking, this intervention acknowledges the strength of such pressures in the peer environment, giving adolescents a better chance of avoiding the negative behavior.success depends on working with socially interactive groups” 6) This method is powerful because it teaching adolescents in their peer environment, the environment they will eventually make the choice to initiate or resist the behavior. In his book, Predictably Irrational, Dan Ariely describes how research shows that despite intentions to choose healthy behaviors in other setting, when actually in a high pressure decision-making setting people have limited ability to predict how they will react. 7) Through practice of skills to avoid smoking this intervention acknowledges the strength of such pressures in the peer environment, giving adolescents a better chance of avoiding the negative behavior.

Although focusing on influences has had success in developing anti-tobacco interventions, there are fundamental difference between the successful anti-tobacco intervention and the Above the Influence campaign. In the Above the Influence campaign, print and media ads merely show adolescents that pressure to do drugs exist, then tries to convince them that the behavior is not worth fitting in. However, in contrast to the above intervention with some measure of success in preventing smoking, merely pointing out peer influence has not been shown to be successful in helping adolescents to resist pressure. (8) This is especially true when the intervention does not provide any useful skills to accomplish this difficult task.

 

The Use of Individual Level Behavior Change Models versus Countermarketing

            In the Above the Influence Campaign, the behavior change emphasis clearly lies on youth resisting peer-pressure, thus this is an individual behavior change model. This differs drastically from a very effective campaign, Florida’s Truth campaign, which aimed to change social norms, thus directly impacting the influences on behaviors. (9) In this model, instead of telling youths that they must resist social norms, it actually aimed to change those social norms.

 

            A study of the impact of the Florida intervention showed that after the national intervention teens were significantly less likely than other teens in the nation to have smoked in the past 30 days or to have ever tried smoking. (10-11) Also, youths in Florida had less favorable beliefs than those nationwide about the tobacco industry even though their beliefs about the social and physical effects of smoking were still similar. Since this intervention focused on rebranded corporate tobacco messages to encourage adolescents to rebel against tobacco companies not the health effects of smoking, this is a good indication that the intervention was responsible for the change in attitudes.

 

            The success of this “anti-manipulation strategy”(10) versus less successful interventions targeting individual resistance to peer pressure (6) may be a good indication that changing social norms has a larger impact than trying to impact the behavior of one adolescent at a time. Given how powerful the desire to “fit-in” as an adolescent is, behavior interventions whose primary aim is to circumvent this powerful desire are likely to be of little use

Reinforcing Stereotypes through the Portrayal of Peer Influences

            Finally, and perhaps most importantly, this ad campaign consistently portrays a friend offering drugs to another friend. This series of commercials may in fact be reinforcing a stereotype that teens do drugs, rather than fighting it. This is directly counter to the most effective type of teen behavior change intervention as seen above (10). By reinforcing the drug-using-teen stereotype this ad campaign is likely to do harm and might be expected to increase rather than decrease teen drug use.           

            In the experience of anti-tobacco advertising, a mismatch of advertising message leads people to “responded with defiance, denial, and other counter-productive behaviors.”(12) There is a strong indication of mismatch of message with target audience with the Above the Influence campaign due to the proliferation of counter-message websites and videos on the web. Above the Influence of Ignorance is one such counter message website, that appears just beneath abovetheinfluence.com in a Google search for the campaign.(13) A YouTube search of Above the Influence seems to yield far more counter ads made by youth than it will yield Above the Influence Ads.

            Adolescents in this country are sending a clear message about what they think about this ad campaign. Another counter website, Highabovetheinfluence.com, is produced by the National Coalition to Remove Misinformation from Media Campaigns. (14) This campaign is clearly not well received by its target audience and there is even a contingent who feels the Above the Influence ads spread misinformation. In order for public ad campaigns to make change in the population, it is clearly a prerequisite that the public trusts and believes the messages in the ads. Without this trust, society will not listen to ad campaigns. This campaign is not only ineffective but is clearly damaging public trust in public health advertising.

            Alarmingly, but not surprisingly then, a five year study conducted by a government contractor found that among current non-using teens " greater exposure to the campaign was associated with weaker anti-drug norms and increases in the perceptions that others use marijuana.”(15) When teens watched these ads, they were more likely to think that other teens did drugs, thus a strong indication that these ads reinforced the negative stereotype. This makes it even harder for youth to be “above the influence” as these very ads have strengthened the influence it seeks to have youth resist. Truly there is more harm than good being done with this campaign.

 

Paper 4 : Building a youth anti-drug counter marketing campaign

The Intervention

This intervention will use social learning theory to develop programs that can teach youth the skills required to choose not to do drugs. This will be modeled after successful school based anti-tobacco programs. However, the core of this intervention will be a national ad campaign based on the same counter-marketing theory that the Truth campaign was based on.

This campaign will use professional marketing consultants to take advantage of the successes of commercial advertising. Also critical, the campaign will employ significant formative research to test potential messages with the target population, teenagers. The campaign will use monitoring and evaluation techniques throughout the campaign. This will ensure that the campaign is accomplishing its stated goals and lend accountability to the program.

Addressing the Irrational Nature of Behavior

 

This intervention will recognize that behavior is not rational and that peer influences are powerful determinants of behavior. This holds true even if the pressure is toward a behavior that is well-known to be harmful. (7)  This intervention will develop a school based corollary to the national ad campaign that reinforces the main messages of the campaign. This school-based component of the intervention will take advantage of the insight of Social Learning Theory, that learning occurs through observation and repetition of behavior. (5) These school seminars will be piloted and employ significant monitoring and evaluation to ensure that it is accomplishing its goals. Only when these small group interventions are successful at changing both attitudes and behaviors will they be implemented at a broader level. The failure, and indeed counterproductive nature of Above the Influence highlights the need to pilot and demonstrate effectiveness before investing substantial resources in that program.

In these seminars, students will learn to develop the skills to resist peer influence in socially interactive groups. (6) Stressing that peer influence are unhealthy has not been successful in helping adolescents to choose healthier behaviors. (8) This method acknowledges the strength of peer influence by teaching adolescents within their peer environment. By giving teens the skills required to resist drug use and teaching them to use these skills with their peers, this intervention is likely to succeed where the above the influence campaign failed. success depends on working with socially interactive groups” (6). This method is powerful because it teaching adolescents in their peer environment, the environment they will eventually make the choice to initiate or resist the behavior. In his book, Predictably Irrational, Dan Ariely describes how research shows that despite intentions to choose healthy behaviors in other setting, when actually in a high pressure decision-making setting, people have limited ability to predict how they will react. 7) Through practice of skills to avoid smoking, this intervention acknowledges the strength of such pressures in the peer environment, giving adolescents a better chance of avoiding the negative behavior.

 

Counter marketing: A tool to bring about societal level change

In this intervention, the higher level theory to be used is counter marketing, a corollary to marketing theory. This theory seeks to change behavior by changing or “rebranding” the image that is currently associated with a behavior or product. Changing the peer environment changes behavior by impacting societal not individual level factors. (5)

One lesson that emerged from the Truth campaign, a successful user of counter-marketing, is that quality formative research with the target population of the intervention is critical. According to the CDC counter-marketing manual, the success of this method depends on understanding the culture, behavior, motivation, interest, and need of target audiences. (15) This campaign will take advantage of qualitative and quantitative research methodologies to ensure that messages developed resonate with youth in the intended manner. Formative research with youths will look to youths for negative stereotypes toward drug use that will not cause youth to rebel counterproductively. (11) Then the intervention will attempt to promote those unappealing stereotypes instead of the message that drugs make you “fit in.”

           

 

Creating new stereotypes to reduce the allure of drug use

This paper previously discussed the ability of  national ad campaigns to impact stereotypes which impact behavior. Potential ads will attempt to recognize and avoid the problem of mismatching message and audience (12). The well matched ad campaign will also function to rebuild the trust that the public needs to have in order for public ad campaigns to make change in the population. Therefore, the ad campaigns developed must have a well matched message to the target audience, avoid rebellion to the message, and convey trustworthiness to its audience. Messages must ring true.

Conclusion

            Models of behavior at a societal norm level, used effectively in marketing of consumer products, would be a better fit for modifying behavior change in young adults. Telling adolescents about the health effects of drug use has not been shown to be very effective. However, as in the Florida Truth campaign, the rebranding of images to encourage a rebellion against the negative health behavior resonates effectively with teenagers. (9) By using a strategy similar to the Truth campaign to change social norms instead of fighting them on an individual level, a national ad campaign to reduce drug use among teens would be more likely to succeed than Above the Influence. Creating a new stereotype could be analogously successful to the Florida model if successful targets for counter marketing could be found through extensive formative research with the target audience.

 

           

References

1.            National Youth Anti-Drug Media Campaign. “Above the Influence.” Office of National Drug Control Policy. accessed 4 April 2009 .

2.            National Youth Anti-Drug Media Campaign. “About this site.” Office of National Drug Control Policy. accessed 4 April 2009 .

3.            Rosenstock, I. (1974). Historical origins of the health belief model. In Health Education Monographs. 2, 328-335.

4.            Salazar, M. (1991). Comparison of four behavioral theories. AAOHN Journal , 39, 128-135.

5.            Edburg, M. (2007). Essentials of Health Behavior. Sudbury: Jones and Bartlett Publishers.

6.            Reid, Donald. (1999). Failure of an intervention to stop teenagers smoking. BMJ, 319, 934-935.

7.            Airely, Dan. (2008) Predictably Irrational. Harper Collins Publishers.

8.            Bruvold WH. A meta­analysis of adolescent smoking prevention programs. Am J Pub Health 1993;83:872­80.Hicks JJ. (2001) The strategy behind Florida’s “truth” campaign. Tobacco Control. 10, 3-5.

9.            Bauer UE, Johnson TM, Hopkins RS, et al. (2000) Changes in youth cigarette use and intentions following implementation of a tobacco control program: Findings from the Florida Youth Tobacco Survey, 1998-2000. JAMA. 284, 723-728.

10.            Niederdeppe J, Farrelly MC, and Haviland ML. (2004) Confirming “truth”: More Evidence of a Successful Tobacco Countermarketing Campaign in Florida. AJPH. 94(2), 255-257.

11.            Wolburg, Joyce. (2004) The need for new anti-smoking advertising strategies that do not provoke smoker defiance. Journal of Consumer Marketing. 21(3) 173-174.

12.            AbovetheIGNORANCE. “Live above the influence of Ignorance, Marijuana & Hemp Fact.” 2009 accessed 5 April 2009 .

13.            National Coalition to Remove Misinformation from Media Campaign. “High Above the Influence.” 2009 accessed 5 April 2009.

14.            United States Government Accountability Office. August  2006. “Report to the Subcommittee on Transportation, Treasury, the Judiciary, Housing and Urban Development, and Related Agencies, Committee on Appropriations, U.S. Senate : “Contractor’s National Evaluation Did Not Find That the Youth Anti-Drug Media Campaign Was Effective in Reducing Youth Drug Use” accessed 5 April 2009

 

15.            Centers for Disease Control and Prevention. Designing and Implementing an Effective Tobacco Counter-Marketing Campaign. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, First Edition October 2003.