Thursday, December 16, 2010

Texting and Driving: Public Health Campaigns Fail To Acknowledge and Adapt to Motivations Behind Human Behavior – Kate Johnson

Texting and driving is a relatively new phenomenon to enter the public health landscape. The world has seen a rapid evolution of interconnecting technologies over the past decade, but texting has only become mainstream in the United States over the past few years (1). The development of Personal Digital Assistants (PDA’s) and keyboard technologies for cell phones have helped facilitate and encourage a shift to communication via text. As with the emergence of any new cultural behavior, the implications for society going forward must be addressed. Texting, like cell phone use in general, has dangerous implications when it comes to public health.
A recent report from the National Safety Council finds that 28 percent of all traffic accidents, or 1.6 million crashes per year, are caused by cell phone use or texting while driving (2). While cell phone use is still a more dominant cause of traffic accidents because more people engage in cell phone use (calls) than text, texting has been found to the most dangerous activity when it comes to distracted driving (2). Additionally, findings show that teenagers are the most at-risk population group; individuals 20 years and under have the highest incidence of distraction-related fatal car crashes (3).
Currently, 19 States and the District of Columbia have established laws that ban texting while driving (4). These laws, while important in establishing authority, are inherently hard to enforce. Text messages are often sent below the dashboard of a vehicle, out of sight of an observing officer. While law enforcement may recognize faulty driving practices that are indeed a result of texting while driving, it is hard for them to prove it.
In addition to the enactment of laws against texting and driving, there has been a recent push to raise public awareness. Various outlets have released public service announcements (PSA’s), commercials, billboards and celebrity-endorsed warnings against texting and driving (5-6). Despite numerous organizations’ attention to the matter and increasing coverage by the national news media, the current efforts to prevent and combat texting while driving are very disjointed. The Federal Government has established its own campaign aimed at combating distracted driving, which centers around providing facts and statistics on a newly established website, but has made no real strategic effort to address the issue through media or programs (3).
The most noteworthy campaign to-date has been the ‘It Can Wait’ campaign, administered by AT&T (7). AT&T’s campaign has released a series of PSA’s, which show the image of an incomplete text message, accompanied by a tragic story of a car accident resulting in death or injury. The incomplete text is meant to represent that which was never sent or received because an accident occurred in the midst of writing or receiving a text message. The major message ‘It Can Wait’ aims to convey is that ‘not text is worth dying over,’ or that no text is so important that it can’t wait. (7)
The following critique will focus primarily on the ‘It Can Wait’ campaign, given its stature among current efforts, though the collective state of public health efforts will continue to be addressed.

Illusion of control and perceived risk are not accounted for.

The ‘It Can Wait’ campaign offers a simple and concise message. Everything from the black and white color scheme to the lack of imagery is intentionally devoted to communicating a clear and straightforward message (7). The advertisers want viewers to focus on the story being told by an invisible voice while simultaneously focusing on the visual of the incomplete text message. This type of communication is strictly looking to appealing to emotion. ‘It Can Wait’ advertisements are not informative beyond the singular experience of the story being told, which disregards key aspects of human behavior and serves as a major flaw in their campaign.
Individuals who engage in texting while driving are operating under an illusion of control based on a false sense of perceived risk, among other behaviors. This could also be viewed as an ‘it won’t happen to me’ mentality. Given the newness of attention being paid to texting while driving, there is little data with regard to actual perceived risk. But, as we have seen with other public health issues, public perception of the riskiness of behaviors, when it comes to them personally, is often misguided (8). A specific study targeted to cigarette smokers found that only 40 percent of smokers believed that they had a higher than average risk of cancer (9). Studies like this highlight the fact that despite knowledge of certain health risks associated with a behavior, as the dangers of smoking are widely known, individuals will still disassociate themselves from unfavorable outcomes.
Surveys conducted by the Pew Research Center have confirmed a low sense of perceived risk among teenagers and an illusion of control when it comes to texting and driving. In addition to cavalier attitudes, which expressed no perceived risk in texting and driving, those who acknowledged risk proceeded to rationalize ways in which they ‘control’ the situation to reduce perceived risk. Some teenagers felt holding the phone at eye-level while texting eliminated risk because they were able to see the road at the same time, while other expressed a sense that sending a text, versus reading a text, raised and lowered your risk levels, respectively. (1)
The views of control expressed by teenagers in the Pew surveys highlight human desire for control: “most social scientists agree that there is a motivation to master one’s environment, and a complete mastery would include the ability to ‘beat the odds,’ that is, the control chance events (10).” While individuals may know that there is some risk in texting while driving, a view of the act as a particular skill set, which can be mastered, contributes to the illusion of control and the desire to master that skill set and, thus, control the situation.
The ‘It Can Wait’ campaign fails to realize that, while the emotional content of their messages may play to human emotion, it does not encourage action. People will feel bad for the tragic stories of other, but account for low perceived risk and illusion of control tells us that they will not be convinced that it can happen to them.

Lessons from the ‘Truth’ campaign: ‘It Can Wait’ needs a message other than ‘don’t.’

The ‘It Can Wait’ campaign is centered on appealing to people’s emotions. They have framed the issue to be one focused on tragedy and death, essentially communicating: ‘if you text and drive, someone will die.’ As has been established through trial and error with other public health initiatives, this strategy of telling people what they should not do on the basis of doom and gloom does not work, particularly with teenagers.
An important campaign that showcases a successful way of advertising to youth by defining and overcoming the pitfalls of authoritative advertising methods of the past is the ‘Truth’ campaign. The key elements of the ‘Truth’ campaign that contributed to its success were involving youth/conducting research, using affirmed youth sentiment to establish tone and making ‘Truth’ a brand (11).
‘Truth’ committed itself to learning from and formulating its campaign around its target population. Youth sentiment, obtained through annual summits, review boards and qualitative research, was determined and used to guide campaign initiatives. A major point of interest established from this research was overwhelming youth consensus about judgmental advertising: they don’t like it. Individuals, and particularly youth, do not want to be lectured or told what to do. (11)
In the case of smoking, youth see performance of this behavior as a rebellion (11). Texting and driving, on the other hand, has more to do with illusions of control and the culture of instant gratification facilitated by technology. But, in either case, how youth views the behavior and how they prefer to be addressed must be established in order properly frame the issue through campaign tone, imagery and delivery. The construction of a communication effort can play a major role in affecting people’s perception of information (12).
Lastly, the ‘Truth’ campaign experienced continued success due to branding. While most public health campaigns felt the unique nature of their subject matter inherently separated them from the traditional advertising, ‘Truth’ looked to the successes of commercial advertisers and embraced the idea of brand-identity as a major trigger for youth behavior (11). Branding is a marketing tool, which is increasingly being used in social contexts because of its ability to create important associations between consumers and products, or similarly, individuals and behaviors (13). “Public health branding aims to induce behavior change so that the individual is motivated to engage in beneficial health-related behavior. (14)” While the commercial and public health models of branding differ, the tenant of establishing relationships and recognition between the brand and those committing to the brand either through purchase or behavior remains the same (13). The ‘Truth’ campaign was able to utilize branding in a way that enforced youth identity through recognition.
Unlike the ‘Truth’ campaign, the ‘It Can Wait’ campaign fails to recognize the need for qualitative research in establishing its message and how traditional methods of advertising can be applied to public health communication efforts.

‘It Can Wait’ and other texting and driving initiatives fail to acknowledge social context.

The collective public health response to the texting and driving problem has, thus far, been a series of efforts, not particularly linked, that employ a number of social science and marketing-based tactics. Celebrities have signed on as anti-texting and driving spokespeople, even Oprah, the queen of – well, everything, has begun a campaign against the unhealthy behavior (5-6). Laws have been enacted in many states and there is federal effort to see that more states begin to adopt bans against texting while driving (4). Campaigns like ‘It Can Wait’ have attempted to strike an emotional chord with the public in order to discourage the behavior. While all of these efforts have certain merits and can play a role in bringing about change, they will prove futile without an umbrella acknowledgement of the social context.
In order to determine the fundamental causes of a behavior, as with disease or other public health problems, investigators must determine the social conditions under which individual behaviors, or risk factors, are born (15). In the case of texting while driving, this requires an acknowledgement of the role of technology and instant communication mechanisms that have become ingrained in American life. There is an ability and expectance to access information immediately that cannot be ignored. While we know the risks associated with texting while driving, is it unrealistic to think that an individual who receives a text, a facebook message or a tweet would want to view it immediately? The answer is no, in fact it is normal in today’s culture to want and be able to access information immediately.
Having a sense of this cultural normative behavior is imperative to the development of public health campaigns and subsequent methods of combating the behavior. For instance, if a behavior is performed due to deeply ingrained cultural cues, it may be extraordinarily difficult for individuals to overcome that behavior. While enforcement can work to derail a behavior, if enforcement is difficult to achieve, as with texting and driving, the solution may lie in providing individuals with another viable (safer) way to perform culturally ingrained behaviors. “Complex, interrelated behaviors such as nutrition or unprotected sexual behavior are difficult to change through simple communication of health risks and benefits – the social context in which they occur needs to be recognized, and associations and relationships between desired goods for the consumer can be an effective strategy to promote health behavior. (13)”
Ultimately, the failure of current public health initiatives to account for the social context of texting and driving has negatively affected the campaign strategy. While it is still early in terms of responding to this particular public health problem and knowing the outcomes of that response, lessons from past campaigns show us that addressing and influencing normative behavior is most effective.
Most notably, the designated driver campaign serves as a prime model for this type of effort: “The designated driver concept was invented in the Nordic countries. It promotes a new social norm that the driver doesn’t drink. Pollsters found a very sharp rise in the reported use of designated drivers such that four years into the campaign, a majority of Americans said they had either served as a designated driver or been driven home by one. During that period, alcohol-related traffic fatalities dropped by 25 percent. (16)”

A Social Norms Approach to Reducing Texting While Driving
A campaign whose aim is to realize and redefine socially normative behaviors, such as texting and driving, should focus on increasing awareness through multiple channels, establishing a memorable message that empowers individuals and easing the transition of behaviors.
Creating a Memorable Message
Any public health campaign that is looking to influence behavior, and ultimately change behavior, must find a way to not only reach individuals, but to keep their attention. A memorable message is an important way of branding a behavior to meet the needs of the target population.
For texting and driving, a new ad campaign, modeled after the designated driver campaign, could be established that uses alliteration to communicate a new behavior. Tandem Texting. The premise would be that each individual assigns someone to be their ‘Tandem Texter’, so that when operating a vehicle the designated individual would be responsible for sending or responding to any text messages that the driver would otherwise handle. The alliteration of the message makes it catchy, which is important in becoming memorable. Additionally, the mechanism of assigning someone to be your ‘Tandem Texter’ introduces a new behavior, which serves to replace the old behavior of texting while driving and allows for a new sense of ‘control’ over the situation.
Creating a new behavior through branding is an important way to ‘add value’ for the individual and encourage movement away from the unhealthy behavior. “Public health brands can also add value to the practical benefits of engaging in a preventive or health-promoting behavior beyond its immediate practical benefits. (13)” ‘Tandem Texting’ would empower individuals to perform a new behavior rather than pass judgment on the performance of an existing one, which is an especially important characteristic in reaching out to teenagers.
Increased Awareness and Communication of Message
One of the positive aspects of recent initiatives involving texting and driving has been the flow of information. While there are many flaws, and no single initiative seems to be particularly effective, the news media attention and celebrity endorsement of anti-texting and driving campaigns can only help, not hinder, changes in social behavior.
Going forward, awareness efforts should continue both nationally and on state and community levels. Additionally, these awareness efforts should be coupled with the communication of the new message and behavior we are looking to promote. “The general lesson is clear. If choice architects want to shift behavior and to do so with a nudge, they might simply inform people about what other people are doing. (17)” In order for the new behavior to gain mainstream acceptance, it is important that people see it as common practice. Community-based efforts become increasingly important under this context; leaders in communities need to exhibit the new behavior so that others will follow suit, as is true of herd behavior. “Herd behavior is often said to occur when many people take the same action, because some mimic the actions of other. (18)”
Herd behavior can be accounted for not only at the local level, but also nationally. Television and film are important outlets for communicating a public health message and encouraging behavior change. A major way to target teenagers and encourage behavior change is by exhibiting these behaviors in individuals they idolize on screen, though exhibition of these behaviors should not be explicit. “Perhaps one way to persuade people to make the change from the old to the new is to make the new more familiar and to increase involvement and participation in the changeover. (10)” Rather than celebrities preaching the behavior, characters in television and film should act out the desired behavior as if it is a normal activity, thus creating the fact. Knowing that teenagers, and often adults, emulate things they see on screen, especially idioms, any public health campaign would be remiss to ignore this mode of communicating its message.
“The question of whether closer “local” norms of a group or more distant “global” community norms should be addressed in a particular norms correction initiative is a complex one, and must take into account the culture of the group in question and the context and social ecology of the community. Ideally both can be addressed together through a combination of primary and secondary prevention strategies such as small group norms interventions and community-wide social norms media campaigns. In most cases either general campus-wide campaigns or more local group norms challenging interventions can result in behavior change, although there may be some groups who are resistant to campus-wide interventions. Selecting the most relevant and salient norms for a particular intervention and the appropriate strategy for changing those norms is an important part of the planning process of a social norms intervention. (19)”

Utilizing Enforcement and New Technology
The issue of distracted driving is a complex one. Its complexity is particularly relevant when it comes to enforcement and the development of new technologies. It must be understood that there is no way to completely eradicate distracted driving because there is no way to protect against all contributing behaviors; daydreaming, etc. But, there are factual elements that we can apply in order to use enforcement and new technology to reduce risk from particular behaviors.
It has been established by a variety of sources that texting while driving is much more dangerous than numerous other distractive activities, including simply talking on ones cell phone (1-20). Knowing this, it is important that new technologies be researched and development that eliminate the need for the mechanical behavior of texting that proves most dangerous on the road. Efforts to develop and implement these new technologies should not be ignored, simply because the new behaviors pose certain risks of distraction, as well. It is statistically proven that texting is far more dangerous than engaging in conversation and that fact should influence how we move forward with public health campaigns and technological efforts aimed at reducing the harmful effects of distracted driving (20). Promoting the use of Bluetooth, speakerphone or VoiceTXT technologies may be an effective intermediary step in public health initiatives to combat texting while driving because they are proven to be safer alternatives (20). Cultural change of social norms is the ideal goal in changing texting while driving behavior, but it is important to recognize that these efforts take time and complementary policies and innovations can prove beneficial in the interim.
It seems self-evident that any successful public health initiative attempting to change unhealthy public behavior should have the support and assistance of its governing bodies. It is unfortunate that to date only 19 states and the District of Columbia have policies in place that ban texting while driving (4). Even though there is a question as to whether enforcement of texting while driving laws is viable, having the laws in place is necessary to provide validity to public health efforts working to combat the behavior.
In Conclusion
The campaign I envision would address illusions of control and perceived risk by supplanting them with a new behavior mechanism that involves role-assignment and call to action of individuals. This behavior mechanism will be effective communicated through local and national channels and will have a clear, yet catchy slogan to encourage involvement and brand the behavior: Tandem Texting. The campaign in no way preaches or tells individuals what they should or should not do; rather it encourages a new behavior through formation of a new social norm. New technologies and roles for enforcement will continue to be taken into account because they are inextricably linked to the social context of the behavior.


(1) Pew Research Center. Teens and Distracted Driving: Texting, talking and other uses of the cell phone behind the wheel. Washington, DC. Pew Internet & American Life Project, 2009.
(2) National Safety Council. NCS Estimate 1.6 Million Crashes Caused By Cell Phone Use and Texting. Itasca, IL: National Safety Council.
(3) U.S. Department of Transportation. Statistics and Facts About Distracted Driving. Washington, DC: U.S. Department of Transportation.
(4) Halsey A. (2010, January 13) 28 percent of accidents involve talking, texting on cell phone. The Washington Post.
(5) Oprah. Oprah’s No Texting Campaign. New York, NY: The Oprah Winfrey Show.
(6) Thumb Wars PSA. New York, NY:
(7) ‘It Can Wait.’ Multimedia Gallery. AT&T Texting and Driving: It Can Wait Campaign.
(8) Weinstein N. Unrealistic Optimism About Future Life Events. Journal of Personality and Social Psychology, 1980; 39(5): 806-820.
(9) Ayanian J, Cleary P. Perceived Risks of Heart Disease and Cancer Among Cigarette Smokers. JAMA, 1999; 281(11): 1019-1021.
(10) Langer E. The Illusion of Control. Journal of Personality and Social Psychology 1975; 32(2): 311-328.
(11) Hicks J. The Strategy Behind Florida’s ‘Truth’ Campaign. Tobacco Control 2001; 10: 3-5.
(12) Coffman J. Public communication campaign evaluation: An environmental scan of challenges, criticisms, practice, and opportunities. Cambridge, MA: Harvard Family Research Project, 2002.
(13) Evans W, Hastings G. Chapter 1: Public Health Branding: Regonition, Promise, and Delivery of Health Lifestyles (pp. 3-24). In: Public Health Branding: Applying Marketing for Social Change. Oxford: Oxford University Press, 2008.
(14) Blistein J, Driscoll D, Evans W. Chapter 2: What is a Public Health Brand? (pp. 25-41). In: Public Health Branding: Applying Marketing for Social Change. Oxford: Oxford University Press, 2008.
(15) Link B, Phelan J. Social Conditions as Fundamental Causes of Disease. Journal of Health and Social Behavior 1995; Extra Issue: 80-94.
(16) The Boston Globe. Interview with Jay Winsten: Designated Driver Turns 21. Boston, MA: The Boston Globe.
(17) Sunstein C, Thaler R. Chapter 3: Following the Herd (pp. 53-71). In: Nudge: Improving Decisions About Health, Wealth and Happiness. New Haven, CT: Yale University Press, 2008.
(18) Sornette D. Chapter 4: Positive Feedbacks: ‘Herd’ Behavior and ‘Crowd’ Effect and Forces of Imitation (pp. 91-114). In: Why Stock Markets Crash: Critical Events in Complex Financial Systems. Princeton, NJ: Princeton University Press, 2003.
(19) Berkowitz A. The Social Norms Approach: Theory, Research and Annotated Bibliography. Trumansburg, NY: Independent Consultant, 2004.
(20) National Science Foundation. Driving Transportation Policy through Technological Innovation. Washington, DC: National Science Foundation.

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