How America’s Popular D.A.R.E. Program Poses Threats to Adolescent Freedom and Ignores Universal Core Values – Lisa Kelly

The D.A.R.E., or Drug Abuse Resistance Education, program is a well-established anti-drug campaign instituted in schools across America. Since its inception in the early 1980’s, it has received praise from many political persona’s and government programs as well as notoriety among educators and parents (5). The program consists of police officer led lectures to students, ranging from elementary grades through high school, and teaches the “skills needed to recognize and resist the subtle and overt pressures that causes kids to experiment with drugs” (5). Its core aim is to communicate the dangers of drugs to students, with the ultimate goal of steering kids away from drug use (5). While D.A.R.E’s popularity and longevity suggest that the program works, however its belief that simply informing kids of the dangers of drugs to curb substance use is not enough to cause behavioral change. To combat the social pressures, enticement, and excitement of experimenting with and using drugs, the D.A.R.E. program needs to gear their curriculum towards the alternative options teens can pursue.

Unfortunately, fundamental flaws lie in D.A.R.E.’s traditional officer-led approach, core values, and lecture format. Psychology and Social Sciences theories including the Psychological Reactance Theory and Marketing Theory expose these flaws in D.A.R.E.’s design and reflect the need for the inclusion of these theories in anti-drug interventions or programs. Thus, D.A.R.E.’s program is currently flawed because it aims to change adolescent attitudes and behaviors using authority figures to spread the dangers of drugs via dry, boring lecture formats. This approach has the counter effect on students because it creates high levels of reactance and does not appeal to their core values.

Are D.A.R.E. Officers Leading Kids to Drugs?

D.A.R.E. takes deep pride in the training processes their officers undergo in order to provide the best drug information and awareness to students across the nation. In fact, the D.A.R.E. program is specifically designed around the officer as the teacher (5). Officers receive over 80 hours of training in subjects ranging from “classroom management, teaching strategies, communication skills, adolescent development, drug information, and curriculum instruction” (6). After this preparation, it is believed that D.A.R.E. officers are ready to handle the tough questions adolescents have about drugs and criminal activity. (5). Furthermore, these officers are now declared experts by the D.A.R.E. program in teaching the skills needed to recognize and resist pressure to use drugs, along with promoting self-esteem and self-confidence (6). Yet, despite D.A.R.E.’s encompassing and rigorous program to educate and prepare their officers for the classroom setting, the very use of a police officer as the expert, authority, and teacher is a major shortcoming in the program. As highlighted by the Psychological Reactance Theory, the officers pose a threat to adolescent’s freedom of choice and are likely to push kids to experiment with drugs rather than keep kids away from them (18 ).

Psychological Reactance Theory was first introduced by Jack Brehm in the 1960s around the idea that humans have an innate desire for freedom of choice because it “fulfills our satisfaction of needs” (2-3,18). Every person is born with the task of fulfilling certain basic needs via any one of many behavioral possibilities (4). Brehm saw the freedom to choose which of these possibilities to pursue as crucial to human survival because without choice, people become overly aroused and are unsatisfied (2). People want to decide their own fates and maintain control (4). Along with this idea, Brehm believed some personal needs are seen as more important than others, depending on the individual. Therefore, because people are born with self-determination and the desire for freedom of choice to fulfill daily needs, any threat to their behavioral freedoms causes people to become highly aggravated and angered (2). This emotional response, called reactance, is targeted toward the specific threat to one’s freedom and is correlated with the importance given to the need which one wants to fulfill (2). Basically, people don’t want to be told what to do, and when they are, they get angry and will react. Unfortunately, their reaction often results in the enactment of the very behavior that someone told them not to do. In fact, when threatened, people will try to ensure that they maintain their freedom by whatever means possible, even if this means partaking in an activity that is deleterious to one’s health (2,4,9). This dilemma works out quite clearly in the D.A.R.E. program.

Using police officers to teach students to not do drugs in the D.A.R.E. programs is most likely going to create high reactance among adolescents because their authority status poses a threat. Because adolescence is a particular time where independence and individuality is important, having an adult figure telling one not to do something is often not received well (4). This is a time of life where most kids don’t want to listen to their parents, none the less an individual in uniform with whom they have no personal relationship with. When it comes to drugs and experimentation, adolescents have a strong belief that they can choose one path or the other. This is their time in life to challenge social norms and experiment if they so choose (15). So, the very nature of the police officer coming in to a classroom to tell kids to “just say no” sets up a dynamic in which the adolescent student feels pressured to make a certain choice. Having a figure who is given legal power to enforce rules and take away freedoms is the person most likely to create reactance, according to Brehm’s theory. The more dominant the authority of a message is, the more it will increase reactance (13). Yet, the police officer is the face of D.A.R.E. and is the person sent into schools across the nation to spread the program’s message and reduce drug use. Undoubtedly, with reactance increasing due to D.A.R.E.’s police officers, adolescents will react by trying to take back their freedom of choice by deliberately trying drugs. This counter effect, often called a “boomerang effect”, is the exact opposite of D.A.R.E.’s agenda and shows their program is clearly flawed (4, 9).

Why Selling Health Fails

Another major flaw with D.A.R.E.’s current design is the fact that its main message is to spread the importance of healthy choices for adolescents, while in reality this message is far from a priority on many teen minds. D.A.R.E.’s core design follows the Health Belief Model, which states that in order for someone to adopt a health behavior in and avoid disease, or in this case addition to drugs, one would need to believe that they are susceptible to drug use and addiction, that the drug use would have some severity on his one’s life, and that avoiding drugs would be beneficial (11). If a person is simply made aware of their susceptibility to a disease or unhealthy behavior, and its degree of severity, than that knowledge should motivate them to take action to prevent a negative outcome. For D.A.R.E. this model explains why they place so much value in the education and awareness about the dangers of drugs and the susceptibility of teens to social pressures (6.) The program believes that exposing the harmful effects of drug use while selling the promise of a healthy lifestyle is enough to persuade teens not to use. However, is the idea of health really alluring to teens in the face of the exciting enticement of drugs offer?

According to Marketing Theory, telling kids to “just say no” on the basis of health is not a powerful enough message to counteract the freedom, control, acceptance, and rebellion that drugs may offer. The premise of marketing theory states that when one is developing and promoting a product, one needs to consider consumer needs and desires first (8,10,16). The consumer should be “the backbone” of the product because it needs to fulfill his or her needs and wants if he or she is going to buy it (8). In comparison, traditional public health approaches are seen as having a sales or product orientation, where the health behavior itself is the product, or the center of the message (10). Then, public health officials are left working to sell health to the public, assuming that health alone is a consumer desire and want. However, universal consumer desires or needs, often called core values, usually override health. Core values like love, freedom, control, acceptance, family, rebellion, self-esteem, and more are true motivators for humans to act and change (12). These are the values that should be the forefront of health campaigns or any product according to marketing theory because they are natural human desires. Promoting these values is more likely to result in successful adoption of a health behavior or change than by selling health alone.

D.A.R.E. is essentially competing with drugs and social pressures to win over teens and is inappropriately using health as their persuasion. According to marketing theory, drugs offer freedom, control, acceptance by peers, and rebellion to teens. All of these core values would lead one to see that drug use could have multiple benefits and fulfill our most basic desires. Therefore, D.A.R.E. faces a large challenge in trying to be more appealing than drugs on the basis of health alone. Not only is it not a core value, but also health is something that people often don’t think about until later in life. For teens, the benefits of drugs, i.e. freedom, control, acceptance, come immediately. Teens in particular have a feeling of invincibility about them and worry very little about health in the long run (15). Since no teen is going to want to buy into health alone, it is time for D.A.R.E. to go beyond teaching kids to just say no.

D.A.R.E.’s Curriculum: Keeping Students Out of the Discussion

A third and final flaw in the original D.A.R.E. design lies in its lecture based structure, which takes place over several weeks and keeps students very much removed from the conversation. D.A.R.E.’s “core curriculum” consists of 17 weeks of hour long lectures for teens “emphasizing the teaching of information and skills designed to increase resistance to pro-drug social influences and the correction of inaccurate/exaggerated normative beliefs” (1). As one student described the program, “They taught me different ways of saying no to people” (7). While there is some group discussion and role playing, most of the sessions are traditional lectures relying “heavily on the officer as expert”, with only a short question and answer section at the end (6). Also, the role playing exercises are part of a national curriculum that is used in schools across the country (6). These exercises along with the audiovisual material are generic and not tailored to any region of the country or population. Thus, D.A.R.E.’s curriculum is designed to be taught by police officers, with heavy emphasis on the instruction and little emphasis on interaction.

Both psychological reactance theory and marketing theory expose why D.A.R.E.’s dry lectures are both boring and ineffective for students in the classroom. Besides the fact that policeman threaten students’ freedom of choice because of their authority, the lectures themselves can create reactance because they don’t include student involvement or ask for opinions. The rigidity of the program makes the D.A.R.E. experience like sitting through another boring classroom instead of an interactive experience that will get teens talking to one another honestly about drugs and social pressures. Students sit through enough lectures every day in their other classes, and will not benefit from sitting through 17 weeks of lecture with people rattling off facts about drug use or describing social influences. Students will most likely develop reactance because they are being told what to do without any consideration of their thoughts or views about drugs. Their freedom to partake in the conversation is limited and this lack of consideration for their opinions is another threat on top of the authority of the police officers themselves. Also, when dealing with teen populations it is important to remember that they particularly value expression, and will see barriers to this ability as severe threats. However, just based on human nature according to the psychological reactance theory, the fact that “people do not appreciate being told how they should behave” is enough motivation for D.A.R.E. to reevaluate their format (4).

From a marketing theory perspective, D.A.R.E.’s lecture structure doesn’t adhere to teen core values. Marketing theory promotes the idea that “understanding target groups [should be] a key program strategy” (16). If teens value freedom, control, and rebellion, they need to be able to express those values in a program that encourages such expression. Giving teens the power to control the format of the lectures or the platform to speak their minds, would be a way to infuse their core values with the program. Unfortunately, D.A.R.E. does the opposite of this, and creates their curriculum from an adult standpoint, that is mostly factual and ultimately very boring.

Many studies and evaluations have been done on the D.A.R.E. programs that use the traditional curriculum and have proven them to be ineffective (17). Furthermore, one Indiana study found that “D.A.R.E. graduates were actually more likely to have recently smoked marijuana than those who hadn’t taken the course” (7). Regardless of similar findings, in looking at the underlying theories and beliefs that the D.A.R.E. curriculum is based on, it is very clear that the program is likely to be highly ineffective. Using authority figures to connect with teens, having health as their selling point, and formatting the program around a non-interactive lecture setting is not the way to connect with teens. These techniques will result in creating high levels of reactance and may even have a “boomerang effect”, or counter effect, and push kids to actually try drugs (9). Fortunately, using the same theories described in this paper to expose D.A.R.E.’s core flaws can also shed light on the possibilities for change in the program and offer better design solutions.

Teen to Teen: A New Face for D.A.R.E

Since police officers are a threatening communicator to adolescents in the discussion of drug use and pose a major threat to their freedom, D.A.R.E. should adopt a radical style of teaching by using teens as both role models and the new and improved face of D.A.R.E. To limit the levels of reactance among the students who attend D.A.R.E. programs, the teachers of its curriculum should be the least threatening as possible. In fact, having a high level of similarity between the communicator and the listeners is a great way to prevent high levels of reactance (13). If the person talking about drugs is a teen, they are automatically more relatable to the students. They will be less of an authority or threat, and students are more likely to approach D.A.R.E. educational programs as a discussion, not a demanding set of rules. Additionally, beyond the fact that teens are less threatening in comparison to police officers, they can be seen as fellow peers of the students, which could have a very positive impact on the students’ experience. Peers are so important to adolescents and it is seen that when peers are seen as the source of information, there is much less reactance (4). Adolescents formulate so much of their beliefs and attitudes based on their peers that having someone on their level speak to them honestly about drugs is likely to be received better by D.A.R.E. audiences.

Ideally, the way that teens could lead the D.A.R.E. sessions would be to have students, possibly a year or two older than the students themselves, say they have “been there before” and understand the pressures they may be feeling while entering junior high or high school. The students used to be program leaders could even be former drug users, so that they could explain why they initially tried drugs, and how it affected their lives. Their stories should be truthful and detailed, but still show what it is like to experiment with drugs and ultimately realize that is not the lifestyle that teens should live. Students want to hear from people just like them who they feel understand what it is like for them in the current culture to be pressured to use. Teen leaders could acknowledge the real world pressures and create a greater connection between them and the students, which the officers could not do, simply because they are in the same age cohort .

These teens are not likely to limit student’s freedom because they themselves exercised their own freedom to try drugs. However, their message of course would be one that promotes a life with out drug use. Also, while the police officers in the classroom seemed like an invasion, the teens’ presence is not threatening because they are in the natural environment that students see their peers in every day. The use of teens as legitimate, honest, and relatable messengers is the best communicator for D.A.R.E. to avoid high levels of reactance and hopefully make a greater impact on students (3).

Selling Students What They Really Want

When it comes to the subject and topics of the D.A.R.E. sessions, the program should steer away from promoting health and focus on how adolescents can obtain core values like freedom and control through a drug free lifestyle. As emphasized by marketing theory, people are most likely to buy into a product that promotes universal core values. Unfortunately, health is not on of those values, while acceptance and rebellion are far more powerful influences on human behavior. Therefore, D.A.R.E. should change its curriculum to focus on how saying no to drugs is related to the core values of its student audiences. For example, choosing not to do drugs is a way to exercise the core value of control over ones life and over the social pressures that all teens face. By saying no to drug use, students will have the freedom (another core value) to live active lifestyles and spend time with friends doing things they would not be able to do if they were drunk or high. Overall, the curriculum needs to turn away from the negative aspects of drug experimentation to the positive benefits of a life without drugs. By emphasizing the opportunities that a drug free lifestyle offers, they are making the idea of saying no to drugs more appealing.

While it may seem challenging to reframe a curriculum around something beyond health, successful public health campaigns have done it before. “The 84” is an anti-tobacco group in Massachusetts that consists of students who agree to be part of the 84% of non-smoking youth in the state (14). As the website says, their mission is to “raise awareness of the tobacco industry’s deceptive marketing tactics and promote this message to peers” (14). This program centers on the core value of rebellion, one that is particularly strong among adolescents, since it centers on standing up against tobacco companies through not smoking. By not acknowledging health as their ultimate selling point, this program successfully displays how marketing theory can be used in public health campaigns. D.A.R.E. is fully capable of a similar strategy. D.A.R.E. could also use the core value of rebellion like “The 84” did, by getting students to join together against the marketing strategies of tobacco and alcohol companies though not using drugs . There are many different options for D.A.R.E. to redesign the subject of their curriculum around any one of these core values.

Bringing Students into the Discussion

Finally, D.A.R.E. should make student interaction the foundation of their curriculum by allowing teens to be a part of the conversation and to format the group sessions. The current lecture format is anything but stimulating and very likely to keep students disengaged. Because the information is given out in a lecture style, it is also prone to stimulate reactance among teens. Instead, D.A.R.E. should re-format their curriculum around small group discussions and student participation. The goal of the new curriculum should be to talk about the dangers of drugs among the students themselves, not just from teacher to student. Small groups will allow students to talk about these issues with people their same age, so if someone offers strong opinions they can be received as less of a threat than if those opinions were given by an authority. Also, if students are talking about drug related topics amongst their peers they are more likely to have honest communication and feel comfortable participating. Instead of students “tuning out” due to boredom as they usually do in traditional lectures, students will be active members of the D.A.R.E. experience (1). Hopefully, this will result in a more fulfilling experience for all involved.

Additionally, D.A.R.E. should look to get students involved beyond small group discussions and into the planning and format of the very curriculum itself. Since the program takes place over the course of 17 weeks, D.A.R.E. could easily infuse greater flexibility into the lessons and allow the students to have a say in the content of their meetings. Whether it be allowing students to pick between watching a movie or doing role playing or simply running an open Q&A session where the students decide where the conversation should go, allowing students to have control of the curriculum will keep them interested. Control, a key core value for adolescents, is a high motivator for behavior and participation in a program like D.A.R.E. (12). Structure and oversight by D.A.R.E. coordinators would still be crucial to ensure that the lessons ran smoothly and stayed relevant. However, by appealing a central core value of adolescents, D.A.R.E. could show they value teen opinions and arouse greater interest among their listeners.

Clearly, D.A.R.E.’s future is bright and has many possibilities for change and growth. Despite recent small changes toward more interactive curriculums in some locations, the traditional curriculum and teaching styles still remain overall (5). A dramatic overhaul of the program is necessary to address its current flaws and to prevent high levels of psychological reactance and greater experimentation with drugs. If D.A.R.E. focuses on the core values of their audience and places teens in the forefront of their campaign, than D.A.R.E. can have greater results and deeper impacts among their audiences.

References

1. Botvin G. J. Preventing Drug Abuse in Schools: Social and Competence Enhancement Approaches Targeting Individual-Level Etiologic Factors.” Addictive Behaviors 2000; 32.6: 5-8.

2. Brehm J. W. A Theory of Psychological Reactance (pp. 377-390). In: Burke W. W., D. G. Lake, and J. Waymire Paine ed. Organizational Change: A Comprehensive Reader. San Fransisco, CA: Jossey-Bass, 2009.

3. Brehm J.W. A Theory of Psychological Reactance. New York, NY: Academic Press, 1966.

4. Burgoon M., et al. Revisiting the Theory of Psychological Reactance: Communicating Threats to Attitudinal Freedom (pp. 213-232). In: Dillard J. P. and M. Pfau, ed. The Persuasion Handbook: Developments in Theory and Practice. Thousand Oaks, CA: Sage Publications Inc, 2002.

5. D.A.R.E. The Official D.A.R.E. Website. Drug Abuse Resistant Education. Los Angelos, CA: D.A.R.E. America. http://www.dare.com/home/default.asp

6. Ennett S., et al. How Effective is Drug Abuse Resistance Education? A Meta-Analysis of Project DARE Outcome Evaluations. American Journal of Public Health 1994; 84,9:1-5.

7. Firshein J. The Dare Approach. PBS Online. http://www.thirteen.org/closeto home/prevention/html/dare.html

8. Grier S. and C. A. Bryant. Social Marketing in Public Health. Annual Review of Public Health 2005; 26:319-339.

9. Johnson P. and W. C. Buboltz. Differentiation of Self and Psychological Reactance. Contemporary Family Therapy 2000; 22: 1.

10. Lefebvre, C. R. PhD, and J. A. Flora, PhD. Social Marketing and Public Health Intervention. Health Education and Behavior 2010; 11: 859-866.

11. Rosenstock IM. Historical Origins of the Health Belief Model. Health Education Monographs 1974; 2:328-335

12. Siegel, M. Class Lecture. Social Behavioral Sciences in Public Health. Boston University, Boston, MA. Oct, 21 2010.

13. Siegel, M. Class Lecture. Social and Behavioral Sciences in Public Health. Boston University, Boston MA. Nov, 11 2010.

14. The 84.org. A Youth Led Movement Fighting for a Tobacco-free Generation in Massachusetts. www.the84.org.

15. Tinelli G. Reconsidering DARE: A Report for School Superintendents. Reconsider: A Forum on Drug Policy. http://www.reconsider.org/issues/ education/dare.htm

16. Walsh D. C., et al. Social Marketing for Public Health. Health Affairs 1993; 12, 2: 104-119.

17. West, S. L., PhD and K. K. O’Neal, PhD. Project D.A.R.E. Outcome Effectiveness Revisited. American Journal of Public Health 2004; 94,6: 1027-1029.

18. Wicklund R.A. and J. W. Brehm. Perspectives on Cognitive Dissonance. Hillsdale, NJ: Lawrence Erlbaum Associates, 1976.

Critical Review Of The Montana Meth Project As A Reflection Of Current Drug Policy – Andrew O’Connell

Introduction

One of the most difficult areas of public health intervention is drug prevention and control. As of 2009 21.8 million Americans over the age of 12 were current (within the last month) illicit drug users, this accounts for 8.7% of that population (1). These numbers are up from 8% in 2008. This trend shows an increase in illicit drug use and illustrates a gap in public health prevention.

Currently one of the most accessible and widely used drugs is methamphetamine or “meth.” Meth is a central nervous system stimulant that can be taken in a number of different ways including smoking and injecting. Meth creates an initial rush that increases a users activity while decreasing their appetite. Long-term health effects include addiction, anxiety, paranoia, and violence. As of 2008, 12.6 million Americans aged 12 or older admitted to trying meth at least once in their lifetime (2).

Because meth is so widely used it is a good indicator of effective public health prevention interventions. And since 2003 there seems to be a national downward trend of new meth users nationwide, from 260,000 in 2003 to 95,000 in 2008. This is very promising data and should encourage public health professionals to continue promoting drug prevention.

The Montana Meth Project

One program that is taking a lot of credit for the downward trend of meth use is the Montana Meth Project. The Montana Meth Project was created by, businessman and rancher, Thomas M. Siebel in 2005. The project is a prevention program that uses a research-based marketing campaign in order to depict meth as a consumer product that is readily available and affordably priced. Their goal is to give the facts regarding meth use to Montana’s youth in order for them to make informed decisions based on perceived benefits versus perceived risks (3). The program has gained national attention and is being funded federally and similar programs are being implemented in multiple states.

The Montana Meth Project takes a lot of credit for decreasing meth use in Montana since 2005. However, there are many reasons why this program is flawed and could be even more effective. The website for the program itself acts as a trophy case and a testament to the “success” of the program and does little to offer immediate accessibility to meth related prevention materials. Even the theories that are the basis for the advertisements in the program are used improperly and could potentially do more harm than good. In order to offer a truly effective campaign the approach that is taken by the Montana Meth Project must be re-evaluated.

Validity

When visiting Montanameth.org, the first thing you see is “63% decrease in teen meth use since 2005.” Elsewhere you can read about all the accomplishments regarding the program and in addition there are plenty of places to “take action” or donate to the project. The website also offers links to their award winning advertisements. The biggest issue with the main page for the project is the lack of alternatives and treatment options immediately visible. There is a “Get Help” tab in the upper right hand corner of the page, however this is too little for a campaign that is getting so much attention (4).

One thing that should be taken into question is the validity of the numbers that are presented by the Montana Meth Project. The mission statement that is offered on the front page of the site is, “Montana Meth Project is a large-scale prevention program aimed at significantly reducing first-time meth use…(4).” The project should not limit their focus on new users. One big reason is that these numbers were already on the decline even prior to the program being implemented in 2005. In 2003, the number of new users was 260,000 nationally and by 2005 when the project was implemented it was already down to 192,000 (2). The Montana Meth project takes a lot of credit for the decrease in new users but it seems a national downward trend was already occurring.

With the amount of new users already on the decline the project should work to increase the number of current users seeking treatment. As previously reported there are 12.6 million current meth users in the United States (2). The advertisements that put out by the Montana Meth Project show the dangers of beginning to use meth, but they do very little to encourage current users to seek treatment.

Erceg-Hurn takes a critical look at the numbers presented by the Montana Meth Project, and not all of them should be considered credible. The very first indicator that the projects data is selective is Erceg-Hurn’s discovery that as of 2008 none of the data presented by the Montana Meth Project has gone under peer review (5). This indicates the project is using data that has not been validated. Another basis of the program seems to be raising the stigma of those using meth. Erceg-Hurn actually found that perceived stigma of meth users, along with heroin and cocaine has actually decreased since the program began in 2005. And as for the claim of 63% reduction in teen meth use, Erceg-Hurn actually finds that between 2005 and 2008 there was a actually a 1% increase in lifetime meth use. Erceg-Hurn does indicate that although the projects data may show in actual increase, another set of data from the Montana Youth Risk Behavior Study showed a natural decrease between 2005 and 2007 but indicates that is more likely due to more stringent laws in regards to purchasing cold medicine that is used to create meth, rather than the effectiveness of the Montana Meth Project (5).

Just by looking at the numbers it would seem that the numbers that are being presented by the Montana Meth Project have little validity to them. The project is taking credit for other policy changes and trends that were present before the implementation of the project. The project should be focused more on a quality well rounded prevention program that reaches new and current users, rather than building their own ego. A website that is easy to navigate and offers both alternatives to meth and treatment options for meth would be more impressive than a trophy case.

Intervention

When developing an effective website to motivate meth prevention, the psychological reactance theory can be very effective in showing how meth can steal control away from the individual. An effective prevention should have a source that allows users to gain information and confidence to fight his or her disease. Giving the user a sense of rebellion towards meth can give them the sense of control that can motivate them to change.

One approach that can help reduce reactance is to increase the perceived similarity between who is delivering the message and who is receiving the message. Silvia found that similarity and liking of the source of the message would increase compliance to a behavior by the user seeking treatment (6). This indicates that the message that is being delivered from montanameth.org should not be coming from a businessman or rancher, but instead a former meth user or someone who was able to abstain completely from using.

In addition to increasing the similarity between the source of the message and the meth user, an effective intervention should display the freedoms and control that is lost by using meth. Brehm and Weinraub who analyzed psychological reactance in two year olds demonstrate this. They analyzed the effects of presenting a physical barrier in playing with a set of toys that is similar to set of toys that was out in the open without any barrier. What they found in two-year-old boys is that when they are told they are unable to have something they pursue it even more (7). This is the basis for psychological reactance. If freedom or control is taken away from an individual, he or she will do whatever it takes to regain that control.

The website of the Montana Meth Project currently is more about their own personal statistics, rather than empowering meth users. An effective intervention should display the freedom that is gained by not using meth and the control that is lost by becoming in addict. This should be done by using true stories of people that have been directly affected by meth and been able to overcome the barriers it creates. Creating a community of anti-meth sentiment with clear ways to receive help would be much more beneficial than promoting statistics.

Health Belief Model

The use of the health belief model is one of the largest flaws in the Montana Meth Project. The health belief model uses a person’s perceived susceptibility in order to predict behavior change. By increasing a person’s perceived susceptibility, while at the same time convincing him or her of the low cost of change, a public health professional can effectively encourage behavior change (8). The issue with the health belief model is that it does not take into account self-efficacy and social factors in predicting behavior.

Critics of the health belief model believe that it inherently does not take into account context of the information that is being presented. In order to effectively deliver a message related to health awareness one must fully take into account “the relationship between health status and historical, social, and political structures (9).” Individual’s who are receiving the message delivered may not raise their perceived susceptibility because it is not presented to the in the correct context.

The Montana Meth Project advertises their approach to marketing as decreasing the perceived benefits of using meth and increasing the perceived risks of using meth.³ This approach only works on the individual level and does not offer any social benefits and does not promote self-efficacy, which are essential for non users to avoid meth and current users to seek treatment. The health belief model can only explain someone’s intent to seek treatment, however it cannot predict action.

Hser, et al, supports this by concluding that many drug users who decide not to seek treatment do so because they have other psychological stress and lack of external support as barriers to seeking treatment (10). A meth user’s social situation and mental status must be taken into account when predicting behavior change. Simply increasing perceived risk is not enough.

Strecher, et al, defines and reviews the importance of self-efficacy. Self-efficacy is the perceived ability to perform a task or behavior.¹¹ In order to increase the probability of behavior change it is important to not only increase perceived susceptibility but perceived self-efficacy. Strecher argues that self-efficacy comes from many sources including personal experience, observation, verbal persuasion, and psychological state of mind. All of these sources must be taken into consideration when encouraging behavior change. Also in order to use efficacy properly a campaign must address a person’s perceived efficacy versus their actual efficacy. Many users may have lower perceived efficacy especially if they don’t have a strong social network. When perceived efficacy is too low, it is beneficial to break the overall goal down into smaller tasks. This causes the perceived efficacy of the smaller tasks to add up to the larger goal (11).

It is necessary for the Montana Meth Project to take into account social connections and efficacy when delivering their message. Simply increasing one’s perceived susceptibility is an incomplete task especially when there is no context to which they can relate too. A proper intervention needs to incorporate a model that takes into account social relationships and works to both educate and build self-efficacy in a user.

Intervention

It is very important for people thinking about using meth to understand the consequences of using illicit drugs. The health belief model works to increase the perceived susceptibility of using meth however it lacks social level interventions to encourage idea or behavior change. Using advertising and marketing theory would be beneficial in delivering a group level intervention.

One aspect of the Montana Meth Project that can be utilized in a new intervention is exposure. The Montana Meth Project is able to reach their desired target audience 3 times a week to deliver their message of the dangers of becoming a meth user (3). Randolph, et al, considers this one of the most important aspects of delivering an effective public health campaign using social marketing (12). There is no denying how the Montana Meth Project has been able to reach their audience. However, the message they are delivering will not be effective if it does not connect to their target audience. The message that is being delivered needs to stand out amongst other advertising.

Randolph goes on to discuss the importance of framing the issue. Framing the benefits of not using meth can be more beneficial than framing the costs of using (12). An effective campaign should promote the benefits of not using meth rather than striking fear in people by showing the risks of using.

Black, et al, concludes that when marketing for an intervention it is important to promote things such as convenience and affordability, but also goes on to indicate that social support is important as well. He elaborates that attending treatment with social support such as friends may work as a motivating factor to hold the person accountable (13).

A successful intervention should look at the core values of the population in question and offer a means to maintain those core values. In a state like Montana where outdoor activities are prominent, their campaign should encourage outdoor activities with a social group as an alternative to meth use. In addition to the alternatives to meth use, illustrating a social support group involved in similar interests and core values is necessary.

Stigma Theory

The Montana Meth Project uses graphic imagery and strong wording in order to depict meth users as prostitutes, thieves, and rape victims. The advertising is shocking to look at and the phrases, such as “Before meth, I had a daughter. Now, I have a prostitute,” are heart wrenching. It seems the project’s main goal is to strike fear into those who are thinking about trying meth for the first time, but what about any of the currently 12.6 million people that have said they have already tried meth (1). The advertising that is used by the Montana Meth Project and subsequently being used by more and more states is creating a truly negative view about meth users. This stigma that is being perpetuated will have a negative effect on the want for current meth users to seek help.

Stigma is very powerful in dictating behavior but it needs to be broken down into two aspects, stigma and discrimination. Stigma itself is the overall negative beliefs that society has towards a group of people. Related to stigma, discrimination is the negative actions towards a specific group (14). It is important to realize that discrimination may not always take place against meth users, but stigmatizing them can be just as damaging. Deacon argues that stigma is drawn from both societal and environmental factors and can be defined as, “1. Illness is constructed as preventable or controllable; 2. ‘Immoral’ behaviors causing the illness are identified; 3. These behaviors are associated with ‘carriers’ of the illness in other groups, drawing on existing social constructions of the ‘other’; 4. Certain people are thus blamed for their own infection; and 5. Status loss is projected onto the ‘other’, which may (or may not) result in disadvantage to them (14).” This definition of stigma does not require any definite act of discrimination in order to cause a disadvantage to the individual. The simple act of applying a stigma creates an “out-group,” which can raise a barrier to seeking treatment. Those that feel as if he or she only uses meth casually and do not want to be categorized as an “addict,” may be more secretive of their habit and avoid any form of treatment.

Using advertisement that harshly stigmatizes meth users can be counter-productive in encouraging treatment for addiction. As described by Radcliffe, et al, stigmatizing an individual can have negative consequences on their quest for treatment. Radcliffe’s study shows that stigma can create a societal group that many users will not want to be associated with. Many meth users are not to the point of prostitution or theft and feel that by admitting they may have a problem they are automatically grouped in with perceived criminals and lowlifes. By seeking treatment users expose themselves to not only their peers, but also themselves. Being categorized in this manner is a huge barrier to overcome in seeking help (15).

Radcliffe goes on to describe treatment programs as perpetuating the stigma of a user. If a user is able to overcome personal and societal barriers and enter treatment, stereotyping continues as they are grouped as addicts in recovery (15). This can have a negative effect in that users will look for support in those they can identify with. It is inefficient for individuals who are experiencing the same troubles to rely on each other for support.

Semple, et al, found similar results in her study on the role of stigma in seeking drug treatment programs. Semple found that those who had entered into the treatment system were more likely to be negatively labeled as a drug addict and had stronger feelings of rejection from their peers (16). Semple indicates that even when users are able to overcome the barriers of stigma that are set in place by campaigns such as the Montana Meth Project, they are magnified when they enter treatment programs and the likelihood of completing treatment is diminished (16).

Going through treatment for substance abuse is one of the most difficult things anyone facing addiction can experience. The Montana Meth Project’s depiction of meth users creates an enormous initial barrier to overcome in order to seek treatment. An effective campaign should empower a user to want to seek treatment by limiting the barrier of stigmatization.

Intervention

Overcoming the stigma of meth user is the most important aspect of seeking treatment. The Montana Meth Project focuses too much on stigmatizing users in order to create fear in those who were thinking of trying meth. They do a poor job of encouraging those who have already tried meth in seeking help. While you do not want to glorify meth users and create a truly positive stigma of users it is important to show meth users who have risen above the stigma and sought help. Create a community of both meth users and families and friends who support the will to seek treatment.

Semple comes to the conclusion that one important aspect to encourage the pursuit of treatment is to teach proper coping strategies for the stigma of being a meth user. One of the most common strategies currently is avoidance or denial of the problem (16). A campaign should encourage social support as a coping mechanism. This is echoed by Sirey, et al. Sirey concludes that in order to maximize adherence to treatment program limiting the stigma presented by social cues is important (17). Advertisements should be created depicting not just stereotypes of people on meth, but should include families and communities who acknowledge the issue but show complete support.

In addition to family and community support it is important to depict current meth users who are willing and able to stand up against his or her stigma. Deacon presents that stigmatization can be advantageous in creating a strong community. It is necessary to have a group that can acknowledge their stigma and rise above it (16).

The advertisements currently out under the Montana Meth Project should be replaced with true stories of not just meth users who have experienced prostitution and crime but also users who didn’t feel they had a problem and only used occasionally. Not everyone who is a meth user is a prostitute or a thief and by stigmatizing people this way can create a barrier to seeking treatment. In addition to the meth users it is important to show the social network that has helped them in seeking treatment, such as family, friends, and healthcare facilities.

Conclusion

Illicit drug use is currently on the rise in the United States and it is important for public health officials to come up with innovative and effective prevention campaigns. While the Montana Meth Project is gaining national attention it is a flawed program and should be researched further. The program seems to be more worried about personal statistics rather than true case results. The advertisements that are based on the health belief model create stigmas that increase barriers to not only saying no to meth, but also seeking treatment for meth addiction. Future interventions should take these barriers into account and use social support and efficacy to offer alternatives to meth.

References

1. MethResources.gov. Use Rates. Office of National Drug Control Policy. http://www.methresources.gov/use.html

2. Whitehousedrugpolicy.gov. Methamphetamine Facts & Figures. Office of National Drug Control Policy. http://www.whitehousedrugpolicy.gov/drugfact/methamphetamine/methamphetamine_ff.html

3. Montana Meth Project. About Us. Missoula, MT: Montana Meth Project. https://www.montanameth.org/About_Us/index.php

4. Montana Meth Project. Home. Missoula, MT: Montana Meth Project. https://www.montanameth.org/index.php

5. Erceg-Hurn DM. Drugs, money, and graphic ads: a critical review of the Montana Meth Project. Prev Sci. 2008 Dec; 9(4):256-63.

6. Silvia PJ. Deflecting reactance: The role of similarity in increasing compliance and reducing resistance. Basic and Applied Social Psychology 2005; 27:277-284.

7. Brehm S.S., Weinraub M. Physical barriers and psychological reactance: 2-yr-olds' responses to threats to freedom. Journal of Personality and Social Psychology 1977; 35(11): 830-836.

8. Rosenstock I, Strecher V Becker. Social Learning Theory and the Health Belief Model. Health Education & Behavior 1988; 2(15): 175-183.

9. Thomas LW. A critical feminist perspective of the health belief model: implications for nursing theory, research, practice, and education. Journal of Professional Nursing 1995; 11:246-252.

10. Hser YI, Maglione M, Polinsky ML, Anglin MD: Predicting drug treatment entry among treatment-seeking individuals. J Subst Abuse Treat 1998; 15:213–220

11. Strecher VJ, McEvoy-DeVellis B, Becker MH, Rosenstock IM. The role of self-efficacy in achieving health behavior change. Health Educ Q. 1990; 13:73–91

12. Randolph W, and Viswanath K. Lessons learned from public health mass media campaigns: marketing health in a crowded media world. Annu. Rev. Public Health 2004; 25: 419–437.

13. Black DR, Loftus EA, Chatterjee R, Tiffany S, Babrow AS. Smoking Cessation Interventions for University Students: Recruitment and Program Design Considerations Based on Social Marketing Theory. Preventive Medicine 1993/05; 22(3): 388-399.

14. Deacon H. Towards a sustainable theory of health-related stigma: lessons from the HIV/AIDS literature. J Community Appl Soc Psychol. 2006;16:418–25.

15. Radcliffe P, Stevens A. Are drug treatment services only for ‘thieving junkie scumbags’? Drug users and the management of stigmatized identities. Social Science & Medicine 2008; 67: 1065-107.

16. Semple SJ, Grant I, Patterson TL. Utilization of drug treatment programs by methamphetamine users: The role of social stigma. American Journal on Addictions. 2005;14(4):367–380.

17. Sirey J, Bruce M, Alexopoulos G, Perlick D, Friedman S, Meyers B. Stigma as a barrier to recovery: perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatr Serv. 2001;52:1615.

Above the Influence: A Critique and an Alternative Solution – Andrea Doersam

The current teenage generation is bombarded with media advertisements. The question is whether or not what is being advertised to the teen is successful or not. Public Health officials undoubtedly have a large task at hand: to create an intervention that is successful in relaying the desired message to teenagers. A major public health intervention that is currently being used is the “Above the Influence” campaign.

The Above the Influence Campaign was created with the intention to target teens with anti-drug advertisements. It is a creation of the National Youth Anti-Drug Media campaign whose role is to focus on substances that are statistically most abused by teens, primarily marijuana (Above the Influence, 2010). The campaign efforts work on both the national level through broad prevention messages as well as at the community level through more specifically targeted messages (Ex: Native American populations). The primary mediums used by the Above the Influence campaign to reach teens, is by television commercials and internet advertisements. Additionally, this public health intervention is allocated a good deal of monetary resources by the government. However, despite the financial support and extensive media outlet, Above the Influence has failed to perform its primary task: to successfully influence teenagers to not smoke marijuana or abuse any type of recreational drug (Rx drugs, alcohol, meth, inhalants, ecstasy, etc.).

This specific campaign is based off the social and behavioral science “Theory of Reasoned Action” which is defined as “a series of hypotheses which link beliefs and attitudes to behavior. It suggests that behavioral change ultimately is the result of changes in beliefs, and that people will perform behavior if they think they should perform it” (Salazar, 1991, 132). This theory historically tends to prove unsuccessful when applied to Public Health initiatives, despite the fact that it is used in a vast percentage of public health interventions (Siegel, 9/30). The Theory of Reasoned Action model works on the individual level, it predicts an individual’s behaviors; group level models tend to show higher success rates in Public Health initiatives (Siegel, 9/30). It assumes that an individual will rationally weigh their perceived outcome expectancies against their perceived subjective norms of changing a behavior.

Additionally, the model is based on the idea that behavior is planned, it does not account for unplanned behavior which is evident in human nature (Ariely, 2008, xx). In order for Above the Influence to have the effect it hoped for, teenagers would need to compare their personal attitudes towards smoking marijuana with how they think people in their environment feel about them smoking marijuana. They then would need to conclude that one option’s benefits outweigh the other, and proceed to dictate their behavior based on it. Expecting a teenager to rationally weigh out their options is unrealistic. This campaign’s core basis is similar to expecting a teen to write out a Pros and Cons list, and then decide whether or not they want to smoke marijuana based on what they came up with. Expecting that not only teens, but people in general will make reasoned decisions and then act on them in this way is ridiculous. Strengths of the Theory of Reasoned Action model include the fact that it takes into consideration one’s environment and surroundings, one can be influenced to change their behavior by other people. In the campaign’s small defense, consideration is given to a teenager’s environment. Commercials are primarily based on depicting an ‘average teenager’s’ surroundings. By making the surroundings in the commercials comparable to a teenager’s actual life, the campaign attempts to be relatable. However, overall, Above the Influence did not reap the benefits of the behavioral science model it is based upon.

One must take into consideration the target audience of the “Above the Influence” campaign, teenagers. The campaign challenges, or more so tells its viewers to not do drugs in unsuccessful attempts. The public health initiative targets ‘pot heads’ as outsiders and in essence, unproductive members of society. Although the campaign made the settings of its commercials somewhat relatable, they made the teenagers acting in those settings un-relatable by depicting them as outsiders. Upon examining the website, the campaign looked to actual teenagers to determine what influences them to figure out how to affect their target audience. The “Influence Project” was conducted to interview groups of teens across the country to determine who and what has positive and negative influences in their environments (Above the Influence, 2010). Answers included celebrities and musicians having negative effects, while friends and family on average having positive effects. With this information, Above the Influence decided on using other teens, something supposedly relatable to the campaign’s viewers in its advertisements. They then depicted teens that smoke marijuana in an extremely negative light; this is where the campaign becomes un-relatable for its viewers. Above the Influence used their gathered information incorrectly. Using teenagers within the advertisements was a correct move by Above the Influence, however, they should have portrayed them differently to maintain relativity. Had the idea of relativity been used correctly, Above the Influence would have used teenagers in a positive manner. Dan Ariely’s book Predictably Irrational exemplifies the idea of relativity: “we tend to focus on comparing things that are easily comparable- and avoid comparing things that cannot be compared easily” (Ariely, 2008, 8). By portraying teenagers in the advertisements as outsiders, Above the Influence falls into the ‘cannot be compared easily’ category and therefore its audience avoids it.

The campaign failed in giving appropriate consideration to the Advertising Theory, which takes into account the importance of portraying a relatable message tied together by core values (Siegel, 10/21). Above the Influence does not provide teenagers with any type of ‘promise,’ and it furthermore does not support its message with real people and real stories. David Ogilvy’s article Confessions of an Advertising Man explains that when it comes to advertising one’s idea or initiative, the “most important job is to decide what you are going to say about your product, what benefit you are going to promise.” (Ogilvy, 1964, 93). Above the Influence focuses on the negative aspects of abusing drugs and alcohol, it does not capture its viewers buy-in with its initial slogan “get the facts-before you risk it.” (Above the Influence, 2010). The campaign chose to rely more on scare tactics of all the risks involved with smoking marijuana and using other drugs to appeal to its audience instead of incorporating a promise based on core values. Nobody wants to associate themselves with the ‘risks’ or negative aspects of anything, and teenagers especially are already more prone to feelings of invincibility, so advertising through ‘risks’ will not seem relative.

Furthermore, Above the Influence relied heavily on the concept of information dissemination throughout its website to implement behavior change in teenagers. The campaign does not successfully incorporate social marketing theory; recognition is not given to price and exchange principles (Blisterin, Evans, & Driscoll, 2008). The campaign makes the assumption that the benefits of not smoking marijuana, not using alcohol, etc., are self-evident and therefore fails to recognize the perceived price of a behavior. Price highlights “the importance of recognizing perceived costs and benefits offered by competitors in understanding consumer behavior” (Blistein, Evans, & Driscoll, 2008, 27). Appropriate branding strategies and labeling provide the means to include this vital exchange principle. However, Above the Influence only focuses on risks of abusing drugs (i.e. cost) and forgets to include approaching the perceived “benefits.” According to social marketing and branding, both aspects need to be addressed for a consumer, the teenager, to successfully be targeted.

The theory of reasoned action, which the campaign is based upon, insists that “people are rational beings and therefore, they consider their actions before they decide to perform or not perform a behavior” (Salazar, 1991, 132). The campaign fails in that predicting behavior is not based on reason; just because one intends to perform a behavior does not mean they will actually do it. The campaign assumes that by advertising the risks of drugs, teenagers will decide that doing any type of drug is not worth those risks and therefore they will make the rational decision to avoid all drugs. Ariley describes that rational behavior “implies that, in everyday life, we compute the value of all options we face and then follow the best possible path of action” (Ariely, 2008, xx). However, human nature is prone to mistakes (irrational behavior) and prone to making decisions based on emotion (Siegel, 10/21). Above the Influence does not play on this phenomenon of emotional decision making.

If anything, the Above the Influence commercials may pose a reverse effect on teenagers; there is currently a huge number of parodies that make fun of the campaign posted on YouTube that show teenagers actually getting high in the home-made commercials. In this aspect, teenagers are rebelling in an effort to protect their freedom that the Above the Influence campaign threatens to take away, when “people think that a freedom is threatened they experience reactance, a motivational state aimed at restoring the threatened freedom” (Silvia, 2005, 277). The Above the Influence campaign failed to recognize that mankind will do anything to restore their freedoms if they feel as if they are trying to be taken away. The advertisements created do just that, they tell the viewer that they must live above the influence of drugs and alcohol or they will be just another statistic. By depicting teenagers that smoke marijuana as lazy and irresponsible, the campaign disassociates with its primary target audience, it ignites the sense of rebellion in them. The campaign does not give teens a sense of control, that lapse of control acts as the primary instigator for rebellion (Siegel, 11/10). The theory of reasoned action does not allow the Above the Influence campaign to account for “variance in behavior” and relies on “logistical construction” of beliefs and actions (Ogden, 2003, 424). Appropriate consideration was not given to the theory of psychological reactance. If this theory had been incorporated, Above the Influence would have avoided ostracizing the teens portrayed in the commercials.

Additionally, by using consequences in an effort to prevent teen drug use, drinking, etc, Above the Influence acts in a manner of threatening one’s personal freedoms. The campaign stresses teens on what not to do, how not to be. They strive to have the teen avoid being labeled (This can be seen in the commercials “stage hands” and “human puppet”). This acts as a major flaw in the campaign. Research shows that allowing a person to be labeled serves as a type of identity for a person. Depending on what type of label they are given, that person will meet the label’s expectations (Siegel, 12/2). Above the Influence does not provide a source of identification for teenagers, if the campaign had used labeling theory to its advantage, they would have created a sense of value for teenagers (Evans & Hastings, 2008, 357). Instead, the Above the Influence Campaign puts its focus on advertising risks, and consequentially inhibits the teen’s sense of control by threatening their person freedoms.

The United States Government Accountability Office released a report on the effects of the Above the Influence Campaign. The report claims that it “did not find that the youth anti-drug media campaign was effective in reducing youth drug use” (US Government Accountability Office, 2006). Social Scientists examined the campaign, and proceeded to find flaws within it. When the study was completed, it was determined that “among current, non-drug-using youth, exposure to the campaign had unfavorable effects on their anti-drug norms and perceptions of other youths’ use of marijuana—that is, greater exposure to the campaign was associated with weaker anti-drug norms and increases in the perception that others use marijuana” (US Government Accountability Office, 2006). The teens that were exposed to the campaign retaliated and rebelled in response to the information they were receiving. The Government Accountability Office report confirmed that the wrong approach, and behavioral science theory is being used in this campaign. The Theory of Reasoned Action is not only failing to show positive results, it could actually be working in reverse. The amount of parodies on the Above the Influence commercials created on YouTube serve as evidence that the campaign could perhaps be altering teen’s perceptions of the frequency and amount of use of marijuana as much higher than actuality.

The failure of the Above the Influence campaign begins with the incorrect assumptions of the behavioral science theory it is based on. The campaign’s only shot at being successful relies on the idea that a person will consider an action or behavior, consider its alternatives, and then map out rational solutions to those considerations. Human beings just are not wired to behave in such a rational, coherent way. Successful interventions take into account practices of advertising and marketing theories to have an effect on, and change behavior. These interventions take into consideration that people act, behave, and make decision with their emotions, and not always with their brains. Above the Influence has all the resources to create an intervention that will actually have an impact on teenagers and drug use, but they are using the wrong approach. Unless they alter their core behavioral science theory, the Theory of Reasoned Action, this campaign will continue along its unsuccessful, resource wasting path.

Proposal for an Alternative Intervention

An alternative intervention to the Above the Influence Campaign could show significant improvements in the campaign’s current (lack of) results. By incorporating appropriate social science theories and learning from what does not tend to work within the current campaign, Above the Influence can re-organize its approach. The primary change necessary in the campaign is to alter the social science theory, the Theory of Reasoned Action, which Above the Influence is based on. Mass amounts of research and literature have shown this theory to not be an exceptionally effective one in the public health community (Salazar, 1991). Theories such as the theory of psychological reactance, labeling theory, as well as marketing and advertising theories should be taken into great consideration, and used in a combination, throughout the alternative intervention. In partnership with appropriate social science theories, the alternative intervention will look to other similar public health interventions that have proven to be successful, as well as avoid mistakes that Above the Influence made in creating their campaign.

The new intervention, let’s call it “Be the Influence,” will be based on the principles that the theory of psychological reactance, labeling theory, and marketing and advertising theories assume. This approach will counter the flaws of the Above the Influence Campaign. Be the Influence will target teens primarily through the understanding that a person will react to a perceived threat to their freedoms when they are told what to do as well as what not to do (Siegel, 11/10). The theory of psychological reactance “explains human behavior in response to the perceived loss of freedom in an environment, reactance is postulated to be experienced in response to the environment and used to help persons reestablish freedom and control of a situation” (Edwards, Li & Lee, 2002, 83). When there is a perceived threat to a person’s freedoms, the individual will act in opposition or resist pressures to conform to restore their freedoms. By avoiding the mistakes that Above the Influence made, Be the Influence will not tell teens what they should do but instead allow for a sense of control for the teens in that they can be their own influence and be a part of a group that stands to “be the influence” in their own lives and decision making. This alternative campaign will use psychological reactance to its advantage instead of falling victim to it. Similar to the successful intervention, truth campaign, which “captures the promotion of rebellion against the tobacco industry as a call to action to commit to a tobacco-free lifestyle,” Be the Influence will be a rebellion not against abusing drugs themselves, but a rebellion against unhealthy influences, similar to truth calling for a rebellion not against cigarettes, but the industry behind it (Douglas & Hastings, 2008, 352).

In correspondence with rebelling against negative influences that promote drug abuse, the alternative campaign will show teenagers in action, the advertisements need to be relatable to its target audience. The commercials and advertisements will incorporate teenagers standing up for their core values, the positive influences in their lives. Be the Influence needs to incorporate a promise based on support of those core values. Teenagers and people in general are prone to making decisions based on their emotional perception (Siegel, 10/21). Be the Influence can use this type of irrational decision making to its advantage. By including the advertising theory in the campaign’s core basis, a teenager’s emotions can be targeted. Be the Influence will provide its target audience with stories of real people surrounded by visual images and music to really try and captivate the emotions of teenagers. It will avoid the mistake that Above the Influence made by creating commercials that become unrealistic (depicting teens on puppet strings, using talking dogs, etc.). The most successful advertisers incorporate this basic idea in selling their products, the same process can be manipulated to meet the needs of public health initiatives (Ogilvy, 1964). Be the Influence needs to sell the idea that teenagers can be their own influence, they can rebel against the negative influences in their lives and make their own healthy choices. This will happen by creating emotionally stimulating advertisements and commercials.

Also, an important theory to look towards and incorporate in Be the Influence is marketing theory. How a product is packaged to an individual is crucial in whether or not that individual will want it. Be the Influence will be packaged in a way to meet the needs and wants of the target audience. Teenagers want to be a part of something, a group to identify with and a positive label to live up to, Be the Influence will be packaged and marketed as such. Currently, social marketing “is typically employed by public health and social scientists who believe the benefits of behavior change are self-evident, there is a tendency for the price and the exchange principle to be forgotten” (Blistein, Evans, & Driscoll, 2008, 27). By incorporating the ideas of price, promotion, products, and place when marketing the initiative, it is possible to influence voluntary behaviors (Grier & Bryant, 2005). Be the Influence will incorporate these principles of exchange (perceived costs and benefits of alternative behaviors) to successfully market through the wants and needs of teenagers. By using labeling and branding to acknowledge the crucial exchange principles, Be the Influence has a much greater shot at implementing behavior change among teenagers.

Be the Influence will acknowledge the labeling theory and incorporate it in the same way that successful public health interventions such as The 84 and Crush Campaign have. The labeling theory states that individuals will emit certain behavior and that correspond with their self-identification based on the terms that are used to describe them (Becker, 1997). The creator of the labeling theory, sociologist Howard Becker, describes the theory as a type of self-fulfilling prophecy for individuals. The Above the Influence campaign practically preaches against this theory in that they aim to have teens avoid being labeled as a pot head, smoker, etc. The campaign does not recognize that teens will respond better to being part of something, to identify with a group or organization. Be the Influence will allow for teens to be a member of a group who chooses to make their own educated, healthy decisions. By choosing a healthy, drug free lifestyle they will be able to associate themselves with other teens that choose to do the same. The 84 and Crush Campaign are great resources to look too in this aspect. They allow for “members” to be a part of their group by practicing safe behaviors. By creating this alternative intervention, teens will be able to identify themselves as being the ‘influence,’ they have control over their own lives and their own decisions.

In contrast to Above the Influence, Be the Influence will not preach about what not to do, but will offer healthy alternatives throughout the community. By being a part of Be the Influence, members will have access to online blogs where they can share their thoughts on healthy behaviors in an open forum, they can give advice or ask others questions on ways that they have a positive influence in their own lives as well as others. Mentoring programs can be initiated throughout the community for those that are members, to act as an example for someone younger (similar to a big brother/big sister program). This aspect will set a standard of a healthy lifestyle for the members, and will therefore allow them to rise to those standards and further lead by example. This type of labeling will be used in Be the Influence. The members will have expectations of practicing safe, healthy behaviors, and will then rise to the occasion of those expectations.

Additionally, Be the Influence will become a brand. The Crush Campaign has been incredibly successful in creating a public health initiative that mimics advertising a product in the business world. The campaign used the same principles of branding and labeling that companies who want to sell products in a market use and manipulated them to fit in the public health environment. The Crush Campaign provides a forum for non-smokers to take on a label as a ‘crush cutie’ (The Crush Campaign, 2010). It furthermore creates a brand by allowing members of the organization to access merchandise with the Crush logo, that brand becomes identifiable for members and further enhances their want to be a part of the label. Blistein, Evans, and Driscoll recognize that “branded campaigns promote a consumer orientation that emphasizes the nature of the exchange by appealing to the individual’s self-interest. This approach will become increasingly important to the field of public health as individuals are required to take a more active role in managing their health” (2008). By incorporating the same practices that successful businesses have, Be the Influence can appeal to teenagers at a much higher level of success. Creating a recognizable brand will play a key role in Be the Influence.

Be the Influence’s success is dependent on the incorporation of each of the previous behavioral science theories, and that they are used in a cohesive, complimentary manner with each other. It is important to take away conductive material from the failures of the Above the Influence campaign and learn from those mistakes in an effort to avoid making them again. Impacting a teenager’s behavior is albeit an incredibly difficult task, but it is not impossible. An alternative public health initiative, such as Be the Influence, has the potential to be successful and influential.

References

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Evans, W. D., Hastings, G. (2008). Chapter 1: public health branding: recognition, promise, and delivery of healthy lifestyles. Public Health Branding: Applying Marketing for Social Change, Oxford: Oxford University Press. 3-24.

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Salazar, M.K. (1991). Comparison of four behavioral theories. AAOHN Journal. 39(3);128-135.

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United States Government Accountability Office. (2006). ONDCP media campaign: contractor’s national evaluation did not find that the youth anti-drug media campaign was effective in reducing youth drug use.