Inadequate Formulation and Execution of NHTSA Drunk Driving Public Service Announcements – Stephen Iacono

Alcohol related motor vehicle accidents have been on the decline since 1982, when legislation prohibiting the drivers with a blood alcohol content (BAC) above .08 g/l from operating motor vehicles became more strictly enforced (1). Despite various efforts by the government and private organizations, in the 2005 over 59,000 citizens were killed in the United States due to fatal car accidents. Of the 59,000 deaths, a driver with a blood alcohol content of above .08 was responsible for approximately 20% of the people killed (2). In a continuing effort to reduce the volume of drunk drivers the National Highway Traffic Safety Administration (NHTSA) adopted the new campaign and slogan entitled “ Drunk Driving: Over the Limit, Under Arrest” (3). The “Over the Limit, Under Arrest” campaign was designed to discourage all individuals from driving under the influence of alcohol. The campaign emphasized the nationwide police efforts to stop and arrest drunk drivers on the road by increased police vigilance and security checkpoints on major roadways. The campaign was publicized using mass media television commercial, flyers, and billboards as well as the campaign’s website www.stopimpaireddriving.org. (4,5,6)

Despite the effort made to advertise the “Over the Limit, Under Arrest” campaign to gain exposure in the general public, there has been minimal changes in the amount of drunk driving fatalities in the United States in the subsequent years after the program implementation. Furthermore, data collected by the NHTSA as well as private researchers suggest that public exposure to the campaign did little to effect peoples’ decision to drink and drive (7,8,9).

The campaign had major flaws that contributed to the insignificant impact that it had on discouraging drunk driving amongst the public. One of the major flaws in the campaign design is the negative image use in the various advertisements. The advertisements include images of severely impaired drivers being questioned by an authoritative police officer, as well as images of people in handcuffs, in prison, and hospitalized (4,5,6). None of the advertisements offer safe alternatives to drunk driving, nor do they give positive reinforcement to those who do not drink and drive. Another major flaw of the “Over the Limit” campaign is the use of the Health Belief Model and Theory of Reasoned Action as its methods to influence pubic behavior. Both the Health Belief Model and Theory of Reasoned Action have been proven to be ineffective measures to influence people. By analyzing the various flaws of the NHTSA’s campaign, a public health advocate would be better equipped to develop a new campaign to combat drunk driving with a much more effective and tolerable campaign.

Health Belief Model and Theory of Reasoned Action is Proven to be Ineffective in Influencing and Predicting Behavior

The initial wave of the NHTSA’s “Over the Limit, Under Arrest” advertisement campaign was implemented during the summer of 2006 and ran from August 16^th to September 4^th costing approximately $18 million in advertisement spending alone (7). After the initial campaign wave the National Highway Traffic Safety Association issued a wrap up report summing the effectiveness of the campaign. The statistics in the report were collected from the FBI’s Uniform Crime Reporting (UCR), which analyzes DWI arrests trends; information from the NHTSA’s Fatality Analysis Reporting System (FARS) to analyze the trend in alcohol related fatalities before and after the campaign waves. The NHTSA data revealed that there was both an overall increase in both DWI arrests as well was alcohol related motor vehicle incidents (7). As part of the effort to evaluate the effectiveness of the program, random telephone surveys were conducted by the NHTSA prior to the campaign enactment; similar phone surveys were conducted after the first wave of the campaign advertisement. The findings reveal that there was an overall increase in the instance of self-reported drunk driving from 32% of total respondents to 48% after the advertisements aired (7).

Despite the evidence of the counterproductive effects of the program, the NHTSA continued to advertise the “Over the limit, Under Arrest” until the present year and released statements continue to indicate the program’s ineffectiveness (7,8). The common trend is that there are consistently more arrests made for motorists driving while intoxicated, but there is no significant change in drivers’ perception about the dangers of drinking and driving.

Why then, despite great effort to reduce peoples’ desire to drink and drive, the results consistently show that there has been little change in the population perception of drunk driving? The reason is most likely due to the way the public service announcements used in the “Over the limit…” campaign is largely based on two models that have been proven to be ineffective. Health Belief Model and the Theory of Reasoned Action have been extensively used in public health advertisements and campaigns. The Health Belief Model began gaining popularities during the 1950s and is still widely used today (10). The premise of the Health Belief Model is that all decisions are made based on the individual’s analysis of the problem. The model assumes that people make decisions by weighing the perceived susceptibility to the problem and the severity of the problem to the perceived barriers to solving the problem and the benefits of solving the problem. It is assumed that a person will make a rational decision based on these evaluations (10). The Theory of Reasoned Action is similar to the beliefs and assumptions of the Health Belief Model. The Theory of Reasoned Action’s presumes that the only way to change a person’s behavior is by changing their intention (10). Intention is based on what a person feels the outcome would be of an action, and his attitude towards that outcome; the theory also provides that people will make decisions based on how others will perceive their actions. Both behavioral models are based on influencing the individual and assume that each person inherently acts rationally.

The “Over the Limit, Under Arrest” campaign uses both models to influence the population’s behavior about drinking and driving. The campaign uses advertisements in mass media to raise awareness that anyone who drinks and drives is susceptible to being stopped and arrested by law enforcement; the campaigns assume that people will choose not to drive for fear of being charged with a DWI offense. The advertisement campaign also assumes that people do not want to endure the public embarrassment of getting caught while driving intoxicated and this will influence the individual to refrain from drunk driving. Several research studies have extensively displayed the ineffectiveness of the Health Belief Model and Theory of Reasoned Action in significantly influencing the public.

Both the Health Belief Models and the Theory of Reasoned Action individualistic models that try to influence individuals when they make decisions. The reason why these models do not work is because they do not account for the emotional attachment in doing a behavior, as well as the social influence that influence their decisions. In a study conducted in 2000 by Airhihenbuwa and Obregon showed how the Health Belief Model and Theory of Reasoned Action are ineffective in promoting preventative measures to reduce the spread of HIV in communities where family and social ties are essential to daily life (10). Neither model addresses emotional and social demands of the individual when making health conscious decisions. The researchers claim that because both theories appeal solely to the individual’s understanding of the risks, they fail to account for the social influences that inhibit people from using preventative measures to stop HIV infection. Obregon and Airhihenbuwa state that the common social understanding is that using condoms and other barrier devices are not accepted by the social construct of the communities and are generally ignored (10). So despite people’s understanding of the dangers of unprotected sex they do take steps to prevent infection.

The Health Belief Model states that an individual will engage in a health conscious behavior based on their personal perceived susceptibility to a problem as well as the perceived severity of the problem. According to the research done by Clarke, Lovegood, Matchperson and Williams in 2000, the people underestimate susceptibility and severity of a problem when they are personally endangered (11). The researchers in this study interviewed both men and women and asked questions regarding susceptibility to developing prostate or breast cancer respectively; subjects were also asked how severely each cancer would impact an individual’s health. The subjects were divided into two groups, one group was asked to answer questions involving the susceptibility and risk of the general public, while the other group was asked questions about their personal risk and susceptibility. The results showed when women and men were asked about their person susceptible to cancer they believed that they were 25.7% and 25.2% susceptible respectively (11). Conversely, when asked about the susceptibility of others women and men reported that the general population was 44.0% and 31.5% susceptible to cancer (11). Similar results are shown when women were asked the chance of curability if diagnosed with cancer. When asked for their personal chance of curability women responded that 70.5% chance of being cured where as other women had a 58.1% chance of being cured (11). The results of this study show that individual’s personal susceptibility to a problem is imprecise and there is an optimistic tendency for individuals to lower their perceived risks. Such data shows how the Health Belief Model cannot accurately influence personal behavior because the individual’s perception of risk and severity is inaccurate.

This data can be applied to the results of the “Over the Limit, Under Arrest” campaign. NHTSA data showed that there was an overall increase from 32% to 48% awareness in the dangers of drunk driving and of the increase in DWI enforcement during the campaign (7). The data also indicates that there was no change in respondents who reported drinking and driving during the campaign. Due the phenomenon of personal optimistic perceptions, the Health belief model is shown to be ineffective.

The Negative and Restrictive Messages Invoke Psychological Reactance

The “Over the Limit, Under Arrest” campaign if filled with negative images aimed to deter people from driving drunk. The commercials portray individuals getting arrest and embarrassed in public by police officers because they chose to drive drunk. Other aspects of the campaign include posters and billboards of drunk drivers being arrested, using a breathalyzer, or fingerprinted at the police station. Although the message disseminated is clear and logical, the very same message may inadvertently cause people to drink and drive more often. This phenomenon is known as boomerang effect and is part of the Psychological Reactance Theory. Jack Brehms and colleagues first introduced the Psychological Reactance theory in 1966 (12). The theory states, “Theoretically, when a behavior that the individual believes him/herself to be free to engage in is threatened with elimination or is actually eliminated, psychological reactance is aroused and the individual is motivated to restore the freedom. Freedoms can be reestablished in a variety of ways – the most direct being engagement in the threatened behavior” (12). Simply put, when an individual senses a threat to his freedom, he responds in such a way that will restore his freedom. The theory has continuously been studied in psychology since its inception, and is becoming more vital in the formulation and execution of public health programs.

In a study conducted in 2008 by a team of researchers at the University of Alabama in Huntsville, the researchers attempted to identify what type of threat to freedom would cause the most significant reactance (13). The three different types of research as described by the 2008 study were classic threat, social threat, and barrier threat. The researchers gave 2 groups of subjects 3 short vignettes describing a situation in which the person’s freedom is threatened in accordance to the three different types of threats to freedom. The classic threat vignette included an authoritative figure who takes control of a group, the social threat is a condition where an employee is told by an angry employer not to make any mistakes, and finally the barrier threat is a situation where a student loans notes out to another student who in turn loses the notes. The subjects were asked to rate each threat on a scale from 1 to 3; level 1 indicated the least reactance, and level 3 indicating the most reactance. At the end of the study, the results show that the social threat induced the highest reactance with a mean reactance rating of 2.28 for Sample 1 and 2.22 for Sample 2 (13).

The results of the study reveal that when people are faced with a threat to their freedom in social contexts, they are most likely to react negatively to the threat. This knowledge has enormous implications when formulating and delivering public health campaigns such as the “Over the Limit, Under Arrest” campaign. The campaign is advertising puts barriers on a person’s freedom of choice, most importantly it is a threat to his social freedom of drinking. It can therefore be expected that the message will cause some reactance in individuals and the cause them to respond in such a way to reestablish their freedom, which consequently leads to an ongoing problem of drunk driving.

The proof of psychological reactance can be seen in the NHTSA report released after the initial wave of the “Over the Limit, Under Arrest” campaign. As mention earlier, prior to the campaign’s initiation 32% of all telephone survey respondents reported drinking and driving, after the campaign was completed 48% of all telephone respondents reported drinking and driving (7). This is a clear indication that the campaign may have had an inadvertent negative effect on the target audiences. The “Over the Limit, Under Arrest” campaign is designed to inhibit drunk driving by explicitly showing audiences the most negative consequences of being caught driving drunk. However, the unconscious reaction of individuals is to reclaim their freedom of choice by engaging in drunk driving and reasserting their own autonomy against authority. If public health messages could utilize messages that do not convey such restrictive or authoritative images, the psychological reactance could be minimized and the message would better be adhered to by the public.

Ineffective Use Of Public Service Announcements Do Not Influence Individual Preventative Action.

The ability for public health personnel to expose messages to the public through mass media is limited to public service announcements and simple visual items. The “Over the Limit, Under Arrest campaign” is designed to be a public service announcement warning people about the dangers of drinking and driving, as well as a means of deterring people from drinking and driving by using scare tactics to threaten individuals with arrest and embarrassment. Unfortunately, research has shown that even the best thought out and comprehensive public service announcements may not actually effect public perception of a problem. Even without the boomerang effect and psychological reactance, public service announcements have traditionally had very little effect on influencing public behavior.

A research experiment done by Goodall and Slater in 2010 analyzed the individual perceptions to alcohol that people experience after witnessing different types of media (14). The researchers claim that companies that produce different types of alcoholic beverages use social branding to influence the audience’s feelings about the products. As a result of the social branding, people tend to feel more positively about alcohol consumption after witnessing videos or advertisements displayed by companies to sell specific alcoholic beverages. As public health advocates, we expect that our advertisements have the opposite effect on audiences invoke negative perceptions about consuming a lot of alcohol.

Goodall and Slater hypothesize that alcohol advertisements positively influence an individual’s autonomic response to alcohol thereby effectively influence the probability that a person will engage in a deliberate action involving alcohol (14). The goal of public service announcements should conversely negatively influence an individual’s autonomic response to alcohol in order to deter him from making deliberate decisions while engaging in alcohol use.

The researchers divided their subjects into three different groups, a control group, an alcohol advertisement group, and an alcohol PSA group and each were shown several 30 second advertisement. The control group was exposed to non-alcoholic product advertisements, the alcohol advertisement group was exposed advertisements for alcohol brands, and the PSA group was exposed to advertisements made by different private groups (14). After the advertisements were shown, the subjects were asked to report their feelings about alcohol on a survey to measure their deliberate feelings about alcohol. They were also required to take an Implicit Association Test to analyze their autonomic feelings about alcohol. The results showed that the alcohol advertisements had a significantly positive impact on both deliberate actions about alcohol awareness as well as implicit perception about alcohol use. The results also showed that exposure to the Public Service Announcements “showed no evidence of effect, either explicit or implicit” on the feelings or perceptions of the subjects. Thus, it can be inferred that the public service announcements make no impact on a person’s decision to use alcohol before driving (14).

In another research study conducted by Flexon and Guerette in 2009, the researchers assessed the likeliness to drink and drive and exposure to the “Buzzed Driving is Drunk Driving” campaign (9). The subjects were given surveys asking questions pertaining to the use of alcohol socially and while driving as well as their exposure to the “Buzzed Driving is Drunk Driving” campaign. The results showed that exposure to the campaign had no effect in influencing the personal perception of drinking and driving. Additionally the campaign had no effect in the subjects’ feelings that authorities would stop them if the subjects were driving under the influence would stop them.

These studies clearly shows how public services announcements about alcohol awareness are ineffective in changing the way people feel about impaired driving. If an advertisement cannot change a person’s feeling about a behavior, it cannot elicit any response to change a behavior. According to the data, drunk driving public service announcements are unable to reduce the probability that a person will decide to drink and drive.

Intervention

Drunk driving is a serious safety concern for the public and efforts must continuously be made to reduce the amount of drunk drivers on the roads. Not only do impaired drivers pose a danger to themselves, but more often than not they seriously harm innocent people. The “Over the Limit, Under Arrest” campaign has made a strong effort, in conjunction with the strict enforcement of state laws, to reduce the amount of impaired drivers; however, the results show that the public perception of drinking and driving has been unchanged by the campaign efforts. Several changes could be made to the “Over the Limit, Under Arrest” campaign that would make it a more approachable and acceptable to the public. The more appealing the campaign is, the greater the probability that it deter individuals from drunk driving. A new program should be implemented that engages the public to be more active in the awareness of the dangers of drunk driving as well as provide positive support in the prevention of drunk driving.

An important part of any campaign is the title. The title conveys to the public the general message of the campaign, provides insight to how the program is implemented, and inspires public action in response. One suggested title of an improved campaign against drunk driving could be called “Bring a Buddy Home”. The emphasis of the “Bring a Buddy Home” campaign is not on the negative impacts of drunk driving or being caught by the authorities; rather the campaign would be aimed at influencing the public to help out a friend. The general message of the “Bring a Buddy Home” campaign is to encourage people to be designated drivers for a night and rotate designated drivers amongst groups of friends. It is important that being a designated driver does not seem like a burden to social dynamics, rather, it is a positive choice of the individual. The campaign should emphasize being a designated driver empowers the individuals and is a sign of good character, trustworthiness, and popularity

The campaign should have both an advertisement component, as well as an interactive, community based component. The advertisement component of the “Bring a Buddy Home” campaign can be supported by both commercial advertisements as well as published billboards, flyers, and advertisements online and in printed media. The commercials of the campaign should include a group of friends out together engaging socially and the commercial ends with the designated driver pulling out the keys to leave. The commercial should also include an advertisement slogan that appeals to the audience such as “don't just take one for the team, take the whole team home,” this not only engages the audience, but also puts a positive brand on the campaign. Printed and web based advertisements should also feature positive and engaging themes that appeal to the audience; they should also include the advertisement slogan to further elicit the branding effect.

The interactive and community based component of the campaign should be a campaign website that includes a social network for designated drivers. In this social network, people should be able to post their designated driving schedules, as well as the people they are planning to be driving with, where they are going and other aspects about the event. The website’s social network should also feature a fun stories section where people can post their stories about being a designated driver for a group.

Social Marketing Theory Works

Social Marketing theory is an alternative to traditional behavioral theories that have become more popular in recent years. Marketing theory is a population based theory that assumes that a population can be influenced by a campaign or advertisement, not just the individual. This is an important step away from the narrow individualistic assumptions of the Health Belief Model. The Marketing Theory takes into account the importance of social structures the influences of societies on behavior. A key part of social marketing theory is branding. Branding is defined as “a set of associations linked to a name, mark, or symbol associated with a product or service;” (15) branding makes the association between a product and symbol to a specific feeling or even behavior. Branding is used constantly in consumer media to add value to the product being sold. For example, Guinness uses the “how to pour a perfect pint” or “slow” pour advertisement as part of its brand. The slow pour has become an inherent attribute of a Guinness and arguably has made the drink more popular. Another popular brand is the Nike slogan “Just Do It.” The Nike brand is used to associate power and control with Nike products enticing viewers to buy their products. We use brands to give us a reason to choose if one product or action is better than another. The examples above are just two examples of how branding widely successful in the consumer market.

The “Bring a Buddy Home” campaign as described above uses the branding technique to influence people to choose to not drink and drive. The campaign associates positive character qualities to the decision to be the designated driver. The campaign is meant to associate trustworthiness and responsibility towards designated driving, as well as establishing that the designated driver must have a solid group of friends to watch out for. The positive images remind the audience of the positive effects of being a designated driver, and influence their decision to take part in the campaign.

Positive Reinforcement Minimizes Reactance

As mentioned above, one of the main flaws in the “Over the Limit, Under Arrest campaign is the negative and authoritative images that tell the audience not to drink and drive, or face the consequences of arrest. The campaign message restricts the freedom of the individual and takes away his ability to decide his own actions. This type of advertising inadvertently causes a boomerang effect that may actually increase the likeliness that an individual would drive drunk.

The “Bring a Buddy Home” campaign does not utilize any restrictive or authoritative language or images to convey the message to not drink and drive. Rather, the newly proposed campaign features advertisements and images that convey a message of empowerment and free choice. The campaign focuses around the individual choosing to remain sober, and taking up the responsibility of driving for the evening. It is expected that limited use of restrictive or authoritative languages will decrease the tendency for people to react against the advertisement. If we are successfully able to limit reactance, then we could also expect greater compliance to the campaign message amongst the population. As shown above psychological reactance played an important role in the results of the “Over the Limit, Under Arrest” campaign in 2006. If psychological reactance can be minimized, we can significantly decrease the number of drunk drivers on the road and increase the awareness of the population about the dangers of drunk driving.

Social Networking Goes Beyond the Effects of Public Service Announcements

Another major shortcoming of the “Over the Limit, Under Arrest” campaign was the extensive use of isolated public services announcements. These public service announcements created no sense of community or involvement, nor did it take into account the social strains that influence people’s behaviors. The lack of acknowledgement to social needs is most likely one of the main reasons that public service announcements have done so poorly in effectively altering people’s behaviors.

The success of the Marketing Theory can be partially attributed its acknowledgement of the importance of establishing a relationship between the consumer and distributor, but also between different consumers (insert citation. When groups of people use the same product, there is a sense of community between the users. This community requires that its members keep using the product, and it allows social forces to determine how the product is used. The “Bring a Buddy Home” campaign utilizes this need for community on two fronts. The campaign’s main goal is to influence people to be designated drivers for a group of people and the group should rotate drivers from week to week. This invokes a strong sense of mutual dependence and respect between group members. The second aspect of community that the “Bring your Buddy Home” advocates, is the web based social network. The web based social network allows individuals wide access to many other people taking part in the same activity of designated driving. This allows people to build bonds and share stories, deepening the sense of community of people who follow the campaign.

Conclusion

Public service announcements such as the “Over the Limit, Under Arrest” campaign are very important in educating the public about the dangers of drinking and driving. However, the efforts have not shown any significant results and this can be largely blamed on the construction and execution of the campaign. The way the campaign is delivered does not adequately influence any new behavior by the audiences. As a result, we cannot expect any changes in drunk driving rates if these types of campaigns continue. By reevaluating the goals of the campaign, and utilizing more inclusive and positive themes, a new campaign can be devised that will significantly decrease the frequency of drunk driving and provide for safer roadways for the population.

REFERNCES

1.) http://en.wikipedia.org/wiki/Drunk_driving_in_the_United_States

2.) National Highway Traffic Safety Administration. Statistical Analysis of Alcohol Related Driving Trends, 1982-2005. Washington,DC: 2008

3.) National Highway Traffic Safety Administration. The 2006 National Labor Day Impaired Driving Enforcement Crackdown: Drunk Driving. Over the Limit. Under Arrest. Washington, DC: 2008

4.) http://www.youtube.com/watch?v=CAonspm6LmU

5.) http://www.nhtsa.gov/Impaired

6.) http://www.in.gov/core_old/images/feature_9-04-07_rdax_100.jpg

7.) National Highway Traffic Safety Administration. The 2006 National Labor Day Impaired Driving Crackdown: Over the Limit. Under Arrest. Washington,DC: National Highway Traffic Safety Administration, 2009

8.) National Highway Traffic Safety Administration. 2007 Traffic Safety Annual Assessment – Alcohol-Impaired Driving Fatalities. Washington,DC: National Highway Traffic Safety Administration, 2008

9.) Flexon J, Guerette R.T. Differential effects of an offender-focused crime prevention media campaign. Journal of Criminal Justice 2009; 37:608-616.

10.) Airhehenbua C., Obregon R. A critical assessment of the theories/models used in health communication for HIV/AIDS. Journal of Health Communication 2000; 5:5-15

11.) Clarke V. el al. Unrealistic optimism and the Health Belief Model. Journal of Behavioral Medicine 2000; 23:367-376.

12.)Brehm S. Psychological Reactance and the Attractiveness of Unobtainable Objects: Sex Differences in Children's Responses to an Elimination of Freedom. Sex Roles 1981; 7:937-949.

13.) Seemann E., Carroll A., Woodard A., Mueller M. The Type of Threat Matters: Differences in Similar Magnitude Threats Elicit Differing Magnitudes of Psychological Reactance. North American Journal of Psychology 2008; 3: 583-594.

14.) Goodall C., Slate M. Automatically activated attitudes as mechanisms for message effects: The case of alcohol advertisements. Communication Research 2010; 37: 620-643.

15.) Evans W., Hastings G. Public health branding: Recognition, promise and delivery of healthy lifestyles (pp. 3-24). In: Public Health Branding Applying Marketing for Social Change. Oxford University Press, 2008.