Challenging Dogma - Fall 2007

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

Saturday, December 8, 2007

“Parenting Skills Campaign”: Not So Informative – Apryl Pagliaro

According to the 2006 Partnership Attitude Tracking Study on parents, collected by the Partnership for a Drug-Free America, there was a decline in discussions among parents and their children about drug and alcohol abuse. The study showed a 12 percent decline (55% to 49%) from 2005 in frequent discussions, defined as four or more (6). This is troublesome as new trends in drug use among teenagers are consistently presenting themselves. The latest of these trends is abuse of prescription and over-the-counter medications, primarily cough medicine. Studies show that just 36 percent of parents talk to their children about abuse of prescription medication and only 33 percent about over-the-counter drugs (6).

In light of these findings, the MetLife Foundation incorporated with the Partnership for a Drug-Free America designed a media campaign targeted at parents. The campaign consists of radio messages, aired in New York, Boston, Chicago, Philadelphia, St. Louis, Providence, Hartford/New Haven, Washington DC, Pittsburgh, Miami, and San Francisco, along with web resources and a free brochure (6). The purpose of the campaign is to stress to parents the importance of talking with kids about drugs and alcohol, and staying involved in children’s lives to keep them healthy and drug free (6).

The “Parenting Skills Campaign,” a media campaign supplemented with a website of resources and a free brochure, run by MetLife in conjunction with the Partnership for a Drug-Free America, will not be effective in the goal of encouraging parents to talk with their children about staying drug free. Evidence for this will be portrayed in three arguments. The first will utilize the Theory of Planned Behavior and the campaign’s lack of acknowledgment of self-efficacy. The second argument will focus on the campaign’s failure to reach high-risk populations. Thirdly, the final argument will show the ineffectiveness of the use of the Health Belief Model in this type of media campaign. To conclude this critique of the “Parenting Skills Campaign” implications and recommendations for future public health programs will be identified.

1. Self-efficacy

According to the Theory of Planned Behavior, self-efficacy, perceived norms, and attitudes about a behavior dictate an individual’s intention to carry out that behavior, which is linked to actually doing the behavior. The “Parenting Skills Campaign” does not take into account self-efficacy, the impression that one is capable of performing in a certain manner or attaining certain goals. Most parents know that they should talk to their kids about staying drug free, but they may not have the confidence or feel they have the skills to do so.

Parental self-efficacy to change a child’s behavior has been considered a protective factor in preventing adolescent substance abuse (5). Most prevention programs are based on psychosocial theories that state that self-efficacy has to occur before any change in parent behavior can transpire (5). This campaign does not utilize those psychosocial theories.

Self-efficacy is developed through a number of influences, one of which being mastery (13). In other words, if a parent masters the art of talking to their child about drugs, then they will be empowered to do so. However, this campaign offers no way to master that skill. Another source of self-efficacy is to watch models carry out the intended behavior (13). If parents were given the opportunity to watch other parents talking to their children, then they will feel more confident. A simple message aired over the radio does not present any opportunity for interaction between parents. An additional failure of the campaign to address self-efficacy is by not utilizing social persuasion (13). The messages are simply telling parents to talk to their kids, not instilling in them the belief that they have what it takes to actually do it.

2. Internet Access

Messages from the campaign are being aired over the radio in English in New York, Boston, Chicago, Philadelphia, St. Louis, Providence, Hartford/New Haven, Washington DC, Pittsburgh, Miami, and San Francisco. Spanish messages are being aired in the limited locations of Miami, New York, and Chicago. The radio messages refer parents to the Partnership for a Drug Free America website to access web resources and to download a free brochure. While these resources may be useful to the parents that can actually access the website, it does not reach the people who do not have any internet access.

According to the 2000 census, only 28% of families with a yearly income lower than $25,000 owned a computer and just 19% had internet access. That is a huge difference from families with a yearly income above $75,000, in which 88 percent owned a computer and 79% had internet access (10). They also showed that people who lived in the western part of the country were more likely to own a computer and access the internet, and southerners were least likely. People who lived in metropolitan areas, but outside of the center city were more likely to own computers and have internet access than those people who lived in the center city (58% and 48% compared to 46% and 38%). Rural dwellers were even less likely (42% and 32%) to own a computer and access the internet (10). Differences were also recorded across race/ethnicity. Among white non-Hispanic children aged 3-17, 77% lived in households in which a computer was owned. However, only 43% of black children and 37% of Hispanic children lived in computer-owned households (10).

The data shown above is important because it paints a picture of who can actually access the web resources connected with the “Parenting Skills” campaign. By making these resources only available over the internet, the campaign is only reaching those with access, mostly white, middle to high-class populations. This leaves out those populations that are considered to be at the highest risk for drug use. Some risk factors associated with drug use include lack of parental supervision, poverty, drug availability, a caregiver who uses drugs, and associating with drug-abusing peers. Gender, race, and geographic location can also play a role in children using drugs (11, 12). This campaign will not be effective in increasing the number of parents who talk to their kids about drugs, if it does not reach those parents of kids who are considered high-risk.

3. Failure of the Use of the Health Belief Model

The “Parenting Skills” campaign is based on the use of the Health Belief Model. Using this theory means that parents will weigh the costs and benefits of talking to their children about drugs, which will lead to intention, and eventually to the parents carrying out the behavior of speaking with their kids. However, this is not necessarily true for a number of reasons. It is these reasons, discussed below, that will contribute to the failure of the “Parenting Skills” campaign.

First of all, the Health Belief Model assumes that health is highly valued by most people (8). In this case, parents may not have talking about drugs to their kids high on their agenda. They may think that having that conversation is really not that important, or that their children are already taught about these issues at school and do not need to hear the same thing at home. Secondly, the model views the individual as lacking emotion (9). There is a failure to recognize that parents may have a hard time talking to their children about drugs. It does not take into account that perhaps talking about drugs is hard for parents because they are users themselves. In addition, the parents may believe that this issue does not affect their children or they may also be afraid of finding out that their children are already using. Another major flaw with the model is that intention does not always lead to behavior. Parents may have the best intentions to talk with their children, but then neglect to do it. The campaign does not include anything to help make the link between intention and behavior. Web-based resources are available to aid parents in their talk, but on the same note, parents are busy, leading to more intentions. Parents may have it in mind that they are going to access the website and then never do it.

The model also does not take into account that intention may be only one factor that influences behavior. It has a limited ability to account for variance in behaviors related to attitudes and beliefs (8). Again, parents may have different beliefs on whose job it is to talk to their children about using drugs. The Health Belief Model does not account for the fact that people come from all different backgrounds and cultures. There may be a varying acceptability across cultures around drug related issues, which dictates whether a parent talks to their child about drugs. There are numerous other factors, that cannot all be named here, that may prevent a parent from addressing this issue with their child. One last critique of the Health Belief Model is that there is an assumption of rationality in decision making. However, all decisions are not made in a rational manner.

4. Implications for Future Public Health Programs

MetLife’s “Parenting Skills” campaign is implemented in a single context and not considered a multi-contextual program. The most successful youth drug abuse interventions have been shown to be multi-contextual (5). Airing media messages over the radio is a great way for a lot of people to hear the message. However, many messages are being played over the radio and the trick is to get this one to stick out. MetLife and the Partnership for a Drug Free America have a great deal of influence and collaborations with community organizations. The campaign would prove to be more effective if these two companies took advantage of those relationships and set up local outreach projects in various communities. Giving parents the information they need and letting them develop their communication skills, in a setting that promotes self-efficacy, would yield more positive outcomes.

Increasing access and availability of resources would also make these types of programs more successful. Supplementing web-resources with brochures given out in schools or at physicians’ offices would reach an array of parents. Also, expanding the campaign to include televised and billboard components would ensure that more people within the target population are reached. Knowledge is power, meaning that making more parents privy to information on child and adolescent drug use will make them more likely to talk to their kids about it (4).

5. Conclusion

The “Parenting Skills” campaign is an ineffective public health program. It fails to reach the populations that are considered to be most at risk for drug use, by prohibiting them access to resources. It focuses on informing parents of the importance of talking to their children about drugs, but fails to provide parents with the tools to do so. If parents are to be expected to speak with their children about drugs they need to be educated, have access to knowledge, and be empowered and motivated to go through with it. This campaign falls short of offering the support parents need to fulfill the expectations of the messages communicated by the campaign.

6. References

1. Coleman PK, Hildebrandt Karraker K. Parenting Self-efficacy Among Mothers of School-age Children: Conceptualization, Measurement, and Correlates. Family Relations 2000; 49(1): 13-24.

2. Nath PS, Borkowski JG, Whitman TL, Schellenbach CJ. Understanding Adolescent Parenting: The Dimensions and Functions of Social Support. Family Relations 1991; 40: 411-420.

3. Hornik R, Yanovitzky I. Using Theory to Design Evaluations of Communication Campaigns: The Case of the National Youth Anti-drug Media Campaign. Communication Theory 2003; 13(2): 204-224.

4. Harakeh Z, Scholte R, Vermulst AA, Vries H, Engels R. Parental Factors and Adolescents’ Smoking Behavior: An Extension of The Theory of Planned Behavior. Preventative Medicine 2004; 39: 951-961.

5. Riggs NR, Elfenbaum P, Pentz MA. Parent program component analysis in a drug abuse prevention trial. Journal of Adolescent Health 2006; 39: 66-72.

6. MetLife Foundation Begins New Phase of Award-Winning Parenting Skills Campaign In Collaboration With Partnership. New York: Partnership for Drug Free America, 2007.

7. MetLife Foundation. Health. New York: Metropolitan Life Insurance Company. http://www.metlife.com.

8. Salazar MK. Comparison of Four Behavioral Theories – A Literature Review. AAOHN Journal 1991; 39(3): 128-135.

9. Choi K, Yep GA, Kumekawa E. HIV Prevention Among Asian and Pacific Islander American Men Who Have Sex With Men: A Critical Review of Theoretical Models and Directions for Future Research. AIDS Education and Prevention. The Guilford Press 1998; 10A: 19-30.

10. Newburger EC. Home Computers and Internet Use in the United States. United States Census Bureau, 2000.

11. National Institute on Drug Abuse. Preventing Drug Abuse Among Children and Adolescents – Risk Factors and Protective Factors. http://www.drugabuse.gov.

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3 Comments:

  • At December 10, 2007 at 6:02 PM , Blogger Read said...

    Apryl- What a great intro. The background information was summarized nicely and then you clearly laid-out what the reader was to expect.

    I would've liked more info on the media you were critiquing. What did the radio ad say that made it so ineffective?

    Overall great insights. And thank you for the statistics regarding computer usage. They really strengthened your arguments.

     
  • At December 13, 2007 at 6:56 PM , Blogger Victoria said...

    It's a really interesting intervention - one that is aimed at adolescents but through their parents. I liked how you critiqued it, especially how you brought up mastery and how the commercials really didn't provide information about how to talk about these subjects (unless you went to the website). I remember these ads and I thought they were pretty good (besides being kind of cheesy), but I definitely see the points you are making!

     
  • At December 14, 2007 at 9:57 AM , Anonymous Deinera said...

    Really interesting points...I agree with Read about the use of the statistics on access to computers. They create a very strong argument, and leave you wondering how the creators of the campaign could have neglected such an important detail.

     

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