Challenging Dogma - Spring 2009

Thursday, May 7, 2009

The “Alcohol, Know Your Limits” PSAs and Binge Drinking: Helping People to Know Their Limits or Just Some Funny Commercials? – Jennifer Burda

Binge drinking is a popular topic in the public health world and on college campuses. However, the magnitude of this public health problem is not just concentrated in American college campuses. Many young people around the globe binge drink. This is also the case in the United Kingdom. Binge drinking is defined as excessive alcohol consumption which usually results in a blood alcohol concentration (BAC) of .08 grams percent or above. A BAC this high is often achieved during a short period of time, such as a woman consuming four drinks over the course of two hours (1). There are numerous health problems associated with binge drinking including unintentional injuries, alcohol poisoning, liver disease, and neurological damage (2). The European School Survey Project on Alcohol and Other Drugs shows 54% of youth in United Kingdom schools have had heavy episodic drinking within a 30 day period (3). The United Kingdom Home Office developed a public health ad campaign called “Alcohol, know your limits” in an attempt to curb binge drinking among young people within the country.
The “Alcohol, know your limits” campaign released several Public Service Announcements (PSAs) to convince youth to not overindulge on alcohol. One PSA features a young woman getting ready for a night out. In the process of getting ready, she rips her tights and top, vomits in the sink with her hair in the way, smudges her eye make-up, pours wine on a chair, breaks the heel off of her shoe, then leaves her home. The PSA ends with “You wouldn’t start a night like this so why end it this way?” (4). This PSA has a similar counterpart. In another PSA, a young man puts on clothes and rips them, goes to the refrigerator and wipes food on his shirt, urinates on the floor next to the toilet, puts an earring in and tears his ear, bangs his head against the door, then leaves his house with a bloody nose. The PSA ends with the same tagline “You wouldn’t start a night like this so why end it this way?” (5). The PSAs attempt to portray the characters as drunk before departing for the evening. The PSAs also demonstrate somewhat extreme examples of binge drinking behavior. However, these PSAs have not proven very successful and these campaign ads are overall flawed for three central reasons. These PSAs have not helped the campaign’s success because they do not take psychological reactance into account, do not address the social norms and culture surrounding binge drinking, and lastly fail because they assume people are rational and will choose to not binge drink because of the consequences.
No consideration for psychological reactance
To put it simply, the message of the “Alcohol, know your limits” PSAs is to not binge drink and portrays binge drinkers in a negative light. These PSAs assume young people will be turned off to binge drinking because of how the people are portrayed in the PSAs. However, the PSAs can have an opposite effect on the youthful targeted audience and cause them to revolt against this suggested restriction of freedom (ie being told not to binge drink) instead of embrace the message being sent.
Psychological reactance theory explains how people have an emotional reaction to threatened freedoms or attempts to control their behavior (6). If individuals perceive they are being manipulated, they will often react opposite to the persuader’s intent and reject doing the suggested activity (7). Psychological reactance occurs in four stages – first there is an understanding of the perceived freedom (in this case, ability to drink as much as one wants), then the perceived threat to freedom (being told not to over drink). This leads to a reactance (binge drinking) which thus ultimately restores the freedom in question (freedom to drink as much as one wants).
These particular PSAs were posted on YouTube which provides a comments field for people to remark on a clip. The following comment was posted by YouTube user Pwnagemonkey1 underneath the PSA portraying the girl getting ready for a night out:
fair enough, but dont try and tell people not to drink. People should be allowed to do whatever they want to themselves as long as its what they want, no matter the consequences. its a part of life, there would be no enjoying life if all you did was take no risks and be boring and sh** (4).
This comment demonstrates how this PSA resulted in psychological reactance. Instead of this YouTube user being inspired to not binge drink, he argues that people should have the freedom to do what they want regardless of the consequences.
Similar comments were posted under the YouTube PSA featuring the boy preparing to leave his apartment. One user wrote “This advert never fails to make me wanna go out and get sh**-faced.” Another user replied with “Yeah it just makes me want to go out on the trash! He really does look better at the end, no?!” (5). These comments explicitly demonstrate reactance and how people revolt and do the opposite of the intended message. The “Alcohol, know your limits” PSAs do not have the desired effect of persuading youth to not binge drink and in some cases, actually indirectly encourage them to binge because of psychological reactance.
A study was done examining the reactance of college students to messaging about flossing compared to binge drinking. Students behaved with rational planned behavior to the flossing message; they understood the healthful purpose of flossing which did not have any perceived infringements on their freedom. Binge drinking messaging was perceived very differently because there are social and commercial factors that promote binge drinking among young people. Therefore, the anti-binging message acts as a threat to perceived norms which causes a reactance (8). The “Alcohol, know your limits” PSAs experience a similar negative attitude and revolt since this message is also going against perceived social norms which young adults particularly value as they try to fit in with their peers. Youth negatively view messages that threaten their freedom or ability to fit in. If this ad campaign had taken psychological reactance into consideration, it would have been more successful.
Social norms and culture of binge drinking not addressed
As mentioned above in the discussion on psychological reactance, binge drinking is a social norm among youth and is not only accepted but expected. Norms are defined as patterns of beliefs and behaviors expected in certain situations and shared by a social group. Norms regulate social behavior (13). Social norms play a particularly important role among youth because they feel added pressure to fit in while they go through the stages of adolescence into adulthood. The “Alcohol, know your limits” PSAs do not address or use social norms or context. They only present negative examples of binge drinking instead of searching to change why or how binge drinking has become a social norm.
There are several socially based reasons for binge drinking which have helped it become normalized. Youth and young adults in the 15-17 age range in the United Kingdom drink because it allows them to express their views more easily, develop trust with friends, and explore sexual relations in what they perceive to be a less threatening context. Because of these reasons, alcohol is perceived as relaxing, an excuse for behavior, and provides an opportunity for bonding (14). These socially based reasons for binge drinking are perpetuated into social norms with the help of the media. Movies, television, and music display these supposed advantages to binge drinking. The media acts as a socialization tool and teaches people what to expect in certain situations (15). For example, the film “Animal House” has helped incoming college freshmen expect crazy fraternity parties with alcohol, as depicted in the movie.
The PSAs have not worked to change the social norms around drinking or address them. The campaign would have been much more successful if it had gone to the core of understanding why youth choose to drink and addressed those issues instead of simply presenting binge drinking in a negative light. The problem of binge drinking will not be solved if the root of the problem just continues to be masked – social norms and culture.
A study was done in South Wales which found the local community around the school embodied a culture of heavy drinking. This even impacted non-drinkers because many conversational topics revolved around alcohol (14). In addition to the results found in the South Wales community, the United Kingdom as a whole has been labeled for having a culture that embraces heavy drinking. Brits are known for their fond appreciation for pubs. Getting to the causal reason for binge drinking in the United Kingdom is key for a successful campaign. A study at Leeds University in the United Kingdom found that social context, beliefs, and morals should be considered when tailoring health promotions to hit a targeted young group (16). A much larger picture and framework needs to be considered for the public health campaign to be successful.
People see the consequences therefore do the behavior – not the case
The PSAs have a loose basis on the Health Belief Model (HBM) which is antiquated and has added to the PSAs’ flawed nature. HBM states people will take action against a disease (or in this case, follow the suggested protocol – not to binge drink) if they feel they have a high susceptibility to the disease/behavior (binge drinking), feel the effects of the disease/behavior are at least moderately severe, and taking action will reduce their susceptibility and the severity of the disease/behavior, and in general, be beneficial. People will choose to act if they do not have to overcome barriers, such as cost or pain (9). In other words, if the benefits outweigh the barriers, people will have an intention to take action and thus change their behavior (10).
The PSAs make it look like most young people are susceptible to binge drinking (ie the disease/negative health behavior in HBM) by choosing a seemingly normal young woman and man to represent society. The effects of binge drinking in the ads are moderately severe given the destructive nature of the two main characters. Their behavior indicates binge drinking leads to destruction of clothes and other personal items as well as poor judgment which can lead to pouring wine on a chair or urinating besides the toilet. The benefit to choosing not to binge drink is to avoid embarrassment by not doing these destructive behaviors. The PSAs do not highlight any specific barriers that need to be overcome in order to not binge drink. However as mentioned earlier, these PSAs are loosely based on HBM so they do not necessarily have all of its characteristics. Overall, the PSAs insinuate that because the severity and susceptibility of binge drinking is strong, people watching the PSAs should intend to want to and thus change their behavior, ie not binge drink.
HBM assumes people are rational and weigh their choices and options. However, this is not the case. The PSAs express this key characteristic of HBM. Even if the PSAs did experience some success in convincing people the binge drinking consequences are severe enough to not binge drink, this education does not automatically translate over to people changing their behavior. This is because humans are irrational (11). Weighing of costs and benefits and having an obvious logical outcome does not mean people will automatically do the suggested behavior.
There are two key reasons why people are irrational and are arguably predictably irrational in this case of binge drinking. People are irrational because of ownership – they put a high value on what they own. This does not just apply to physical items but to behavior as well. Habits, which include binge drinking, are particularly hard to change because people assume ownership of the habit. People focus on what they will lose as opposed to what they will gain. With binge drinking, people see the loss of having fun with friends and do not see the gain of living a safer lifestyle. People are also irrational because they lack self-control. They are lazy, procrastinate, and overall have less control over their actions than they think (12). Even though they may want to change their behavior, follow through is low because people lack will power.
The PSAs are faulty because they assume people will choose to change their behavior because of the negative effects of binge drinking portrayed in the PSA. However, this is not the case because people are not rational and do not make changes easily. If these points were considered in the “Alcohol, know your limits” PSAs, the campaign would have been more successful.
Binge drinking is a major public health problem in the United Kingdom and the country has developed a campaign to address the issue. However, its “Alcohol, know your limits” PSAs have not been very successful. Although the PSAs possess a degree of attraction for youth because of the humor in the PSAs, they are still largely flawed because they do not take certain social and behavioral science principles into account. The PSAs do not consider the possibility of psychological reactance to the messaging, nor do they highlight and address the social norms or context surrounding binge drinking. The PSAs also assume that because negative aspects of binge drinking are highlighted, people will be rational and not binge because of the consequences shown. Psychological reactance is the most important issue that needs to be immediately addressed since it can encourage binge drinking. The other two flaws simply make the PSAs ineffective. There is much room for improvement for these PSAs. By taking the social and behavioral science principles into account, the PSAs would be more successful and help curb binge drinking in the United Kingdom.
A new intervention
The “Alcohol, know your limits” campaign has room for improvement. In order for the Public Service Announcements (PSAs) associated with the campaign to be successful, they need to address psychological reactance, social norms and culture, as well as people’s irrational behavior. Incorporating these points into a new PSA will result in a stronger public health intervention to curb binge drinking in the United Kingdom.
The new PSA intervention is markedly different from the PSAs currently used in the “Alcohol, know your limits” campaign which depict a boy and girl getting ready for a night out but with insinuations that they binge drank before preparing for the evening and leaving their house. (4, 5) The new PSA does not use footage of young people who have already made the decision to drink and giving the message to not behave like them. Instead, it contains a happy, young, attractive couple spending their evening going out to dinner, sharing an inside joke, and enjoying themselves without binge drinking. The woman (Sarah) later that night reports to a friend how she had the opportunity to get to know her date and had fun versus her experiences meeting other men in bars in the past. Sarah then says she and her date are going rock climbing in the morning and a group of people should go and her friend agrees. The PSA then shows five people in a convertible on a beautiful, sunny morning on the open road heading towards the mountains. Once they arrive at their destination, they enjoy themselves and belay each other as they climb. They eventually reach the mountain’s peak, then sit down to enjoy lunch and admire the view. It ends with the tag line, “Don’t let alcohol give you limits.”
As seen in the new intervention described above, it advertises freedom and success as alternatives to binge drinking as suggested by the images of driving down the open road and reaching the summit of a mountain. The PSA is improved and addresses the “Alcohol, know your limits” campaign’s earlier problems because it contains positive role models, includes advertising theory which encompasses social context and beliefs, and has a replacement value for binge drinking.
Psychological Reactance – no longer an issue
Psychological reactance is a key concern in the original “Alcohol, know your limits” PSAs because they can actually cause more people to binge drink instead of prevent binge drinking. This is because people can have an emotional reaction when they feel they are being controlled or their freedom is in jeopardy (6). The original PSAs instruct the public to not binge drink, which could cause reactance. The new “Don’t let alcohol give you limits” PSA does not explicitly say to not binge drink, nor gives the impression the government is giving orders. Rather, the PSA provides positive role models who do not binge drink. Youth can aspire to become these models as they are happy, young, attractive, and enjoy life. Because binge drinking is not portrayed in an overtly negative light, the four stages of reactance cannot be completed. The second stage of reactance, which is the perceived threat to freedom, does not occur in the new PSA. The original PSAs’ YouTube comments indicate the viewers are more inclined to go out and binge drink after seeing the commercial - the new PSA avoids that because it does not contain a trigger to spark reactance.
The “Don’t let alcohol give you limits” PSA also does not go against perceived social norms of binge drinking per say by stating not to binge drink. Rather, it provides an alternative. The new PSA offers a sense of freedom by presenting a different lifestyle choice instead of restricting freedom and telling youth to not binge drink. Thereby this reduces the risk of reactance (6). However, the new PSA does contain characteristics to address the social norms and culture of binge drinking which not only have a role in addressing psychological reactance but also help get to the root of the binge drinking problem.
Advertising Theory – a Way to Address Social Norms and Culture of Binge Drinking
Binge drinking is often considered a normal social behavior for youth. The original PSAs do not address the social norms or context surrounding binge drinking in youth. Rather, they simply paint binge drinking in a negative light. Studies on British youth found youth binge drink for a variety of reasons which include the ability to express their views more easily, bond, and build trust with friends (14). These are core reasons why youth choose to binge drink. The “Don’t let alcohol give you limits” PSA addresses these particular reasons and tackles their context.
The new PSA shows the couple getting to know each other and being open without the assistance of alcohol. This is then reconfirmed when Sarah speaks to her friend about her preference to “really get to know someone” as opposed to the men she had met in bars. Being drunk is a fleeting state and not permanent – what matters is who a person is at all times, with and without alcohol. Sarah also bonded with her date as they laughed over dinner and shared an inside joke, which show that it is possible to be intimate with someone sans alcohol. The PSA demonstrates the motivating factors for youth binge drinking do not have to apply. People can build relationships without being intoxicated.
The new PSA also addresses the issue of building trust as seen in the clip of the friends belaying on the mountain. One must have total trust in your belay partner because your life is literally in his or her hands. Belaying is not an activity one can do while intoxicated. The friends in the new PSA build trust without the assistance of alcohol. Moreover, the PSA presents a different social norm – young, happy, attractive individuals having fun and enjoying life without alcohol. The PSA uses advertising theory to help perpetuate this norm.
Advertising theory is a key social and behavioral sciences model. It predicts how an intervention can reach and change a large group of people at the same time by using a universal appeal instead of addressing individual factors. Advertising theory is therefore comprised of attitude change theories as well (17). In advertising theory, people change their behavior or choose to follow the recommendation being given provided the ad has 4 key qualities: the ad makes a promise to the consumer, the concept being advertised has certain benefits, the benefits reinforce a core value the consumer holds dear, and the ad provides support to back up the claim being made.
In the “Don’t let alcohol give you limits” PSA, the promise being made in the ad is the ability to have fun without binge drinking. The subtle benefits to this include being able to get up early to rock climb (or participate in a different activity) and not have to worry about a hangover. Freedom and success are the core values addressed in the PSA. These core values are supported with visual images. For example, the convertible on the road with the top down is symbolic of freedom. The friends are successful because they reach the summit of the mountain and generally give off successful vibes given their happiness and attractiveness. The last scene of the PSA panning the view from the mountain also symbolizes freedom. The PSA presents youth with these two important core values which are achieved by not binge drinking and encourages the culture to not embrace heavy drinking.
In addition to the new PSA using advertising theory as a way to effectively address, understand, and change culture norms surrounding binge drinking, a partnership needs to be developed with the media. The media is responsible for educating the public on what to expect in certain social situations and is thus a socialization tool (15). Music, movies, and television show binge drinking as a common social norm. Partnering with the media and having an agreement to not actively promote binge drinking culture will reduce its normative appearance.
Consequences Do Not Necessarily Lead to Behavior - Embracing Irrationality
The “Alcohol, know your limits” PSAs’ loose basis on the Health Belief Model (HBM) adds to the campaign’s failure. The PSAs assume that because the susceptibility and severity of binge drinking were both portrayed as high in the ads, people will choose not to binge drink. However, desire to change does not necessarily lead to behavioral change. This is because people are irrational and do not follow linear, decision making processes (18). The PSAs also do not work because people lack self control and feel ownership over their habits. Habits are hard to break and people have risk aversion. In terms of changing behaviors, people will focus on what they will lose versus what they gain. Therefore, in order to solve this problem, the public needs to be presented with an alternative to binge drinking that seems worth the risk in order to break their habit. Risk aversion theory helps explain how this can work.
Risk aversion theory explains people will not gamble (whether it be their health, money, habit etc) if they feel the payoff or risk is not attractive (19). Therefore, when working to change people’s habits, the loss of the habit and/or payoff needs to be worth it for the individual. Successful behavioral interventions provide people with a large gain in place of their lost habit. A core value, like freedom, is an example of a worthy replacement of a lost habit. Advertising theory works particularly well to initiate this because it provides a big promise (in this case, freedom) to the audience and works to fill a void.
The new PSA uses advertising theory to tell people that they can attain freedom and success by not binge drinking. Not only does advertising assist with addressing social norms, but it helps with people’s irrational behavior as well. Freedom is the replacement value for the loss people experience by changing their habit. Instead of trying to scare people into changing their behavior and to not binge drink like in the old PSAs, the new PSA understands people are irrational and presents them with an alternative to their loss – freedom.
The proposed new PSA, “Don’t let alcohol give you limits” incorporates advertising theory and addresses where the “Alcohol, know your limits” PSAs fell short – particularly in addressing psychological reactance, social norms and culture, and irrational behavior. The new PSA creates the beginning for improved communication and binge drinking intervention among youth. More needs to be done to truly address binge drinking among youth in the United Kingdom, but the new PSA opens the door for developing more intricate interventions.
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