Challenging Dogma

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

Wednesday, April 25, 2007

Failure To Effectively Reach Adolescents: A Critique of The National Youth Anti-Drug Media Campaign – Sita Yerramsetti

The National Youth Anti-Drug Media Campaign (NYADMC) operated under the auspices of the Office of National Drug Control Policy, is the U.S. government’s largest public health communication campaign (1). As a social marketing campaign, its aim is to “…educate and enable the country’s youth to reject illicit drug use,” and targets adolescents from the ages of 9-18 (2) through the use of a multimedia approach which includes television, radio, and print advertisements and websites (2).

Studies assessing the success of NYADMC have been controversial, having indicated that the campaign was not effective in reducing youth drug use (3). There was actually evidence of a slight negative impact of campaign exposure on intention to use marijuana among teens aged 14-17 (meaning that exposure to campaign was correlated with an increase in intention to use marijuana among non-users), and little evidence of favorable effects of the media campaign on its target audience (4).

With 1.2 billion dollars apportioned to the Office of National Drug Control’s National Youth Anti-Drug Media Campaign (3), one wonders why a targeted youth anti-drug media operation has failed in reducing drug use and why the Government Accountability Office recommends limiting funds for this campaign.

The NYADMC is an umbrella campaign utilizing multiple media outlets to promote drug use abstinence in youth. The focus of this paper will be the television advertisements put out by the NYADMC, between 1999-2004, as this was a time period of “full implementation” with an intended degree of youth ad exposure of about 2.5 ads per week (5). The ads between this time focused predominantly on scare tactics (such as the much maligned and offensive (6) drugs = terrorism advertisements), and the negative consequences of drug use (depicting ludicrous outcomes such as that smoking pot will cause you to shoot friends).

Although studies have indicated that youth, in an experimental setup, understand the negative emotions and consequences of these advertisements (7), studies on the NYADMC’s effectiveness (3,4) and outrage from teenagers (8, 9) indicate otherwise. Much of this indignation is with regards to the scare tactics and ludicrous situations depicted within the advertisements (8, 9).

Elaboration Likelihood Model
It is easy to see why NYADMC campaign is ineffective when analyzed within the framework of the Elaboration Likelihood Model (ELM), a social science theory that looks at how attitudes are formed and changed. The ELM posits that there are two different routes to persuasion and change of attitudes: the central, and the peripheral (10). Although peripheral route processing elicits behavior change (e.g. results in someone buying an advertised product), it rarely elicits attitude change (10), which would be the goal of a campaign aimed at prevention, such as the NYADMC. Peripheral route processing is in contrast with central route processing, which, if activated, results in more elaboration and cognitive processing of a message that ultimately results in the production of stronger attitudes and beliefs (10). Both the motivation and the ability to process a message determine which route will be taken when analyzing it.

Many factors effect central route processing, including perceived personal relevance of the message to the audience (10). Although certain advertisements put out by the Anti-Drug Campaigns (such as the Anti-Drug and Above The Influence campaigns) attempt to make messages personally relevant to teens, most focus on unrealistic and alarmist situations and exaggerations of facts, which only serve to engender fear and mistrust (9). As a result, teens are not motivated to think critically about what is depicted in the advertisements because such absurd situations tend not to be applicable to their lives. Ultimately all that is attained from these efforts to deter drug use in youth is peripheral route processing – an agenda is set about drugs, and teens pay increased attention to the topic of the advertisement (drugs), but not necessarily to the content of the ad (the anti- drug message). Although the purported goal of an anti-drug campaign would be to get teens thinking about drugs and ultimately have a strong anti-drug stance (a goal which would be achieved through central route processing), the National Youth Anti-Drug Media Campaign fails to provide youth with either the motivation or the ability to think critically about the issue and allow for central route processing.

The content of anti-drug ads not only deprive teens of the motivation to centrally process their messages, they also deprive them of the ability to do so. Information that would be essential in order to carefully scrutinize the potential risks, effects, and pitfalls of drug use is not included in anti-drug advertisements in favor of a unilaterally condemnatory approach to drug use (8).
Thus teens also lack the ability, in addition to the motivation, to process these messages via central route. Additionally, any truthful information that may be presented within these ads is ignored in light of their over the top content and sometimes absurd implications about drug use (9). The NYADMC fails by alienating youth through utilizing condescendingly and offensive propaganda, resulting in a lack of motivation and ability to highly elaborate upon and think about the effects of drug use.

In terms of the National Youth Anti-Drug Media Campaign, utilizing these tactics is not only condescending but undermines the goal of getting youth to pay attention to the ads and follow what little advice or factual information contained there-in. Teens are not only 1) turned off to the content, but 2) fail to process any realistic or credible message contained in the ads in any meaningful way.

Maslow’s Hierarchy of Needs
The National Youth Anti-Drug Media Campaign is also unsuccessful in recognizing the basic psychological needs of its target audience. According to Maslow’s hierarchy of needs (11), all humans have social needs and esteem needs, a “desire for a place in [their] group,” following physiological and safety needs. Adolescents especially feel compelled to belong and be accepted within a social group, evident in a study that looked at youth smoking decisions and found that teens will blatantly disregard health risks (that they are aware of) in favor of fulfilling a need to belong and satisfy social needs (12). However, the NYADMC messages do little to give teens an alternative with which to fulfill this need – the more recent approach, Above The Influence, tells youth to“[rise] above the influence,” (13) which entails detaching yourself from your peer group. Tension reduction theories posit (14) that public health campaigns should strive to reduce tension of difficult situations (such as being confronted by the decision between acceptance in a peer group and drug use) by providing coping mechanisms or prevention strategies. By not providing teens with this information, the NYADMC presents youth with the difficult dichotomy of either “caving in to peer pressure,” and ultimately abuse drugs and face dire consequences, or ending up alone and alienated from their social group.

Similarly, the messages fail to adequately acknowledge teens’ esteem needs. According to Maslow, every human desires self-respect and the respect of others, to have “…high evaluation of themselves, for self-respect, or self-esteem, and for the esteem of others (11).” Although the current set of advertisements put out by the NYADMC attempt to emphasize the need for independence and self-affirmation, even this recent approach doesn’t allow teens the opportunity to make a choice.

Despite its stated goal of attempting to inform and empower youth so that they can make their own “smart decisions,” (13) the recent Above the Influence campaign of the NYADMC belies this goal with its one choice only, zero tolerance approach to drugs. Though the powers behind this campaign state, “we're not telling you how to live your life,” the campaign does exactly that – by not allowing a choice on the matter of drug use, they convey that their way, the no drug way, is the only acceptable way. Even though the more recent ads do not depict the exaggerated situations of past ads, one of the Above the Influence ads even states (ironically, given the messages of prior ads), “I smoked weed and nobody died” (15), the underlying message repeats past “Just Say No” approaches, which have been found to be an ineffective way to promote abstinence from drugs (7).

The new campaigns attempt to place the locus of the control on the teen (encouraging them to “decide for [themselves]” 15), and yet they tell them what to do. This, in addition to being condescended to, is in direct conflict with the esteem needs of youth, ultimately making the informed and empowered approach of these new marketing campaigns just as ineffective as the over the top, edgy campaigns of the past (8).

The Theory of Reasoned Action
The NYADMC is based on the Theory of Reasoned Action (TRA) (4), coupled with self-efficacy considerations (also known as the Theory of Planned Behavior). The Theory of Reasoned Action states that attitudes about behavior and perceived norms lead to intention to change, which ultimately leads to alteration in behavior (16). The TRA fails on the whole because it assumes that people act in accordance with rational intent (17), and because it focuses on an individual’s behavior without taking into effect social factors (17).

Additionally, the cause-effect depictions of drug use in advertisements seem to not take into account (because they do not address) the population specific attitudes, norms, and self-efficacy considerations that are required for behavior and attitude change (within the Theory of Planned Behavior), which ultimately leads to ineffective behavior change interventions (7). For example, in the case of teens, peer considerations are crucial when determining behavior, because of social needs (11). Implementing a media campaign that ignores crucial determinants of behavior is bound to be inefficient and not illicit the intended behavior/attitude change of turning youth away from drug use.

The NYADMC has focused on depicting the consequences of drug use as always negative and oftentimes disastrous – this unilateral approach is condescending to youth in that it does not take into account their ability to critically think about drug use and weigh the risks against the benefits. By utilizing scare tactics and exaggeration, and ignoring the social and esteem needs of teens, the media campaign is condescending and has alienated many teenagers, leading them to ignore anti-drug propaganda altogether, whether it is potentially useful or not.
Unfortunately, the focus of the National Youth Anti-Drug Campaign has not been on educating youth such that they can make informed decisions with regards to drugs. The various approaches that have been utilized by the campaign to motivate abstinence from drug use, from scare tactics to attempts at empowerment, have failed because their underlying ideology is that teens are unable to think critically about drug use and rationally weigh the costs versus the benefits.

Public health campaigns should emphasize choice, autonomy, and information as a means for effectively reaching adolescents in future anti-drug campaigns. Were the content of these advertisements replaced with actual facts, credible information, and education, youth may respond by elaborating upon and internalizing the anti-drug message instead of being turned off by condescending scare tactics. The public health community needs to reach out to agencies (such as the government) that have the resources and funding to mount a wide reaching campaign and inform them of the most effective strategies and messages that will lead to modification in beliefs, attitudes, and, ultimately, behavior.

1. Office of National Drug Control Policy. National media Match Policy National Youth Anti-Drug Media Campaign. Washington, DC: Office of National Drug Control Policy, 2005.
2. Office of National Drug Control Policy, National Youth Anti-Drug Media Campaign, Campaign Overview. Washington, DC: Office of National Drug Control Policy National Youth Anti-Drug Media Campaign.
3. Office of National Drug Control Policy. Contractor’s National Evaluation Did Not Find That the Youth Anti-Drug Media Campaign Was Effective in Reducing Youth Drug Use. Washington, DC: Office of National Drug Control Policy, 2005
4. Hornik, R. et al, (2001). Evaluation of the National Youth Anti-Drug Media Campaign: Fifth Semi-Annual Report of Findings, Report prepared for the National Institute on Drug Abuse, Washington DC: Westat, 2005.
5. Longshore, D., et al. National Youth Anti-Drug Media Campaign and school-based drug prevention: Evidence for a synergistic effect in ALERT Plus. Addictive Behaviors 2006; 31: 496-508.
6. NORML. Super Bust! Drug Czar's Office to Spend $3.4 Million For Super Bowl Ads NORML Head Calls Ads Linking Drug Use to Terrorism "A Colossal Waste of Taxpayers' Dollars." Washington, DC: NORML.
7. Fishbein, M., et al. Avoiding the Boomerang: Testing the Relative Effectiveness of Antidrug Public Service Announcements Before a National Campaign. American Journal of Public Health 2002; 92(2): 238-245.
8. iVory Towerz. Rise Above the Influence. Washington, DC: iVory Towerz.
9. Students For Sensible Drug Policy. Talking Points on Federal Anti-Drug Ads. Washington, DC: Students For Sensible Drug Policy.
10. Petty, R.E., & Cacioppo, J. T. Communication and persuasion: Central and peripheral routes to attitude change. New York: Springer/Verlag, 1986.
11. Maslow, A. H. A Theory of Human Motivation. Psychological Review, 1943; 50:370-396.
12. Baillie, L., et al. Smoking Decisions from a Teen perspective: A Narrative Study. American Journal of Health Behavior 2005; 29(2): 99-106.
13. Above The Influence. About This Site. Washington, DC: Office of National Drug Control Policy National Youth Anti-Drug Media Campaign.
14. McGuire, W.J. Theoretical Foundations of Campaigns (pp. 43-65). In: Rice R. & Atkin, C. (Ed.). Public Communication Campaigns. (2nd Ed.) Newbury Park, Ca: Sage Publications, Inc. 1989.
15. Above The Influence. The Ads. Washington, DC: Office of National Drug Control Policy National Youth Anti-Drug media Campaign.
16. Booth-Butterfiled S., Reger, B. The message changes belief and the rest is theory: the “1% or less” milk campaign and reasoned action. Preventive Medicine 2004; 39: 581-588.
17. Siegel, M. “DEVELOPING INTERVENTIONS: The Role of Social and Behavioral Sciences – PART ONE.” SB 721. Boston University School of Public Health. Boston, 22 March 2007.

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