Challenging Dogma - Spring 2009

Thursday, May 7, 2009

Social Cognitive Theory: An Effective Method to Deter Teen Smoking– Mobolaji Odewole

A more effective intervention would utilize the Social Cognitive Theory (SCT) methods and could potentially result in successful outcomes.  Social Cognitive Theory posits that human behavior outcomes are motivated by several components of individual characteristics, such as cognitive and biological events, as well as environmental factors (19).  This theory focuses on the continuous interaction between the individual, their social, and physical environment (20).    This paper will show an effective intervention than that of Philip Morris’s “Think, Don’t Smoke” anti-smoking campaign ad, and explains how this particular intervention would work and address the specific flaws that were articulated in previous assignment.  

Intervention

According to the Social Cognitive Model, an effective method to deter teen from smoking would address the basic idea of self-efficacy, positive influence through observation/modeling, and environmental support from the community.  An intervention based on this model would be a television “Anti-Smoking” campaign ad with a tagline that reads “Be Cool, Don’t Smoke.”  This television commercial highlights two different scene settings. One of the scenes shows parents providing emotional support, encouragement, and providing their children tools necessary to overcome peer pressure such as making friends with right group teens (nonsmokers). The other scene shows school teachers educating their students on the importance of not smoking.

There is a shift in scene as we now see them hanging out and playing together at the school basketball court.  Three upper classmates (bullies) approach one of the teen (guy) and ask him for a lighter. The guy responds by telling them that he does not smoke, at this time the boy starts getting teased, pushed and smacked around by the three bullies.  The teasing goes on for about ten seconds with the bullies saying “what’s wrong, mommy would not let you smoke”.  The guy never gives in and continues to tell them “I don’t smoke and I don’t want to smoke”.  Soon enough, every other classmates walking by to class stand right next to the guy and say “I don’t smoke, my friends don’t smoke and I’m cool”.   Finally, the three upper classmates (bullies) left the teen (guy) alone and walked away.  The ad ends by providing a toll-free number for more information on ways to quit smoking.

Self-Efficacy

“Be Cool, Don’t Smoke” anti-smoking campaign ad effectively fulfilled one of the main principles of Social Cognitive Theory by introducing the importance of self efficacy.   The Theory of Self-Efficacy by Albert Bandura suggests that behavior is best predicted by an individual's confidence in their ability to accomplish a given task (6).  Self-efficacy may impact health by influencing the adoption of health promoting behaviors, cessation of unhealthy behaviors, and/or the maintenance of behavioral changes when faced with difficult situations.  In 2002, Kear found that self-efficacy to resist cigarette smoking was a significant determinant of smoking behavior (7). 

“Be Cool, Don’t Smoke” intervention addresses one of Philip Morris “Think, Don’t Smoke” advert flaws by providing teens the necessary tools to enhance their self-efficacy.  This was shown in the ad when parents were providing emotional support, encouragement, and educating their children on the importance of not smoking.  Teenagers are less likely to smoke when parents are involved in their children's activities (8) and are supportive (9).  Similarly, parental emotional support was inversely related to tobacco, alcohol, and marijuana use among adolescents.  Lack of family support, on the other hand, was a significant barrier to smoking cessation among teenagers (10).  These findings suggest that family social support has a positive influence on health promoting behaviors.  Students with a negative social support network are especially at risk to develop poor health behaviors. 

            Additionally, the influence of variables, such as social support, adjustment, and positive climate are also important in protecting youth from participating in smoking.  This was captured in the ad when school teachers were educating the students on the importance of not smoking.  This would promote self-efficacy by providing the opportunity for modeling from other students and encouragement from teachers and students.  Self-efficacy is further influenced by the person’s mastery experience (success in performance), vicarious experience (modeling from others), social persuasions (encouragement or discouragement from others) and physiological factors (response to stress) (21-22).  By providing both children and parents the tools necessary to promote self-efficacy and environment supports at school, “Be Cool, Don’t Smoke” advert would be effective in decreasing teens smoking.

Peer-Influences

“Be Cool, Don’t Smoke” addresses another flaw of Philip Morris anti-smoking advert of failing to recognize the peer influence by providing teens the necessary tools to combat peer-pressure.  This was shown in the intervention when parents were talking to their children about potential scenarios, making friends with the right group (nonsmokers) and thinking through strategies together on how to deal with those scenarios if they arise “Be Cool, Don’t Smoke” campaign ad shows how effective and helpful it’s for both parents and teens to think about peer-pressure ahead of time rather than dealing with situations as they occur or trying to recover after they happen.  An example of this specific situation was capture in the intervention when one teen (guy) was faced with peer-pressure and was able to deal with it without giving in into peer-pressure despite been smack around and tease by three upper classmates (bullies).  Teens watching the television advert would probably be able to relate themselves to the situation the guy “Right, I wish it was that easy as ABC” and turn off the television.  Adolescence is clearly a sensitive time period in the onset of cigarette smoking. Peers and peer relationships have been cited frequently as major factors involved in cigarette use 12).  In addition, youth are viewed as being most likely to imitate the smoking or non-smoking behavior of those with whom they have the greatest amount of contact, both in frequency and duration.  This was illustrated in the intervention when the guy was adamant on his words to the bullies that he does not smoke and neither do his friends. They guy was later on supported by his friends and fellow classmates.  Transitions to increased levels of smoking have been linked to friends’ encouragement and approval and the message conveyed that smoking is an enjoyable activity that promotes popularity 13). Studies have also shown that non-smokers who affiliate with smokers have been found to be at greater risk for transitioning to tobacco use than youth without smoking friends 14).  By addressing the problem of peer influences in the target population, anti-smoking ad campaign to combat teens smoking would be successful. 

Irrational Behavior

“Be Cool, Don’t Smoke” anti-smoking campaign ad addresses the flaw of Philip Morris “Think, Don’t Smoke” advert by recognizing that teens’ behavior might be irrational. This was shown in the ad by providing a toll-free number for more additional information and the availability of nicotine gum at local stores when they have the urge to smoke.  One’s decision is affected by mood, past experiences, thought processes, individual perception of desirable and undesirable outcomes (17), social pressure, time constraints, information and skills (18).  To fully understand teen’s irrational behavior, one must consider the full picture, the context in which teen decision-making takes place behind such behavior.  According to Ariely’s Predictably Irrational, understanding how we are predictably irrational provides a starting point for improving our decision making and changing the way we live for the better (16).  Social Cognitive Theory “Be Cool, Don’t Smoke” advert offered an alternatives behavior with an equal value to that in which they are giving up (cigarette) because teens tend to value option and potential behavior differently than do adults, further decreasing irrational behavior in the target population.  By addressing the problem of irrational behavior in this target population, intervention to combat teens smoking would be effective and successful.  

Conclusion

            Social Cognitive Theory seems like an ideal and more effective technique for an intervention to reduce teen’s smoking and promoting healthy behaviors in the target population.  This intervention provides teens the tools necessary to enhance their self-efficacy and deal with peer-pressure. Finally, this intervention recognizes irrational behavior.

Philip Morris True Motives behind “Think, Don’t Smoke” Anti-Smoking Ad Campaign:   A Critique Based on Theory of Planned Behavior ----Mobolaji Odewole

In 1998, the United States tobacco giant Philip Morris decided to spend 100 million dollars a year on a campaign to reduce teenage smoking (1).  The anti-smoking ad campaign presents the idea that all teens have to say is “No” when they are being ask by their friends or peers if they want a cigarette.   According to a study released by the Wall Street Journal, children found the Philip Morris antismoking ad campaign to be the least effective of all in making them “stop and think” about not smoking.  A focus group of 12-16 year olds from the state of California, Florida, Massachusetts, and Arizona claimed that Philip Morris adverts sounded like a parental lecture, and overall there was a feeling that they lacked substance and good reasons not to smoke (2).  Teen smoking is a growing major public health problem in the United States with teen’s facing increased risk of health problems later in life.  Teen smokers are more likely to use alcohol, illegal drugs, and die early from a smoking related disease than non-smokers.  They are also more likely to have panic attack, anxiety disorders and depression than non-smokers (3).  Supplying millions of dollars for a program that is based on ineffectual methods seems fruitless, and the campaign adverts attempt seems equally ineffective.  In reality, Philip Morris is getting maximum public relations value out of its teenage antismoking campaign while achieving little results. This is not so surprising because the tobacco company has a long history of diverting attention away from its true motives.  In the United States Marlboro, one of Philip Morris tobacco product is preferred by sixty percent of 8th, 10th, and 12th grade boys and girls (14-18 year olds) who smoke and ninety percent of new smokers are under age (4). 

            Given the severity and consequences of teens smoking, an effective public health intervention is necessary to address this growing problem in the United States.  Philip Morris anti-smoking campaign advert “Think, Don’t Smoke” was unsuccessful in decreasing teen’s smoking among children because most of its TV advertisement inappropriately apply Theory of Planned Behavior (TPB).  Theory of Planned Behavior is based on the relationship between people’s attitudes towards a specific behavior and their perceived social norms (5).  TPB stresses the importance of “perceived behavioral control” which originates from self-efficacy.  Theory of Planned Behavior seems like an ideal technique for Philip Morris’ anti-smoking intervention to reduce teen’s smoking; however, the “Think, Don’t Smoke” campaign falls short to connect with teen’s due to three key factors: failure to recognized self-efficacy; negative peer influences; and irrational behavior.

Failure to Recognized Self-Efficacy

            One television commercial employed in the campaign shows that when parents talk to their children about not smoking, they actually listen.  Analyzing this ad will help explain and understand how this campaign falls short.  The television ad shows four children that are friends (three boys and one girl) riding their bikes to school, playing all together at the park.  While this entire event is taking place, there is a voice in the background describing the scenes at the same time.  There is a shift in scene to when the children are older (teens) and we now see them eating together at a fast food restaurant.  Later into the night when they are all going back home, one of the guys takes out a cigarette and asks the girl if she want one.  At this time, there is a pause in the scene with the background voice saying “when you are being ask to smoke, think and say No”. The scene resumes with the girl saying “No”.

            “Think, Don’t Smoke”, in an attempt to employed Theory of Planned Behavior, presents the idea that all teens have to say is “No” when they are being ask by their friends or peers if they want a cigarette. While this commercial makes an honest attempt to fulfilled one of the main principle of Theory of Planned Behavior by introducing the importance of individual attitudes toward a particular behavior, the portrayal of the children just saying “No” seems unrealistic.  The Theory of Self-Efficacy is the belief that one is capable of performing in a certain manner to attain certain goals. Basically, self-efficacy posits a person confidence to perform a certain behavior which is also known as “perceived behavioral control”.  This refers to the degree to which someone believes they have control over a particular action (control beliefs) and the strength of their belief of the action (perceived power).   Control beliefs could also be a person’s belief about factors that will make it easier or difficult to perform the behavior (5).  The Theory of Self-Efficacy by Albert Bandura suggests that behavior is best predicted by an individual's confidence in their ability to accomplish a given task (6).  Self-efficacy may impact health by influencing the adoption of health promoting behaviors, cessation of unhealthy behaviors, and/or the maintenance of behavioral changes when faced with difficult situations.  The role of self-efficacy on smoking, however, needs to be further examined along with other personality and cognitive factors among teens.  In 2002, Kear found that self-efficacy to resist cigarette smoking was a significant determinant of smoking behavior (7).

            Philip Morris “Think, Don’t Smoke” advert simply tells children that they have a choice of saying “No” when asked to smoke a cigarette.  This does not provide teens the tools necessary to enhance their self-efficacy.  This campaign will not succeed unless the parents provide their children with emotional supports, encouragement and ways to overcome peer pressure.  Teenagers are less likely to smoke when parents are involved in their children's activities (8) and are supportive (9).  Similarly, parental emotional support was inversely related to tobacco, alcohol, and marijuana use among adolescents.  Lack of family support, on the other hand, was a significant barrier to smoking cessation among teenagers (10).  These findings suggest that family social support has a positive influence on health promoting behaviors.  Students with a negative social support network are especially at risk to develop poor health behaviors.  The influence of variables, such as social support, adjustment, and positive climate are also important in protecting youth from participating in smoking and drinking.  Without providing both children and parents the tools necessary to promote self-efficacy, just saying “No” will not decrease teen’s smoking.

Failure to Recognized Negative Peer-Influences

            Philip Morris anti-smoking advert also fail to recognize the key role peer-pressure plays when it comes into behavior.  The television advert assumes teens will have positive attitudes toward not smoking, which leads to the intention of them not smoking and they can therefore resist peer-pressure and “just say no” when they being ask to smoke.  I’m amazed that the writers of a multi-million dollars campaign could actually convinced Philip Morris that the anti-smoking advert will be effective, my guess is that Philip Morris knew all along that the campaign writers did not pass their child adolescents class.  Teens watching the television advert will actually say to themselves “Right, I wish it was that easy as ABC” and turn off the television.  Adolescents’ susceptibility to peer influence was examined as a marker of difficulties in the general process of autonomy development. Although peer relationships provide an essential context for adolescent social development, adolescents’ conformity to negative peer norms appears as a major risk factor linked to negative outcomes ranging from delinquency and smoking to risky sexual behavior (11). Adolescence is clearly a sensitive time period in the onset of cigarette smoking. Peers and peer relationships have been cited frequently as major factors involved in cigarette use 12).  In addition, transitions to increased levels of smoking have been linked to friends’ encouragement and approval and the message conveyed that smoking is an enjoyable activity that promotes popularity 13). Studies have also shown that non-smokers who affiliate with smokers have been found to be at greater risk for transitioning to tobacco use than youth without smoking friends 14). Youth are viewed as being most likely to imitate the smoking or non-smoking behavior of those with whom they have the greatest amount of contact, both in frequency and duration.  The Social Network Theory assumes that the individuals in a social system interact with each other and serve as significant reference points in each other’s decision making 15).  Thus, an individual’s location in the network and his/her pattern of relations with others affects his/her behaviors.  Without addressing the problem of negative peer influences in the target population, anti-smoking ad campaign to combat teens smoking will not be successful. 

 

 

Failure to Recognized Irrational Behavior

            The Philip Morris anti-smoking ad campaign fails to recognize that children do not actually go through the process of thinking in the same way that is implied by the Theory of Planned Behavior.  As described by Ariely, “we fail to understand the profound effects of our emotions on what we want, and how expectations, emotions, social norms, and other invisible, seemingly illogical forces skew our reasoning abilities” (16).  One’s decision is affected by mood, past experiences, thought processes, individual perception of desirable and undesirable outcomes (17), social pressure, time constraints, information and skills (18).  To fully understand teen’s irrational behavior, one must consider the full picture, the context in which teen decision-making takes place behind such behavior.  According to Ariely’s Predictably Irrational, understanding how we are predictably irrational provides a starting point for improving our decision making and changing the way we live for the better (16).  Teens tend to value option and potential behavior differently than do adults, so what may look to an adult like an irrational decision may look to a teen like a well-put rational decision.  For example, getting in trouble with the principal for smoking in school may not be big deal to a teen while avoiding being teased at school for not smoking may be a huge deal to a teen.   Philip Morris “Think, Don’t Smoke” advert could  promote teen being teased in school, further increasing irrational behavior in the target population.  Without addressing the problem of irrational behavior in this target population, intervention to combat teens smoking will be unsuccessful.  

Conclusion

            Theory of Planned Behavior seems like an ideal technique for Philip Morris’ anti-smoking intervention to reduce teen’s smoking; however, the “Think, Don’t Smoke” campaign is unlikely to be effective and could have unintended negative consequences due to the inappropriate implementation of the theory.  This intervention does not provide teens the tools necessary to enhance their self-efficacy, leaving teen vulnerable to unhealthy behavior such as smoking.  “Think, Don’t Smoke” campaign fail to recognize the key role peer-pressure plays when it comes into behavior.  Finally, this intervention fails to recognize that children do not actually go through the process of thinking in the same way that is implied by the Theory of Planned Behavior.  A more effective and successful intervention would focus on promoting self-efficacy among teens to improve healthy behavior.

REFERENCES

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6.     Maddux JE, Brawley L, Boykin A. Self-efficacy and health behavior. Prevention, promotion, & detection. In: Maddux JE, editor. Self-efficacy, adaptation, and adjustment: Theory, research, and application. Plenum Press: New York; 1995. pp. 173–202.

7.     Maddux JE, Brawley L, Boykin A. Self-efficacy and health behavior. Prevention, promotion, & detection. In: Maddux JE, editor. Self-efficacy, adaptation, and adjustment: Theory, research, and application. Plenum Press: New York; 1995. pp. 173–202.

8.     Krohn MD, Massey JL, Zielinski MA. Role overlap, network multiplexity, and adolescent deviant behavior. Social Psychology Quarterly. 1988;51:346–356. doi: 10.2307/2786761.

9.     Chassin L, et al. Changes in peer and parent influence during adolescent: longitudinal versus cross-sectional perspectives on smoking initiation. Developmental Psychology. 1986;22:327–334. doi: 10.1037/0012-1649.22.3.327.

10.  Milligan RAK, Burke V, Beilin LJ, Richards J, Dunbar D, Spencer M, Balde E, Gracey MP. Health-related behaviours and psycho-social characteristics of 18 year-old Australians. Social Science & Medicine. 1997;45(10):1549–1562. doi: 10.1016/S0277-9536(97)00092-0.

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12.  Friedman, L. S., Lichtenstein, E. 15:41 PM Biglan, A. 1985) Smoking onset among teens: an empirical analysis of initial situations. Addictive Behaviors, 10, 1–13.

13.  McAlister, A. L., Krosnick, J. A. & Milburn, M. A. (1984) Causes of adolescent cigarette smoking: tests of a structured equation model. Social Psychology Quarterly, 47, 24–36.

14.  Urberg, K. A., Degirmencioglu, S. M. & Pilgrim, C. (1997) Close friend and group influnce on adolescent cigarette smoking and alcohol use. Developmental Psychology, 33, 834–844.

15.   Knoke, D. & Kuklinski, J. H. (1982) Network analysis. In: Sullivan, J. L. & Niemi, R. G., eds. Series: Quantitative Applications in the Social Sciences. Beverly Hills, CA: Sage.Dan Ariely. Predictably Irrational. The Hidden Forces That Shape Our Decisions. 2008

16.  Neumann, P. J., & Politser, P. E. (1992). Risk and optimality. In J. F. Yates (Ed.), Risk-taking behavior (pp. 27-47). Chichester, England: John Wiley & Sons.

17.  Fischhoff, B., Crowell, N. A., & Kipke, M. (Eds.). (1999). Adolescent decision making: Implications for prevention programs: Summary of a workshop. Commission on Behavioral and Social Sciences and Education, National Research Council, Institute of Medicine. Washington, DC: National Academy Press.

18.  Bandura, A. (1989). Human Agency in Social Cognitive Theory. American Psychologist, 44, 1175-1184.

19.  Edberg M. Individual Health Behavior Theories. Essentials of Health Behavioral Social and Behavioral Theory in Public Health. 2007:51-56.

20.  Salazar MK. Comparison of four behavioral models. AAOHN 1991;39:128-135.

21.  Wikipedia. Self-efficacy. Wikimedia Foundation Inc. http://en.wikipedia.org/wiki/Self_efficacy.


 

 

 

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