Failure of the “Above the Influence” Campaign-Grace Yang

Introduction
Despite the efforts of various anti-drug campaigns, there has been no change in the prevalence of youth drug use from 2005 to 2007 (1). The National Youth Anti-Drug Media Campaign attempted to combat youth drug use through its Above the Influence (ATI) initiative. This intervention uses TV, radio, print, and Web-based advertising to prevent and reduce youth drug use. ATI fails to accomplish its goal of reducing youth drug-use because it neglects social factors that are involved in youth behavior, disregards effective marketing strategies, and stigmatizes youth who use drugs.

An ATI advertisement that is entitled “Dog” shows a scenario where a young girl is in the kitchen and she hears someone call her name. She turns around and sees that it is her dog that is talking to her. Her dog expresses his disappointment in the fact that she smokes marijuana. In response to what her dog has said, the young girl looks like she feels overwhelmed with guilt because she failed to meet the expectations of her dog.

Another ATI commercial is called “Pony.” The advertisement shows three teenage boys walking in a field towards a horse. One teenager approaches the horse, pulls its tail, and gets kicked in the shin. The second boy does the same. The third teenager sees the pain that the other two are in and walks away as the adult narrator says, “You know a bad idea when you see one. Live above weed.”
The final example of an ATI advertisement is called “Achievements.” The commercial shows various happy teenagers saying things about themselves that they are proud of. However, they are actually things that people would normally be ashamed to admit. One teenager says that she received straight D’s. Another says that she made her mother cry. A different teenager says that he stole from his younger sister.

The ATI intervention wastes scarce resources by designing and implementing a campaign that fails on many levels. First, the campaign neglects to address social factors that influence health-related behavior. Second, it fails to use marketing techniques to induce behavioral change. Finally, it stigmatizes youth, creating another barrier to drug-free behavior. This paper will discuss these three aspects that result in the campaign’s failure.

Above the Influence Disregards Social Norms, Expectations, and Networks
The ATI campaign fails to change behavior because its advertisements do not address the importance of social norms, expectations, or networks. The behavior of large groups can be changed by understanding these important influences. This is especially true for adolescents. However, ATI fails to address behavior from these social perspectives, resulting in a weak and ineffective campaign.

Interventions must account for social norms, particularly when dealing with youth. Social norms are general rules that are understood and observed by a given group, community, or society (2). These include simple concepts that do not have severe consequences if people deviate from them, such as washing hands after using the bathroom. Other norms are more serious in nature, resulting in grave repercussions if broken, such as not driving while under the influence of drugs or alcohol. Whether these rules are perceived as trivial or serious, social norms play a large role in people’s behavior. The norms of peers are especially important to youth. For example, adolescents are also more likely to use condoms if they believe that their peers use them (3). This shows that the normative behavior of peers influence the boundaries for acceptable behavior rather than individual beliefs and attitudes. Therefore, if public health campaigns change the perceived social norms regarding a certain behavior, their effectiveness would substantially increase. However, ATI disregards the impact that peer behaviors have on individual adolescent behavior.

Another important social influence is social expectations, which is defined as whether an individual’s social groups of influence approve or disapprove a behavior (3). The expectations of peers have been shown to greatly affect health-related behaviors. For example, youth who associated with deviant peers were more likely to be delinquent themselves and use drugs (4). Also, peer perceptions more strongly affected sexual behavior than parental monitoring (3). It is clear that the opinions of peers have a large influence on the behaviors of youth. Despite these findings, ATI rejects the importance of peer approval or disapproval and consequently fails to change youth drug-use behavior.

The ATI media campaign also fails to focus on social networks and its influence on behavior. Social networks are comprised of individuals who influence one another, such as family, friends, or co-workers. The nature of the relationships between people in social networks can have a great impact on the way that people behave. Each person in a social network has a particular role to fill when in a group setting (2). These roles are specific parts that people play when involved in group activities. For example, mothers, fathers, and children all play distinct roles in a family. Similarly, peers play a particular role in an adolescent’s social network. Certain roles are more influential than others, especially regarding health-related behaviors. Peer influence is a significant predictor of adolescent smoking, whereas parental influence has little effect (5). Moreover, the finding that condom use typically declines with age except among youth who perceive that most of their friends use condoms illustrates the powerful role that peer behavior can have on risk-reducing behavior (3).

Conducting formative research, which is research that is conducted before a program is designed and implemented, is an essential tool for creating an effective campaign. The roles of different people in the lives of youth must be researched prior to developing a campaign to better understand which social groups that have a greatest amount of influence. The developers of Florida’s anti-smoking campaign called “Truth” spent months researching and interviewing youth (6). This is one of the key elements that contributed to the success of the campaign. ATI clearly did not conduct enough formative research with youth because it fails to take into consideration the influential role of peers.

When addressing social norms and expectations, it is important to focus on the beliefs and opinions of individuals, rather than non-human beings. Similarly, an individual’s social network consists of people, not animals. Twenty five percent of the current ATI advertisements depict a conversation regarding drug use between an individual and a non-human character. The ATI advertisement called “Dog” is an example of the campaign’s ignorance of the social factors that influence their target population. The scenario depicted in the advertisement is unrealistic and likely to have no effect on drug use, or more likely to have unintended consequences (i.e., increase the probability that adolescents will try or continue to use illicit drugs) (7). Failing to highlight the importance of social factors in decision making results in an ineffective or even counter effective intervention.

Above the Influence Fails to Market Anti-Drug Behavior to Youth
The ATI campaign fails to utilize key components of social marketing to appeal to adolescents. Marketing is a process in which two or more parties each have something to exchange. On one side of the exchange is the party that promotes and sells a product. On the other side are consumers who pay a price to buy the product (8). Marketing is a novel strategy that should be utilized in public health interventions aimed at behavior change. In order to successfully market a product, formative research must be conducted to better understand the targets population’s preferences and needs (9,10). The developers of the ATI campaign failed to thoroughly understand which benefits the target audience values the most. Therefore, they were unsuccessful in creating a desirable product that provides those benefits.

One of the key elements of marketing is the product, which refers to the behavior that is being promoted (8). Product also refers to the benefits associated with the behavior (10). ATI fails to present anti-drug behavior as a product. Rather, it merely presents it as a means for healthier living. Packaging health-related behavior as a valued product that the target population is willing to purchase is a more effective way to induce behavioral change (11).

Price is another key element of marketing. This refers to the costs of adopting a certain behavior. Even in a voluntary exchange, there is a price for a new behavior (9). Price often entails intangible costs, such as embarrassment and decreased pleasure associated with denying drug use. There is also a psychological cost related to change, especially when altering habits. ATI ignores the sacrifices that teenagers make when they decide to be drug-free. These sacrifices include being alienated and losing friends. A constricted social network can be a serious cost to adolescents, but ATI fails to address these costs, rendering the campaign ineffective.

Another aspect of marketing that makes it such a successful strategy is that it puts the decision making in the hands of the consumers. This is especially relevant when the target population is youth because freedom and autonomy are core values that they highly regard. Formative research shows that youth do not want to be told what to do (6). They want to make their own decisions and any threats to their independence is likely to result in rebellion. The success of Florida’s anti-smoking campaign, called “Truth,” is attributed largely to the fact that it marketed anti-smoking behavior as a desirable product. But it was also successful because it had a message other than “don’t.” The goal of marketing is to influence a target population, while allowing them to voluntarily adopt the health behavior that is promoted. What makes marketing so powerful is that the population is in full control of the decision making process. Rather than trying to sell a certain behavior change to youth, ATI advertisements tell them to adopt it. They remove the element of freedom, which is an ineffective way to influence adolescents. For example, the Partnership for a Drug Free America produced anti-drug public service announcements with “just say no” messages, which had a negative effect on drug use (7). The ATI commercial called “Pony” is an advertisement that would result in a similar negative reaction in youth. The tone of this message is one of authority, which is likely to evoke a rebellious response in teenagers in an attempt to preserve their autonomy. The commercial has the potential to cause youth to try drugs in an act of rebellion because the advertisement essentially tells them not to use drugs because it is a bad idea. This demonstrates the ineffectiveness of telling youth what to do, as opposed to providing them with tools and allowing them to make the decision on their own.

The Above the Influence campaign fails to provide youth with new information and allow them to utilize the information that is presented to make their own decisions. Marketing is a proven way to induce behavioral change by allowing target populations to make healthier decisions on their own. This strategy is especially effective on youth because autonomy is so important to them. However, ATI disregards the power of marketing and the value that youth place on autonomy, thereby creating a fruitless campaign.

Above the Influence Stigmatizes Youth for Their Drug Use
ATI overlooks the negative impact that stigmatizing youth has on their behavior. Negatively labeling youth for their drug use is counterproductive because it creates a barrier for behavioral change. Even when youth had different opinions about smoking, there was an overwhelming consensus regarding their abhorrence for anti-tobacco efforts that pass judgment on tobacco users (6). This shows that ATI is not only ineffective, but counterproductive in their efforts to decrease youth drug use. Youth’s strong aversion to stigmatization makes them more likely to continue or start a behavior, rather than prevent or change an existing behavior, in response to negative labeling. Therefore, ATI fails in its attempt to change behavior by utilizing stigmatization.

The ATI intervention is also counterproductive because of the negative emotional effects that stigma has on vulnerable populations. In the context of ATI, vulnerable populations include youth who already use drugs. The effect of stigma on people with mental illnesses highlights the detrimental effect of stigma. One of the most adverse effects of the stigma of mental illness is that it leads many afflicted with such illnesses to believe that they are failures or have little to be proud of. A fear of rejection by others can have serious negative consequences, such as more constricted social networks, poorer life satisfaction, and unemployment. As a result, self-esteem is negatively affected and many people with mental illnesses conclude that they are less capable than others (12). Moreover, stigma is a barrier for individuals with depression to adhere to treatment regimens. Compliance with antidepressant drug therapy is predicted by levels of perceived stigma (13). Individuals with mental illness experience such high levels of social stigma that the Surgeon General emphasizes the importance of reducing stigma as a barrier to improved health outcomes (12). The influence of stigma is so strong that it diminishes self esteem and outweighs the therapeutic value of taking medication. For these reasons, ATI’s use of stigmatization is counterproductive in their attempt to prevent and stop youth drug use.

Stigma is also a reason that people fail to disclose their HIV-positive status. There are salubrious advantages of disclosing one’s HIV-positive status. First, an individual who is HIV positive can reduce potential infections of sexual partners, consequently preventing the spread of the virus, by disclosing their HIV positive status (14). Second, disclosure is also a means to receive social support to facilitate coping with the disease process (15). However, disclosure can also lead to stigma and shame (16). The traumatizing power of stigma associated with HIV overrides the healthy effects of disclosure (17). Clearly, stigma has a strong influence on health behavior. Despite the advantages of disclosing one’s HIV-positive status, the fear of stigma is so overpowering that it negates the benefits of disclosure.

The ATI campaign’s attempt to prevent and reduce drug use is futile because it utilizes stigmatization to reach this goal. Stigma is shown to have detrimental effects in people who have mental illnesses and are HIV-positive. Stigma causes those with mental illnesses to feel less worthy than others, exacerbating their condition. It also prevents people with depression from adhering to their medication regimen. Lastly, stigma creates barriers for people who are HIV-positive to make healthier decisions for themselves. Another example of stigmatization is seen in the ATI “Achievements” advertisement, which negatively labels youth who use drugs as poor students, cruel to their parents, and deceitful to younger siblings who look up to them. Stigmatizing youth for their drug use will only lower their value of self-worth, creating further barriers to behavior change. This use of stigmatization is detrimental to the campaign’s goals of reducing youth drug use.

Conclusion
The ATI campaign fails in its attempt to prevent and reduce youth drug use because it overlooks key components for successful behavior change. The campaign disregards key social factors that influence health-related behavior. It also fails to use marketing strategies to sell drug-free behavior to youth. Rather, it poses a threat to their autonomy by dictating their decisions. Lastly, the content of the messages is counterproductive because it stigmatizes youth, which creates a barrier to behavior modification. Media campaigns are promising means to induce large scale behavioral changes. However, the ATI campaign fails to take advantage of the potential that the mass media has to influence healthier behaviors in youth. ATI dismisses the growing evidence in the literature from various fields that provides strategies for effective interventions. Consequently, it misuses valuable resources to create an intervention that fails on multiple levels.

“Unhooked”: Counter-Proposal to the “Above the Influence” Campaign

Unhooked: Alternative Anti-Drug Intervention
The Above the Influence (ATI) campaign attempts to prevent and reduce youth drug-use. However, it fails on many levels because it does not address important influential social factors, neglects effective marketing strategies, and stigmatizes youth who use drugs. This paper proposes a novel intervention, called Unhooked, to counter the failings of ATI.

Unhooked is a web-based campaign that addresses adolescent drug use from a social and behavioral science perspective. This intervention is superior to ATI for three reasons. First, it approaches behavior from a social context by incorporating the influence of peer groups. Second, the intervention utilizes marketing strategies to promote drug-free behavior as a desirable product. In order to effectively advertise and promote the product, it takes advantage of various media outlets frequently used by youth, such as Facebook, MySpace, and YouTube. Third, the content presented in the intervention is thoughtfully developed in order to avoid stigmatization.

This campaign is comprised of five main components: (1) web groups, (2) a media library, (3) gear, (4) fact sheets, (5) and forums. Web groups are online “clubs” that are led by peer leaders of the target population. Peer leaders are youth who demonstrate leadership skills and have a significant influence over the target population. Leaders create a web group for each of their schools in order to serve as a community of support for those who want to be drug-free. This creates a special social network of youth who are committed to being drug-free. The Unhooked media library consists of videos and commercials created by youth and advertising professionals to decrease the allure of drug use. Commercial topics include the difficulties of saying no to drugs and the social consequences of doing so. Gear is an essential component of the intervention because it facilitates the promotion of drug-free behavior by creating a brand that is easily identified and consequently desired by youth. Lastly, the educational element, comprised of fact sheets and an educational forum, provides youth with information about drug use so that they can make an informed decision about their behavior.

Unhooked Addresses Social Influences Associated with Youth Drug Use
The Unhooked campaign incorporates peer norms and expectations because social factors play important roles in youth behavior. The influence of peers is one of the most prevalent risk factors for early onset or increased substance use during adolescence (18). A key strength of the Unhooked intervention is that it addresses peer norms, a powerful influence on adolescent health-related behavior. Norms that encourage drug use result in greater rates of youth substance use (19). Expectations, which encourage or discourage drug use, also influence adolescent substance use. When teenagers’ peers use drugs and expectations for drug-use increase, teens are more likely to use drugs (20,21). For these reasons, it is necessary to acknowledge the effect of social norms and expectations on youth behavior and address drug use with this phenomenon in mind.

Web groups are a means to create social norms and expectations that deter adolescents from using drugs. They also provide a social network for youth who are already drug-free or would like to be drug-free. Having peer leaders create these groups is an effective strategy to reduce drug use because smoking prevention programs led by peers were successful in reducing adolescent smoking onset rates (22). School health education programs led by peers were as effective or more effective than programs led by adult leaders (23). Peer leaders who advocate for drug-free behavior change social norms and expectations that encourage and accept drug use to those that discourage it. This creates a shift in the perceived normative behavior of youth and provides a network of support for youth who would like to be drug-free. Therefore, web groups led by peers are effective means of compelling youth to change their behavior.

Unhooked Markets Anti-Drug Behavior
Marketing has been used in various fields for decades as a powerful tool to evoke behavioral change. However, public health professionals have yet to incorporate this effective strategy into their interventions. Unlike ATI, Unhooked uses components of marketing to reach its target population. Adolescents are often the target of advertising and marketing efforts because they are easily persuaded and influenced by their messages (24). Youth who were exposed to more alcohol advertisements consumed higher amounts of alcohol on average than those who saw fewer advertisements. Youth in high advertisement environments also increased their alcohol consumption into their late 20’s, while alcohol consumption for youth in low advertisement environments leveled off (25). This illustrates the persuasive and lasting effects of marketing on health-related behaviors.

Marketing is a prevailing force on youth behavior. For this reason, Unhooked integrates marketing strategies into its anti-drug campaign. This intervention uses the internet to disseminate media messages about drug-use. The videos and commercials can be easily accessed on the Unhooked website, and on social networking websites that youth frequently use, namely Facebook, MySpace, and YouTube. The Unhooked media library is created by youth so that drug-free behavior is advocated from the perspective of peers, rather than adults. This minimizes any negative reactions that youth may have against authority and decreases the likelihood of unintended consequences, such as rebellious drug use. The media clips demonstrate the costs of adopting a drug-free lifestyle, such as potential alienation from friends who use drugs. The videos and advertisements show that although youth may lose friends in their social network, there are still countless youth who commend and support their decision to reject drugs.

Unhooked also promotes healthy drug-free behavior through its line of various gear, including bracelets, notebooks, and t-shirts. Unhooked takes advantage of branding, a strategy that creates a set of positive associations with a product. The LIVESTRONG Global Cancer Campaign is a well-recognized campaign that has effectively used gear to brand their efforts for cancer control. Using gear as promotional items marked with the Unhooked logo creates a positive relationship with youth, which results in brand awareness and preference (24). This often leads to brand loyalty, which leads them to desire the product of drug-free behavior. This is a clever tool used by the marketing industry that should also be used in public health interventions.

Unhooked Incorporates Non-Stigmatizing Content
Interventions with stigmatizing content are counter-productive because stigma creates barriers to behavior change. Stigma precludes those living with depression and a positive HIV status from engaging in healthy behavior (11-16). Similarly, the stigma of being overweight and focusing on negative body images deters some youth from losing weight (26). Formative research conducted with youth show that rather than being judged for their behavior, youth want facts to make their own decisions (6). Therefore, it is important that public health professionals pay close attention to the content of their intervention’s message.

Unhooked uses caution when creating the messages that are conveyed to youth about drug use. It is essential that the tone is non-judgmental and the message does not contain stigmatizing content. Because youth are prone to negatively react to stigma, the Unhooked website refrains from incorporating negative labeling into the content of its intervention. This is accomplished by staff members who regulate and remove stigmatizing content that may be posted on the website by the public. This is done strictly to uphold the positive and safe online environment that Unhooked creates for youth. Instead of using to stigma to try to effect behavioral change, Unhooked provides youth with educational tools to receive information and advice about drugs. The website has fact sheets about various illicit drugs and the effects of drug use. There is also an educational forum where youth can ask health professionals any questions they may have about substance use. If there are any question about drugs or behaviors that the fact sheets do not answer, youth are welcome to ask health care providers for additional information. An advantage of using the forum to inquire about the consequences of drug use is that youth can remain anonymous when posting questions to minimize any feelings of stigmatization from peers or the online community.

Conclusion
Youth drug-use is an individual and societal level problem that must be confronted with innovative strategies. Unhooked is a novel alternative to ATI, which fails to decrease rates of risky youth behavior. Unhooked addresses the three key failures of the ATI campaign. First, it addresses the social influences that impact youth behavior by facilitating web-based social networking. Second, it uses marketing techniques to sell drug-free behavior as a desirable product by using media and gear as promotional tools. Third, it contains non-stigmatizing content that informs youth about drug use so that they can make an educated decision on their own. Understanding the target population is a primary strength of the Unhooked intervention, which is based on social and behavioral theory. In order to decrease the prevalence of youth drug-use, it is necessary to stop wasting resources on ATI and implement Unhooked.

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Talking dogs do more harm than good: robbing teens of dignity-Jadie Kim

On an average day in 2006, about 1.2 million adolescents, age 12 to 17, smoked cigarettes, 631,000 drank alcohol, and 586,000 used marijuana (1). In addition, about 49,000 adolescents used inhalants, 27,000 used hallucinogens, such as ecstasy, 13,000 used cocaine, and 3,800 used heroin. Nearly 8,000 adolescents drank alcohol for the first time, 4,300 used an illicit drug for the first time, 4,000 smoked their first cigarette, 3,600 smoked marijuana for the first time, and 2,500 used pain relievers for non-medical reasons for the first time (1, 2). These staggering numbers of teens being exposed to drugs and alcohol is the reason why it is crucial to design a meaningful and effective antidrug campaign.

In an effort to dissuade teens from starting or continuing drug use, the National Youth Anti-Drug Media Campaign funded by the Office of National Drug Control Policy implemented the “Above the Influence” campaign. “Above the influence” campaign has online support as well as televised advertisements which include several talking dog series in cartoon and non-cartoon modes. The main focus of this campaign is to advocate against teen marijuana use and help teens steer clear of smoking and other undesirable habits(6). This campaign, however, has not been shown to decrease teen drug use rate and has even lead to more teens using marijuana (7). A research company hired by the National Institute on Drug Abuse reported that the “Above the Influence” campaign at a cost of $1.4 billion between, did not work: It stated that: “greater exposure to the campaign was associated with weaker anti-drug norms and increases in the perceptions that others use marijuana."(4). Despite the findings that the campaign was not working, the National Youth Anti-Drug Media Campaign continues to produce and air similar types of antidrug ads spending $220 million in fiscal years 2005 and 2006(4). The Office of National Drug Control policy is to blame for implementing an ineffective intervention that does not reduce teen drug use and thereby allowing teens to continue drug use. The reasons for the failure of the talking dog advertisements by “Above the Influence” is due to a lack of respectable intervention, inappropriate use of social learning theory and incomplete guidance to success.

The Interventions’ Failure to Generate Respect

What do teens really think about these talking dog ads? One of the ads titled “Dog” features a girl, Lindsey, in her kitchen when her dog climbs up on a chair and starts talking. The dog expresses that he misses his old friend and implies that she has changed since she started smoking marijuana. While the dog is talking, Lindsey just looks on with a disbelief look but does not say a word (10).

This advertisement gives the leading role to the dog by allowing the dog to do all the talking, and misleading the teens to follow the examples of the dog. Role models must evoke trust, admiration, and respect from the observer (5). This talking dog anti drug campaign fails to effectively deter teen drug use because this ad fails to connect with the youth to evoke trust, admiration and respect. “Dog” is a poorly constructed anti drug commercial dog. The commercial relies on an unrealistic figure to convey its message- a talking dog. The talking dog undermines the message that the commercial is trying to convey. The note at the end of the commercial ‘how would you tell a friend’ in small print might explain what the commercial is trying to say. It is suggesting that friends should look out for each other and give each other support to quit. This is a good suggestion, but the main message has been pushed aside until the last part of the commercial and it may not even get noticed by the teens. In addition, the commercial relies heavily on teen’s soft spots for pets. If the intention was to stimulate teen’s emotional part that is connected to dogs, this ads may work but only for the pet owners. Also, it is not likely that the teen’s soft spot for dogs is associated with drug use.

It is not hard to find out what the teens really think of this ad; the comments left in response to the video suggest that the commercial is not being taken seriously by teens. One comment “I want the dog to talk to me... Pass me a blunt!” implies that this advertisement may actually encourage teen drug use (7, 10). In another comment “she's not doing pot, the dog is” shows how easy it is to misunderstand this advertisement. These reactions clearly indicate that this ad has failed to generate sense of real and serious danger to drug use. Instead, this ad has become the laughing stock among the teens and the subject of their jokes because there is no air of truth and it is unrealistic. Many teens went on to create parodies of this ad that mock the talking dog and its message.

The Message is not Coming from Their Peers

Another reason why talking dog ads by “Above the Influence” campaign failed to effectively decrease teen’s drug use is their failure to introduce and incorporate role models who comes from the teens’ peer group(9). According to Albert Bandura's social cognitive theory, the best way to change behavior is to shift people's overall image of what behaviors are normal and valuable within one's peer group(8). “Above the Influence” has given the role to a talking dog that teen’s peers should have. It is obvious that teens do not consider talking dogs as their peers, but the creators of these advertisements must not have realized the importance of this concept.

Another example of a talking dog advertisement is “Stop Looking At Me” cartoon by “Above the Influence”. It starts with a dog sitting and observing a young male teen smoking and the teen tells the dog that he can stop anytime he wants to. When the dog challenges him to stop now, the guy makes a sad face and suggest next week. The dog expresses disappointment then walks out (12).

If enough thought is given to this commercial, one might receive the message that the makers of this ad wanted to convey. The message, perhaps, is that smoking marijuana will disappoint and hurt our close friends. But at a superficial level, what this ad really suggests is that the dog has the ability to talk and think at a higher level than the teens on drugs. It also suggests that if they don’t stop the drug use, they will disappoint their dogs.

The dog does not say much in this ad, but the comments made by the dog, such as “you disappoint me” can seem judgmental and implies that the dog is making better life choices than the humans. This approach to prevent teen drug use will not only be ineffective but evoke disrespect and irritation from the teens. Teens have expressed their rebellion towards the disloyal dog in this ad by creating parodies. Parodies would start in a similar setting as “Stop Looking At Me” but after the dog says “you disappoint me” the teen shows his anger and acts violent towards the dog. It is inappropriate to expect this talking dog to set up a positive social environment and for it to suggest changing social norms surrounding drug use.

This campaign insults the intelligence of the youth because it does not warn against the real dangers of drug use, and this campaign does nothing to suggest changing social norms surrounding drug use. In many ways, the dog in this commercial is portrayed as superior to the teen. The body language of the dog walking away from the smoking teen is an example. The problem with this approach is that teens are asked to look up to their dogs. Youth is an important stage in identify formation. In each stages of identify formation, the behavior changes in response to social environment (11). It is important for the drug council to understand this and incorporate all the aspect of health behavior modifications to encourage drug cessation.

The Ads Fail to Convey Relevant Facts

Conveying a complete and perfect message about the dangers of drug use and solution for the problem in a 30 second ad is difficult to do. The challenge for “Above the Influence” to do this difficult task was perhaps the main reason for a random style of advertisement that was meant to trigger some deep psychological part that impacts teen’s decisions. But it’s unlikely that it is profound enough to trigger the right part of teen’s brain for them to completely understand the consequences of drug use. The advertisements miss use of psychology and under utilizing various health behavior models have caused the anti-drug programs a lot of money and time. And their continued efforts fail to save teens from the dangers of drug use.

The “Walk Yourself” is another 15 second cartoon commercial by “Above the Influence” very similar to “Stop Looking At Me”. The dog looks at the young male teen who is lying down smoking marijuana, the teen then tells the dog to walk himself and the dog walks away from him saying “You disappoint me” (3). The main message of this commercial is exactly same as “Stop looking at Me”. Smoking marijuana disappoints close friends and dogs. One might wonder why they have wasted money and time creating similar types of ad that are not very effective.

Like the previous two advertisements, this commercial does not generate respect from the teens nor does it use the dog effectively. The main reason why this ad has fails to guide the teens in the right path is because it does not convey the real facts of drug use. It does not show the consequences of continued drug use on themselves, how it might affect their family, and their future. It does not take the opportunity to explain what truly happens to their dog. It also does not demonstrate how one might attempt to stop the drug use and the hope that they are capable of taking control over their undesirable habits. The Transtheoretical model is a good example of a health behavior model that emphasizes the importance of intervention and guidance in stages (5). The failure of “Above the Influence” to utilize this model, as it relates to behavior change, is a primary reason for its unsuccessful campaign. Teens will not understand the simple and direct message this ad sends, rather they will view this ad as insignificant and unimportant. It might even stimulate rebellious and curious nature of teens making them more interested in drug use (4).

Conclusion

Teens follow the norms set forth by their peers in hope of fitting in and being accepted. Creating and promoting a drug free norm is the only way to affectively cure America of teen drug use.

The advertisements by “Above the Influence” campaign has been criticized for undermining teen’s intellect and being offensive by using stereotypes (4). The campaign’s lack of understanding teens, inappropriate use of social learning/cognitive theory, and inability to connect with teens at their level has failed to reach out to teens in America.

Despite the teen’s harsh comments toward these ads and its confirmed ineffectiveness, “Above the Influence” media campaigns have been viewed through YouTube numerous times by teens. Teens may be watching for entertainment, but they may also be actively seeking out for reasons and ways to get help for their desire to stop drug use. Public health agencies utilizing behavior change theories correctly can successfully reach out to the teens who are seeking help, and make real differences in teen’s life that will result in less drug use.

Solutions

Understanding teens

Anti-drug advertisements that use talking dogs have failed because they undermine teens’ intellect and fail to inspire healthy behaviors. In order to create an intervention that discourages teen drug use, it is important to understand how teens think and what is important to them. Most teens are initially introduced to drugs and alcohol by their friends and often are pressured into their first try (6). This initial exposure can also be the inertia behind recurrent drug use (6). Campaigns and advertisements should not overload the teens with information on drug use and its harmful side effects. Rather, they should allow teens to feel respected, to feel they have the freedom to choose, and to help them realize their role and responsibility in shaping the character of their family and this country.

Many teens have misconceptions about drugs and do not realize the true consequences of drug use. While the majority of teens begin drug use due to curiosity, many become dependent on drugs and use them to fill a void. Without proper interventions, this habitual drug use will hinder their adult life and it might debilitate them from holding jobs and leading a good family.

Teen drug use has significant short and long term consequences, therefore it is important for public health officials to intervene for the safety of America (6).

Intervention

The proposed intervention will utilize Framing as the foundation of delivering an anti- drug use. The intervention, “Connection”, uses commercials and a spokesperson to convey the message. The key spokesperson for the intervention is Michael Phelps, a 16 time Olympic gold medalists who was caught using marijuana (17). Framing is key in producing this commercial. In particular, the commercial will not to portray Mr. Phelps as being punished for his actions, but rather highlight his willingness to share his thoughts with teens in America.

The advertisement will start with a series of clips of Michael at winning moments at the Olympics, and then it will turn to a testimonial from Mr. Phelps on why he chose to smoke marijuana. He explains his experiences, how the marijuana made him feel, how long the affect lasted, and what happened after the affect disappeared. Mr. Phelps would then go on to explain the consequences of his choice to smoke marijuana, the negative publicity, and the disappointment from his mother, colleagues, friends, and fans. He also would express remorse for breaking the law, and disappointing everyone especially himself. He elaborates on how it adversely affects his character, qualities, career and image. His purpose would be not to generate feelings of punishment but to express feelings of regret for potentially ruining his career. Lastly, he would provide teens with resources on how to reach out for help. These resources will have suggestions on how to stop, how to deal with peer pressure and a phone number for personalized assistance.

The primary resource that the commercial points to is a website where teens can join the fight for a drug free America. The website can be designed to provide interaction with teen celebrities, opportunities to volunteer at their local communities, and chance to participate in leadership conferences. Teens that volunteer and serve in their community tend to have good family relationships and communication skills that will prevent them from engaging in risky behaviors such as drug use (16).

Respect and being respected

The reason why talking dog commercial failed to lower the teen drug rate in America is because the commercial’s spokesfigure fails to generate respect. According to the social cognitive/learning theory, models must evoke trust, admiration, and respect from the observer (5). Instead of using an unrealistic figure, as seen in “Dog”, the better approach would be to use a figure that teens can connect with and relate to. For this reason having Michael Phelps, or other teen celebrities as spokespeople, will generate the necessary respect for the message being delivered.

Another reason why “Connection” will be more effective is because it treats teens as a respectable and intelligent group by using spokespeople of stature. With Mr. Phelps’s impressive record, anyone would consider him a hero and look up to him for his strength, talent, determination, and perseverance. He already has earned the respect that will hold teens’ attention and allow them to respect him for his honesty and realness.

This intervention also recognizes and understands teens’ desire to be respected. Teens, especially those who feel that they have failed to achieve at the level of standards academically and morally by using drugs, may feel less respected by their peers and by adults(14). Opportunities such as leadership conferences, serving their communities, and becoming a role model themselves will give teens the feel of being respected by their community. Teens being respected are more likely to show their respect for others and follow directions of authorities better than teens who feel that they were not respected (19).

A message from their peers

The advertisement by “Connection” featuring Mr. Phelps will work better than the talking dog advertisement by speaking to the teens at their eye level in two different ways. First, the teens will be able to relate to Mr. Phelps better than they can to the talking dog. The ads by “Above the Influence” had inappropriate expectations for talking dogs to set the social norm (9). Mr. Phelps’s explanation, that the behavior he was engaged in was not the norm and he would not recommend for anyone to try, can set up a positive social environment and suggest changing social norms surrounding drug use(8).

Second, this advertisement utilizes an advertising and branding theory that uses endorsement from a revered athlete to add attractiveness and credibility to the source (13). This approach will allow teens to be open to the messages coming from this campaign. This intervention also promises the benefit of drug cessation by focusing on teen’s character development, teaching valuable skills, such as conflict avoiding, and leadership skills which will help them to become role models to the next generations. Giving teens an opportunity to be part of a positive social network that uses positive psychology will allow teens to help each other to change together and generate feelings of self importance, self-efficacy, and connection to others by providing them motivation to become socially acceptable individuals (18).

The campaign website can also feature other teen celebrities and athletes that have joined the fight for a drug free America. Their main role would be to give teens the sense of connection to a larger network made up of people their age. Teens will have easier time sharing their experiences and their concerns to each other than to adult authoritative figures (8).

The truth and nothing but the truth

One of the main reasons why most anti-drug ads do not work is because it fails to convey the full and complete message about the drug use. Most ads may actually work against the ad by unintentionally implying that others teens are using the drugs which can stimulate teens curiosity to try drugs (4, 15). This web based “Connection” will feature peer role models who has and has not used drugs explaining their direct or indirect effect of drug use. Unlike the talking dog ads that left the teens hanging at the end of the commercial without proper guidance, this campaign will use Transtheoretical model to tailor different intervention to meet the needs of different teens at various levels(5).

Another reason for the failure of “Above the Influence” is its lack of simple and straightforward message in its advertisements. Instead of utilizing hard to understand, deep thought requiring random anti-drug advertisements with lots of room for misunderstanding, “connection” will use non complicated language and images by their peer role models to tell the basic truth and consequences of drug use.

Conclusion

While it maybe impossible to create a perfect intervention that will eliminate all teen drug use, understanding teens and utilizing appropriate social and health behavior models will have a better outcome in discouraging teen drug use. Public health professionals should work with teens to find a solution rather than feeding teens with information that teens can’t relate to. This new intervention will allow teens to feel respected and feel connected to the real world and generate feeling of self-efficacy and self-importance which in turn will discourage teen drug use.

REFERENCES:

1. Lebelle,L. (2008) Drugs and Teens Substance Abuse. Focus Adolescent Services. http://www.focusas.com/SubstanceAbuse.html

2. National Institute on Drug Abuse (August 2008) NIDA Info Facts: Nationwide Trends http://www.drugabuse.gov/about/aboutnida.html

3. “Walk Yourself” The Ads. Above the Influence. http://www.abovetheinfluence.com/the-ads/default.aspx?path=nav

4. Ryan Grim, A White House Drug Deal Gone Bad: Sitting on the Negative Results of a Study of Anti-Marijuana Ads, Slate magazine, September 7, 2006.

5. Grizzell, J. (1/27/2007). Behavior Change Theories and Models. www.csupomona.edu

6. About. Above the Influence. http://www.abovetheinfluence.com/about.aspx

7. United States Government Accountability Office. Contractor’s National Evaluation Did Not Find That the Youth Anti-Drug Media Campaign Was Effective in Reducing Youth Drug Use. Washington, DC: GAO 06-818, 2006.

8. Azar, B Antismoking Ads that curb teen smoking. American Psychology Association. January 1999. http://www.apa.org/monitor/jan99/joe.html

9. University of Georgia (2007, July 20). Why Some Anti-smoking Ads Succeed And Others Backfire. ScienceDaily. Retrieved April 7, 2009, from http://www.sciencedaily.com/releases/2007/07/070719170315.htm

10. “Dog”. The Ads. Above the Influence. http://www.abovetheinfluence.com/the-ads/default.aspx?path=nav

11. Erikson, E. Childhood and Society. New York: Norton, 1950.

12. “Stop Looking at Me” The Ads. Above the Influence. http://www.abovetheinfluence.com/the-ads/default.aspx?path=nav

13. Tellis, Effective Advertising: Understanding When, How, and Why Advertising works.

14. Mclaughlin K. Teens crave respect as much as adults do. Northjersey.com. January 20, 2009.

15. Hornik R, et al. Effects of the National Youth Anti-Drug Media Campaign on youths. Am J Public Health 98(12) 2008.

16. Ma L. Teen Spirit: Give and Let Live. Psychology Today April 29, 2007.

17. Svrluga, Barry. "Phelps Sets Olympic Record". The Washington Post. 2008-08-09.

18. Thomas Kelly, Positive psychology and adolescent mental health: false promise or true breakthrough?, 2004

19. Dillon R. Respect. Stanford Encyclopedia of Philosophy. Jan 2, 2007.

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.