Monday, December 13, 2010

The “Candies Foundation” Abstinence Campaign: Use of Ineffective Methods and behavioral models to Transmit the Message to Teens – Meredith Weiner

Abstinence refers to the idea of postponing sexual intercourse, and in some cases other sexual behaviors as well. People carry out abstinence for moral, religious, or health and safety reasons, such as the prevention of pregnancy, human immunodeficiency virus (HIV), and sexually transmitted infections (STIs) (1). Abstinence-only education gained federal funding in order to prevent teen pregnancy in 1981 with the passage of the Adolescent Family Life Act (AFLA) (2). This act aimed to reduce STD’s, HIV/AIDS and teen pregnancy in youth by supporting programs that endorse abstinence from sex as the sole option (2). In 1996, the passing of Title V, Section 510 of the Personal Responsibility and Work Opportunity Reconciliation Act resulted in government funding focused on abstinence-only education (3). Since 1998, for children under 18, teaching abstinence became the expectation, with programs receiving $50 million each year in order to do so (3). By 2005, funding towards abstinence-only education reached $167 million annually for these programs, with approximately 25% of 15-19 year olds receiving abstinence-only education (4). Many of these educational programs make use of models that center around adult sexuality, placing sex within the setting of marriage, and emphasizing the unhealthy nature of sexual behavior (5). In this way, abstinence-only programs have proven ineffective in reducing adolescent sexual activity, and may even inhibit knowledge of prevention behaviors, such as the use of contraceptives (3). One study looked at nine states’ sexual health curricula, five of which had the lowest teen pregnancy rate, and four of which had the highest rate of teen pregnancy in the year 2000. This study showed that those states which covered abstinence, as well as contraception had the lowest rates of teen pregnancy, while those states that particularly stressed abstinence, and did not cover contraception had the highest rates of teen pregnancy (2). This shows how abstinence-only education and advocacy has existed in the United States for several years now, and even receives endorsement from the government, despite the fact that the evidence clearly reveal that these campaigns and programs have little to no impact on adolescent behaviors regarding sex (5).
The prevention of STDs, HIV, and teen pregnancy in the United States is a huge public health concern. Among the industrialized countries, the United States has some of the highest rates of STDs, teen pregnancy and teen births (4). Abstinence-only campaigns serve as one method of approaching this issue. The Candies Foundation campaigns attempt to spread the word about the “devastating consequences of teenage pregnancy”. The campaign aims to reach their target audience of the teenage population through the use of popular celebrities, such as Beyoncé, Usher and Bristol Palin, among many other familiar teen sensations (6). The Candies Foundation projects their ads through all of the major teen media sources, such as Seventeen and Cosmopolitan magazines; ABC, MTV and FOX channels; and and websites (6). The newest celebrity on the campaign, Bristol Palin provides the campaign’s main message of “Pause Before you Play”, reminding teens to think about the future, consequences, relationships, delaying sex, and asking “why now?” before they engage in sexual activity (6). Despite claims of the Candies Foundation to reach many teens with effective messages, the campaign has flaws in three main areas and will not achieve success with these faults continue to exist.

Criticism #1: Use of the Health Belief Model
The Health Belief Model is a social science theory used to predict health-related behaviors, such as sexual health behaviors. The Health Belief Model takes into account an individual’s readiness to engage in a health behavior, and that person’s belief in how taking that action will benefit the highlighted threat of health (7). Three factors influence the likelihood of a person taking on a health behavior: First, the individual’s idea of how inclined they are to the health threat; second, the perceived severity of the health threat; and third, perceived benefits of reaching the health behavior, weighed against the costs, or barriers to adopting the behavior (7). The Candies campaign attempts to show adolescents how susceptible they are to the health threat (becoming pregnant), by using statistics, such as “over 2,000 teenage girls get pregnant everyday! That’s 750,000 girls a year!” By using these statistics, the campaign is implementing a type of scare tactic, to show girls their supposed high susceptibility to becoming pregnant if they choose to have sexual intercourse.
Next, the Candies Foundation demonstrates the severity of becoming pregnant as a teenager. Severity comprises a large part of this campaign, as many of the public service announcement (PSA) campaigns using celebrities show the “devastating consequences of becoming pregnant”. For example, a commercial with the singer Ciara shows a girl making out with a boy in her bed; afterwards, the ground shakes and her bed transforms into a crib. Ciara then comes out and says “not really the way you pictured your first crib, huh?” Similarly, another campaign shows a boy making out with a girl in his car, when suddenly the girl disappears, and his car turns into a stroller. Teddy Geiger appears saying, “Not exactly what you had in mind for your first set of wheels, huh?” These videos aim to show teenagers how quickly their lives can change if they become pregnant, which can be seen in the sudden nature of the bed turning into a crib, and the car turning into a stroller.
Lastly, the Health Belief Model posits that if one recognizes the severity of the health behavior, that person will see that taking the action to achieve to the behavior will have benefits in reducing the health threat, which will far outweigh the obstacles (perceived barriers) standing in the way of adopting the health behavior (8). The Candies Foundation does not leave room for the viewer to make a choice about the perceived barriers, or what that individual may have to give up by choosing abstinence. Instead, the campaign only provides information about the benefits of choosing abstinence (reducing the health threat), and the costs of not choosing abstinence. In this way, the campaign fails to mention how to have a beneficial sexually active existence before marriage, or the positive aspects of choosing this route.
In any of its applications, the Health Belief Model has many faults, but particularly, it fails in its application to the Candies Foundation’s abstinence campaign. First, this model targets individuals, not groups. Not only does this creates an individualization of risk, saying that individuals determine risk rather than social and societal factors, but it also ignores the fact that interventions can affect groups of people at the same time, known as a “herd mentality” (9). Instead, this campaign is pointing a finger at the individual, placing sole responsibility (or blame) on that person.
Furthermore, the Health Belief Model only accounts for attitudes and beliefs, and assumes that these intentions will lead to the health behavior, not taking into account the irrationality of behavior. Irrationality of behavior does not get addressed in this model, or campaign, especially with respect to sexual behavior among teenagers (5). Although a teenager knows the risks of having sex, often times, the emotions and pleasure of the moment overcome all rational decision-making. Furthermore, Relying only on attitudes and beliefs discounts the influence of outside factors, such as demographics, personality, social support, poverty, public policy, access, and previous health experiences (8). The Candies Foundation speaks only to the attitudes of a typical American teenager, ignoring the cultural diversity of this country, as well as the many societal factors that also have a huge impact on the beliefs and attitudes of adolescents (8). The campaign uses lines such as, “I never thought I would be a statistic”, assuming that these statements can single-handedly influence the individual’s attitude, directly leading that person to choose abstinence.

Criticism #2: Reactance and the Law of Small numbers (Optimistic Bias).
Psychological reactance occurs as a reaction to a threat of freedom, or an individual’s independence to make decisions autonomously. Individuals also have reactance in response to threats on the ability to hold certain attitudes (10). The reactance experienced, is an act that aims to resolve the threatened freedom, which can result in the person carrying out the forbidden freedom. If censoring occurs, the individual will attempt to see/do the censored message or activity; if the behavior involves decision-making, the individual will act on the prohibited decision (10).
Although research shows that successful social influence does not impose threats on valued freedoms, such as sexual behavior, the Candies Foundation does just this, by taking away an adolescent’s decision to become or remain sexually active (10). Reactance occurs among people of all ages; however, teenagers dislike being told what to do more than anyone (5). The campaign uses these lines: “Pause before you play”, “Be smart: You are too young to start”, and “Be smart: don’t give up your education”. Each of these messages takes the form of a command, demanding that the individual do something, whether or not they want to do that. Furthermore, these statements take on a demeaning tone; “Be smart: You are too young to start”, which will only illicit more reactance from adolescents. Adolescents strive to be mature and adult-like, so using phrases such as “too young” will only result in the individual attempting to do the opposite. For some teenagers, sexual activity may serve as a rite of passage into maturity and/or adulthood, giving them more reason to engage in the behavior (5).
Some of the other messages that the Candies Foundation transmits involve statistics like portraying the negative consequences of becoming a teen parent. For example: “Fewer than half of teen mothers receive a high school diploma – fewer than 2% earn a college degree by age 30”, and “8 out of 10 fathers don’t marry the mother of their child”. These statistics are ineffective because of the Law of small numbers, which occurs when an individual makes judgments based on a small sample of information, ultimately ignoring population statistics and information (11). This means that although a person reads the statistics saying that “750,000 teenage girls” get pregnant each year, the number will not carry great importance, because teenagers are surrounded by many (although not nearly 750,000) peers and friends who engage in sexual activity and do not become pregnant. Similarly, people tend to have an optimistic bias, an expectation that negative life events will not affect them (12). One study found that students believed themselves more likely to experience positive events than their peers, and less likely to experience negative events (12). The Candies Foundation continues to display negative statistics and images about becoming a teen parent to America’s adolescents. Due to the optimistic bias and the Law of Small Numbers, this method will not work, because a) the statistics are detached from the reality of these teenagers’ lives, in that they do not personally relate to these statistics, and b) adolescents generally believe that negative life events will happen more to their peers than to them, despite what the statistics read.

Criticism #3: Inability to Relate to the Message transmitters
The Candies Foundation has flaws in how it transmits its messages about abstinence and teenage pregnancy. The campaign uses celebrities, such as Bristol Palin (the newest advocate), Beyoncé, Usher, Lupe Fiasco, Rihanna, Ciara, Hilary Duff, and Mike “the Situation” Sorrentino. The first problem with this choice of featured celebrities can be seen in the reputation that some of these figures hold. For example, the lyrics of one of Usher’s latest songs goes as follows, “let’s both get undressed right now, keep it up girl then I swear, I’mma give it to you non-stop, and I don’t care who’s watchin’” (13). These lyrics obviously do not promote any form of abstinence or safe sexual practices. Furthermore, the latest PSA features Bristol Palin and Mike “The Situation” Sorrentino from the popular show “Jersey Shore”. For any person who has ever watched an episode of Jersey Shore, they will know that “The Situation” gets into many “situations” with many different girls. That is to say, throughout the show, he has sex with many women on national television, and he certainly does not practice monogamy in any way, shape or form. This provides a confusing message for the teenagers that the campaign targets, because on the one hand they are being told to abstain from sex, but on the other hand, those who watch Jersey Shore can see that “The Situation” makes sex look fun, cool, and pleasurable.
The second problem with the featured celebrities in the Candies Foundation has to do with similarity, and the ability to relate to the celebrity advocates. Looking up to a person because he or she is famous differs from relating to that individual on a personal level. Evidence shows that a person is more likely to adhere to, or respond to a message if it comes from a person who shares a similar status, and similar values, interests and needs (11). When similarity increases, messages about the severity of a health threat are more likely to get through to the recipient, and therefore illicit less resistance (11). This serves as a huge downfall of the Candies Foundation. In one of Bristol Palin’s PSAs, she claims to know the difficulties of living as a teen mom, and how this can inhibit the typical life of a teenager. These claims do not carry any truth in them, because Bristol Palin does not live a typical life. Any average adolescent that this campaign targets, does not share the same status as Bristol Palin, or any of the other celebrity features. Would a normal teenage mother make an appearance on the show “Dancing with the Stars”? The answer is no, they would not. Bristol Palin reads from a script that does not apply to her life. No teenager is going to listen to a person who blatantly spreads faulty messages. The Candies Foundation also uses messages of Dominance towards teens, which inhibits the ability of the message to reach the audience. Therefore, the campaign’s utilization of celebrities, who do not share similarities with the adolescents, and transmit governing demeaning messages of abstinence, further provokes reactance and results in an ineffective campaign.

Intervention #1: Using a Group-Level Model
The Health Belief Model does not suffice as a single behavior change model in public health. Perhaps it can serve a useful purpose in conjunction with a group-level model; however, alone it only accounts for individual attitudes and beliefs that influence health behaviors. It does not allow for societal factors, such as poverty, social norms, access, and cultural influences, which have a large influence in the adoption (or not) of health behaviors (7). A better way to approach the Candies Foundation abstinence campaign is through a group-level model, which does address these factors. Advertising theory targets a group-level audience, and focuses on making a promise to that audience. The goal of advertising theory is to make a promise, and then back up that promise with support, through stories, images and/or music – anything that reaches out to the emotions (14). Manipulation plays a key role in advertising, so in a sense, the Candies Foundation has already made an attempt at advertising abstinence. A better way for this campaign to advertise abstinence would involve first sending positive messages about abstinence, rather than negative messages about the horrible impact that teen pregnancy has on your life. In fact, the advertisement does not even need to mention abstinence or health in order to manipulate the target audience. The advertisement could play off of the irrationality of behavior, and the emotions of adolescents. A simple advertisement could involve a male and female adolescent out at a club. The male invites the female back to his house. He suggests having sex, and she declines. They end up watching a movie and cuddling on the couch. In the end, the man becomes more attracted to the woman, because she did not have sex with him right away, which showed her good morals and values (not to say that those who do choose to have sex have bad morals). Notice how this advertisement does not involve any statistics, or comments on the negative impact of sex on a person’s life. Instead it delivers a positive message about how waiting can create even more chemistry and attraction between couples, which is what many adolescents desire. This advertisement makes the promise of love and attraction without sex, backing it up with the story of this couple.
Another aspect of advertising that can benefit a campaign is branding. Branding involves creating a set of associations with the health behavior that the campaign is attempting to sell, which adds value to the behavior for the target audience (15). For example, the Candies Foundation could use a brand such as “making ‘em wait, keeps ‘em at bait”, which gives abstinence a sort of sexy appeal. The Candies Foundation has a slogan “Be sexy: it doesn’t mean you have to have sex”, which by itself, does not sound very appealing, or convincing; however, if an association exists between the new brand and the advertisement, than it may actually influence adolescents to abstain from sex, with the promise that they will not lose their partner if they decline an invitation for sex, and it instead, this may actually make the partner more attracted to that individual. Branding and advertising often times go hand-in-hand to influence an audience to take up a certain behavior (15).

Intervention #2: Minimizing Reactance
The current Candies Foundation campaign for abstinence utilizes many methods that illicit reactance, particularly amongst their target audience of teenagers. They explicitly take away the freedom of choosing whether or not to engage in sexual activity, the campaign imposes dominant demands on the audience, telling teenagers that they must “be smart”, or “pause before you play”, and lastly the campaign throws several statistics in the face of its viewers. Each of these aspects of the Candies Foundation incites psychological reactance among the target audience. The solution to this problem is simply to minimize reactance, by changing or altering the campaign in a few different ways.
First, the message of the campaign, explicitly telling teenagers to wait before having sex needs to change. Explicit messages have a greater chance of provoking reactance than plain messages (10). The campaign should attempt to advertise abstinence in a way that does not advocate for an abstinence only option so obviously. For example, the advertisement described above, which shows a couple out together, and ends with the female declining sex, resulting in the male becoming all the more attracted her does not mention the word abstinence or make any reference to health and teenage pregnancy. In this way, the message speaks catches the attention of teenagers because it addresses aspects of relationships about which this group of teenagers may have concerns, such as losing a partner if a person chooses not to have sex.
Secondly, the current Candies Foundation campaigns assert dominance in the PSAs, which will result in psychological reactance. In most of the videos, the featured celebrity ends the video telling YOU (the audience), what you should NOT do. This assertion of control and dominance over the viewer comes off as threatening and does not entice viewers to follow the instructions (10). Furthermore, the advertisement should not make mentions of how teenagers’ “young” age, or lack of maturity should stop them from engaging in sexual activity, because this statement will cause adolescents to rebel and attempt to prove their maturity, perhaps through having sex. Lastly, the campaign should not contain any statistics, because numbers do not have much meaning, and most of the statistics carry negative messages. A positive story of one person will have more of an impact than a negative statistic about 750,000 people.
In this way, an advertisement or campaign that does not revolve around health or abstinence, and avoids any commanding statements and statistics will have much greater success in achieving the goal of reducing teen pregnancy through abstinence.
Intervention #3: Using Similarity to Reach the Target Audience
The Candies Foundation uses very popular celebrities, such as Bristol Palin and Usher, to spread the word about the negative consequences of teenage pregnancy, and the benefits of abstinence. Although adolescents generally look up to these figures in admiration, they cannot relate to celebrities. Typical adolescents and these celebrities, really have nothing in common at a personal level. Adolescents go to school, have to abide by the rules of their parents or caregivers, and do not have money to spend frivolously. In General, celebrities live in large mansions, play by their own rules, and spend their days in luxury. Furthermore, most of these celebrities have reputations that contradict the messages that the Candies Foundation attempts to send about abstinence.
Thus, a successful campaign will not use celebrities, because teenagers cannot relate to them and take their messages seriously, which may result in reactance. It has been proven that the more similarities that exist between the perceiver and the message sender, the less likely the perceivers are to respond with psychological reactance (10). The campaign should use one adolescent (or two in the case of a couple), to send the message about abstinence. This could be one teen mother, who shares the difficulties she faces with raising a child on her own, similar to Bristol Palin’s campaign, but improved because teenagers can actually relate to someone who leads a life more similar to their own. This could also take form in a more positive message, perhaps from a girl who told her boyfriend that she did not want to have sex. In turn, this made him love her even more, and they ended up staying together, and finding pleasure and displaying their affection for each other in other ways. These examples address many of the concerns that a teenager would face if that person were deciding to become abstinent. Would my partner still want to be with me? How else can we find pleasure and show our affection for each other? These would transmit positive messages, coming from similar people, rather than negative messages coming from people that exist in a world that does not constitute a reality for typical teenagers.

In Conclusion:
In conclusion, it can be seen that the current abstinence campaign from the Candies Foundation will not have successful results in reducing teen pregnancies in the United States. This campaign fails in its use of the Health Belief Model, which approaches health behavior change from an individual level, without accounting for irrational behavior and societal factors that have a huge impact on decision-making and behavior change. Additionally, many of the methods that this campaign uses to persuade teenagers to take up the practice of abstinence are extremely conducive to psychological reactance. The entire campaign contains cues that provoke teenagers to rebel against its demeaning commands coming from dissimilar figures. Lastly, the most recent PSA, featuring Bristol Palin has no ounce of truth in it. Why should a teenager believe that Bristol Palin faced difficulties and hardships raising her child, when she recently made an appearance on “Dancing with Stars”, which any normal teenage mother would never be able to do. This does not serve as a convincing way to change the behaviors of the teenage population in the United States.
Luckily there exist many ways to improve this campaign so that it may in fact have an impact on reducing teenage pregnancy in the United States. The ways in which this campaign must change, revolve around the cognition of teenagers. The new intervention must spread positive messages about abstinence, from individuals to which teenagers can actually relate. Furthermore, the messages should be plain, rather than explicit, and should not come off as dominant, controlling or demeaning. If the campaign utilizes these messages, which do not rouse psychological reactance, and instead catch the attention of youth, they will have success in getting teenagers to engage in abstinence, thus reducing teenage pregnancy rates. On a final note, evidence shows that abstinence-only education and campaigns have lower success rates in reducing teenage pregnancy (4). Abstinence campaigns, including the Candies Foundation, should always inform teenagers of their options for having safer sex, and endorse the use of contraceptives, which in addition to abstinence, lower the rates of teen pregnancy, leading us to the ultimate goal of the Candies Foundation campaigns.

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