Challenging Dogma - Fall 2007

...Using the social and behavioral sciences to improve the practice of public health.

Tuesday, December 11, 2007

The National Youth Anti-Drug Media Campaign: Failure to Change Drug Attitudes and Use- Renata Koziol

The Office of the National Drug Control Policy created the National Anti-Drug Youth Media Campaign in 1998 as a communications and media-based intervention to prevent and reduce youth drug use. The target audience includes youth ages 9-18, with specific focus on middle-school adolescents. The campaign includes many media outlets, such as advertising on television, radio, and in print, partnerships with other well-known organizations, and interactive websites containing information for teens and their parents (1). The Anti-Drug Media campaign utilizes television commercials and its many Internet websites to positively influence and educate the nation’s youth against illicit drugs. A specific campaign program is the Marijuana Initiative, which provides anti-marijuana education and advertising. The objectives of this initiative include educating youth to reject marijuana and preventing or diminishing marijuana use by teens. This initiative utilizes “Negative Consequences” commercials; targeted mostly toward 14-16 year olds, these ads display strongly negative outcomes which can occur as a result of marijuana use (1). Westat, a health survey research company, conducted a study through June 2004 to evaluate the effectiveness of the Campaign on changing substance use, perceptions, and intentions among adolescents. The evaluation found that the Media Campaign may have had unfavorable effects, including increasing teens’ perceptions of marijuana use among their peers, causing weaker anti-drug norms, and resulting in high rates of initiation in teens who were exposed to the Campaign (2). The Youth Anti-Drug Media Campaign failed in achieving its goals because it relies on aspects of the Health Belief Model and fails to utilize social and behavioral science theories such as Social Expectations Theory in creating its intervention methods.

Unrealistic Commercials
The National Youth Anti-Drug Media Campaign’s anti-marijuana ads failed because they did not consider teenagers’ reactions to ads that are unrealistic, subject to mockery, and attack marijuana users directly. Some television ads place blame on the drug user, trying to make them feel guilty for their actions, and by using a moralistic approach, create an opportunity for teenage rebellion. For example, one ad entitled “Dog,” depicts a dog talking to his teenage owner. He tells her that her actions while she is under the influence of marijuana are inappropriate and that she becomes someone he no longer recognizes as his former friend (3). One reason this commercial is ineffective is because it chooses an unrealistic situation containing a talking dog. As a result of its content, this commercial can be subject to mockery, which can negatively affect its intended anti-drug message. Furthermore, the purpose of the ad is to make marijuana users feel guilty. This tactic can have an undesirable effect on teens who already use marijuana. For instance, teens might believe that the campaign is directly attacking their personal characteristics and behaviors, leading them to ignore the commercials and continue using marijuana. Also, targeting teens with feelings of guilt can have separate, undesirable issues regarding self-esteem, which is already a major concern of teens during adolescence. As a result of these aspects of the commercials, teens may be more likely to rebel against these condescending types of ads and continue to use marijuana, despite their exposure to the anti-marijuana ads.

Teenage Rebellion Against Authority
A fundamental characteristic of teenagers is rebelling against authority and social controls which are meant to compel individuals to conformity (4). According to the Reactants Theory, developed within social psychology, a motivational and psychological state of resistance is activated when personal freedoms are being threatened or eliminated. This state of reactance can cause persons to adopt or strengthen an attitude that is contrary to what was originally intended (5). This theory comes into play strongly during the teenage years, during which parents and society attempt to impose restrictions on teens’ behaviors, mostly for their health and safety. Hence, the National Youth Media Anti-Drug Campaign’s commercials, which threaten teenagers’ sense of freedom, play directly into teenagers’ desire to rebel and thus prevent effective anti-drug messages from being perceived. Teens who view the commercials are no less likely to change their marijuana habits or begin smoking in the first place (2).
In contrast, “truth,” the anti-tobacco campaign, uses teen rebellion to its advantage. The truth campaign ads display tobacco companies and their deception in gaining new, young consumers for their deadly product. Teens viewing these ads perceive the authority of Big Tobacco companies, and focus their rebellion against these companies, refusing to be pawns in this corporate game by limiting or avoiding cigarette use. Because these ads give youth the facts about tobacco smoking, rather than preaching to them about the harms, teens respond to these commercials favorably (6, 7). The “truth” campaign and its advertisements have been shown to be significantly effective in reducing teenage smoking, decreasing teen experimentation with cigarette use and decreasing intentions to begin smoking (6).

Efficacy of Youth Marketing
Furthermore, the “truth” campaign has been effective because of its basis for its intervention methods, mainly, youth marketing. The truth campaign began with collaboration between the advertising company in charge of the campaign and Florida state teens. The teens were able to voice their views and opinions on tobacco perceptions, use, and teenage behaviors, characteristics, and perception. Because of direct input from the target audience before ads were designed, the advertising company was able to analyze teenage views and create ads which would be effective because they resound with and appeal to the target audience (8). On the contrary, the anti-marijuana campaign design has not included input from its target audience, teens and preteens ages 9-18 (1). This has resulted in the lack of ability of teens to identify with the commercials and have positive perceptions of the message upon watching the commercials. One particular study conducted by researchers at Texas State University, in which teenage and young adult subjects viewed both anti-tobacco and anti-marijuana ads and then provided their written comments about them, found that anti-marijuana commercials resulted in similar rates of unfavorable and favorable comments, while anti-tobacco ads resulted overwhelmingly in favorable comments (7). Furthermore, anti-marijuana ads resulted in significantly less positive responses than did anti-tobacco ads. Thus, this study shows that anti-marijuana ads have failed in their objectives to produce favorable anti-marijuana responses among teens in order to counter and reduce marijuana use.

Social Norms
Additionally, the anti-marijuana ads were unsuccessful because they failed to take into account social norms and cultural influences surrounding marijuana use. Teenage group norms and peer influence have been shown to play large roles in substance use patterns among adolescents (9, 10). Adolescents identify with single or multiple crowds that can have significant influences on teens’ behaviors and perception. Perceived group norms are very important in influencing teenage health-related behaviors. Self-categorization theory suggests that individuals who identify with a particular group seek to strengthen their acceptance within and similarity to the group by behaving according to the perceived behavioral norms of the group (10). According to a study conducted by Verkooijen et al. in Denmark, teens who identified with groups such as pop, skate/hip-hop, techno and hippie had higher levels of marijuana and overall substance use (10). The study found that because these particular crowds are perceived to have higher substance use, teens who identify themselves with these groups had higher substance use than teens who identified with other groups, such as sporty, quiet, or religious. The results collected by the study showed a positive association between perceived marijuana use among a particular group and use of marijuana by those who identified with this group. The more a person perceived fellow members of the group as marijuana users, the more likely that he would also use marijuana (10). Thus, because many teens perceive marijuana use to be prevalent among their peers, they themselves are more likely to use marijuana or to intend to use it. The creators of the anti-marijuana ads did not take this fact into consideration; the ads were not effective in decreasing intention or use of marijuana among teens. Additionally, it has been shown that some of the anti-marijuana ads have actually increased exposure to marijuana information and increased teens perception of the prevalence of marijuana use among other teenagers, leading to greater interest in and intention to use marijuana.
Furthermore, overall societal norms and cultural influences surrounding marijuana use also affect adolescent perception of the anti-marijuana ads. In America, there is an ongoing campaign to legalize marijuana, for both medicinal and recreational purposes. California has legalized the use of marijuana for physician-recommended medicinal treatment of pain, as per Proposition 215 which took effect in November 1996 (11). Furthermore, there are many organizations, including the Marijuana Policy Project, that advocate the reform of current marijuana policies by legalizing and regulating the possession and sale of marijuana (12). Because teens are exposed to these conflicting influences and political issues surrounding marijuana use, they may not view marijuana as a harmful drug, or they may assume that marijuana use is prevalent or even acceptable (13, 14). Thus, they may be more inclined to try marijuana and then continue using it. Furthermore, ads which display marijuana as harmful and discourage its use may not have the intended effect on teenage perception, because teens have already been influenced by society, and are not seeking to change their strongly held views.

Perceived Risks Versus Perceived Benefits
Finally, the anti-marijuana ads failed because of their reliance on aspects of the Health Belief Model, which leads to the assumption that adolescents use cost-benefit analysis and rational decision-making to influence and determine their health-related behaviors. Thus, many anti-marijuana commercials display risks associated with marijuana use. According to the Health Belief Model, individuals use cost-benefit analysis when making health-related behavioral decisions. The model states that if perceived susceptibility or risk outweighs perceived benefits, the individual will not engage in the harmful behavior (15). However, much of teenage risk-taking behavior is spontaneous and impulsive, leaving little or no room for risk assessment (16). Teenagers do not always identify risks when performing behaviors, especially if adverse consequences of the behavior are not immediate, but gratification is. Research has also shown that even in cases where teens acknowledge high risks, the perceived benefits they identify carry more weight in their decision to perform the risky behavior (16). Thus, when planning on using marijuana, adolescents do not always evaluate risks associated with the behavior, some of which may not be direct or immediate.

Rational Thinking
Furthermore, the Health Belief Model is a “rational” model, assuming that individuals use rational thinking in their behaviors (15). However, many teenagers forgo rational thinking in determining their actions, particularly when influenced by their peers (16). Thus, the anti-marijuana commercials that rely on the Health Belief Model have not been successful because the Health Belief Model’s basic, traditional assumptions fail to account for adolescent decision making, and thus do not apply to all teens and their marijuana behaviors. These anti-marijuana ads do not have any significant direct influence on changing teens’ use of or perceptions relating to marijuana, according to the 2004 Evaluation of the National Youth Anti-Drug Media Campaign (2).

Failure to Achieve Goals and Ways to Improve
In summary, the National Youth Anti-Drug Campaign, and specifically the Marijuana Initiative, failed to achieve its goals of reducing and prevent marijuana use among America’s youth. An evaluation commissioned by the government found that although there was high exposure among youth to the media campaign, the campaign ads did not have favorable effects on teens’ anti-drug perceptions or initiation of marijuana use (2). The media campaign failed in part due to its lack of input from and connection with its adolescent audience. Furthermore, it relies on traditional public health models, such as the Health Belief Model, which do not always take into account aspects of the modern world with all of its outside influences and social contexts. Because the campaign failed to incorporate social, psychological, and environmental theories, it was not effective in producing positive changes. Recommendations for improvements within the Media Campaign include utilizing social and behavioral models based on groups, rather than individuals, to produce more effective ads, targeting teens more directly by creating commercials which have had teen input and feedback, and presenting facts and leaving the conclusion up to the viewer, rather then employing consequence-based messages.

1. National Youth Anti-Drug Media Campaign. About the Campaign. Washington, DC: National Youth Anti-Drug Media Campaign.
2. Orwin R, Cadell D, Chu A, Kalton G, Maklan D, Morin C, Piesse A, Sridharan S, Steele D, Taylor K, Tracy E. Evaluation of the National Youth Anti-Drug Media Campaign: 2004 Report of Findings. Washington DC: Westat, 2006.
3. “Dog.” Television Ad Gallery. Washington, DC: National Youth Anti-Drug Media Campaign.
4. Eve, RA. A Study of the Efficacy and Interactions of Several Theories for Explaining Rebelliousness among High School Students. Journal of Criminal Law & Criminology 1978; 69(1):115-125.
5. Woller KMP, Buboltz, Jr WC, Loveland JM. Psychological reactance: examination across age, ethnicity, and gender. American Journal of Psychology 2007; 10:15.
6. Bauer UE, Johnson TM, Hopkins RS, Brooks RG. 2000. Changes in Youth Cigarette Use and Intentions Following Implementation of a Tobacco Control Program. Journal of American Medical Association 2000; 284 (6): 723-728.
7. Ginsburg HJ, Czyzewska M. National Anti-Marijuana Ads Compared to Anti-Tobacco Ads: Difference between Immediate Favorable and Unfavorable Post-viewing Written Comments. North American Journal of Psychology 2005; 7(3): 367-378.
8. Hicks, JJ. The Strategy behind Florida’s “truth” Campaign. Tobacco Control 2001; 10:3-5.
9. Urberg KA, Luo Q, Pilgrim C, Degirmencioglu SM. A two-stage model of peer influence in adolescent substance use: individual and relationship-specific differences in susceptibility to influence. Addictive Behaviors 2003; 28 (7):1243-1243.
10. Verrkooijen KT, deVries NK, Nielsen GA. Youth Crowds and Substance Use: The Impact of Perceived Group Norm and Multiple Group Identification. Psychology of Addictive Behaviors 2007; 21(1):55-61.
11. National Organization for the Reform of Marijuana Laws (California Chapter). California NORML Patient's Guide to Prop 215. San Francisco, CA: National Organization for the Reform of Marijuana Laws.
12. Marijuana Policy Project. Federal Action. Washington, DC: Marijuana Policy Project.
13. San Dieguito Alliance for Drug Free Youth, “Don’t Underestimate Marijuana.” San Dieguito Alliance for Drug Free Youth.
14. National Institute on Drug Abuse. Monitoring the Future: National Results on Adolescent Drug Use. Bethesda, MD: US Department of Health and Human Services, 2006.
15. Edberg M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Boston, MA: Jones and Bartlett Publishers, 2007.
16. Reyna VF, Farley F. Risk and Rationality in Adolescent Decision Making: Implications for Theory, Practice, and Public Policy. Psychological Science in the Public Interest 2006; 7 (1):1-44.

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