Challenging Dogma - Spring 2008

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

Wednesday, April 23, 2008

Anti-drunk Driving Campaigns Targeting Young Adults-Why It’s Failing-Mona Cai

In 2005, according to the National Highway Traffic Safety Administration (NHTSA), 39% of all traffic fatalities were alcohol related with one alcohol related fatality occurring every 31 minutes. A total of 43,443 people died in 2005 due to alcohol-related car crashes. A staggering 10,321 (24%) of these people were between the ages of 16-24 (1). There have been countless efforts from multiple facets of society to resolve this public health crisis. One facet that is very prominent in this fight is the federal and state government with the help of law enforcement and mass media. Underage drinking laws have been around since the 1930s and the NHTSA has estimated that since 1975, over 24,560 lives have been saved due to these laws (1). Although law enforcement is working to a certain degree, overall efforts have been fruitless because this age group remains the only age group that saw no changes in fatal crashes between 1995-2005 (1). A major failure in the fight against drunk driving among this age group are mass media campaigns used to target this population. This paper will explore some these campaign strategies, look at their effectiveness, and also look for future interventions to address these needs.

Ineffective usage of the Health Belief Model
These campaigns use ‘scare tactics’ to target the 16-24 age group. For example, Department of Transportation in Texas has a massive anti-drunk driving campaign featuring Jacqueline Saburido, an innocent victim of a drunk-driver. Jacqueline story starts in September of 1999 when she was hit by a 17-year-old drunk driver while driving home from a birthday party near Austin, Texas. She suffered third degree burns to over 60% of her body and has lost her hair, ears, nose, lips, left eyelid, and much of her vision (8). This Texas media campaign included a large picture of Jacqueline post-accident with a small snapshot of her before the accident along with the heading ‘Not everyone who gets hit by a drunk driver dies.’

This campaign has many positive aspects to it but it still fails at effectively conveying the message to the 16-24 age group. According to McGuire’s Communication-Persuasion Matrix, the most effective source of a message is from the target audience. Jacqueline Saburido is a 20 year old who suffered tremendously due to a drunk driver. The ad did a good job by using her as the source of the message because she shares characteristics with the people in target audience. The ad has a clear target audience and a clear message to this audience. The message that they want to convey is that living with the consequences of drunk driving may be worse than you would ever imagine. Young adults are very self-conscious of their appearance and are fearful of ridicule by their fellow peers. This ad attempts to target that fear by using a young woman who was severely disfigured in the hopes that this fear will sway the target audience from drinking and driving.

The problem with this ad is that the ‘scare tactic’ does not work for this target age group. The health belief model is an ineffective way to communicate a mess age to this target audience for many reasons. The health belief model is an individual level model that is influenced by individual level factors. It assumes that people will first perceive their relative susceptibility/severity to an outcome, rationally weigh out the ‘costs’ versus ‘benefits’ of taking a certain action, and that will ultimately dictate the intention to act. The Texas Department of Transportation is hoping that young adults will see that a potential ‘risk’ of drunk driving is physical disfigurement, and will then weigh out the ‘risks’ versus ‘benefits’ of drinking and driving. The issue here is that this ad is choosing to highlight a severe ‘risk’ of drunk driving. It ignores the fact that the majority of the accidents caused by drunk driving do not result in third degree burns to 60% of the body. The target population knows this and will therefore brush this ad off as being unrealistic. According to the CDC Youth Risk Behavior Surveillance, during the last 30 days, 29% of high school students nationwide had ridden one or more times in a car driven by someone who had been drinking alcohol. Most of those incidences do not result in a fatal car crash so using an exaggerated ‘risk’ will not be effective for this prevention campaign.

For the young adults that get away with drinking and driving time after time, their perceived susceptibility/severity of the consequences of drunk driving decreases. Because susceptibility and severity is a perception and perception is subjective, inconsistencies between perceived and actual susceptibility/severity occur. The article ‘Risk and Perceived Risk of drunk driving among young drivers’ studied the actual and perceived relative risks of drunk-driving fatalities dependent on the number of drinks ingested before driving. The actual relative risk for ingesting one-two drinks associated with driver deaths was 2.3. That number jumped dramatically to 98 when the drinks increased to more than six drinks. In contrast, when college students were asked what they believed the relative risks to be, the mean perceived relative risk was 1.47 for one-two drinks and 7.43 for six or more drinks (6). There is a huge discrepancy in the perceived relative risk (7.43) and the actual relative risk (98) of six or more drinks. Ad campaigns that choose to use the health belief model must ensure that discrepancies between perceived and actual susceptibility/severity are minimal as a first step in implementing an effective prevention campaign.

Another flaw in employing health belief model for prevention campaigns is that this model assumes that people are rational in their decision-making process. Campaigns using this model tend to be rational based and logical in its presentation of an issue. The journal article ‘Questioning the value of realism: young adults’ processing of messages in alcohol-related public service announcements and advertising’ evaluated the effects of anti-drinking public service announcements among college students (3). Their results showed that logic-based ads were much less effective than unrealistic but enjoyable ads. Campaigns employing the ‘scare tactic’ are many times rational based and never enjoyable so that is probably why they fail to be effective among young adults.

Ineffective framing of the messages within many of these mass media campaigns is another reason behind their failure. The framing theory is very important in the field of public health because it theorizes that the way an issue is framed in society determines the likelihood of a person’s willingness to change a behavior. In other words, the way a public health problem is defined and perceived ultimately affects the success or failure of public health efforts to change an individuals’ behavior. An example of effective framing in public health is the anti-tobacco “truth” campaign that abandoned the standard method of framing the issue (smoking as a individuals’ choice), and instead chose a different angle by framing underage smokers as the ‘victims’ and tobacco companies as the ‘culprits’.

Importance of framing
It is essential that those who develop any public health campaigns recognize the impact framing has on an issue. NHTSA is a front-runner when it comes to developing anti-drunk driving campaigns. NHTSA stands for National Highway Traffic Safety Administration. It was created in 1966 as a part of the Department of Transportation. They are in charge of writing and enforcing safety standards for motor vehicles. One of their major activities is the maintenance of the Fatality Analysis Reporting System, which contains data on fatal traffic crashes within the U.S (9). They recently started a campaign with the slogan ‘Over the limit, under arrest. You will get caught.’ Part of the campaign is a commercial which features intoxicated young males driving at night. As they drive, they show signs of being intoxicated, which include reckless driving and dozing off. Their cars slowly fill up with alcohol and they eventually get pulled over, handcuffed, and escorted into a police vehicle. This commercial successfully tailored itself to its target population, which are young males. In 2005, males caused 41,235 traffic fatalities (74%) among which 14% were between the ages of 15-20 (1). This population is definitely considered a ‘high risk’ group. The study cited above, ‘Questioning the value of realism’ also found in their research that perceived realism and themes that the study subjects could identify with greatly increased the effectiveness of an ad campaign (3). This ad did a good job in creating a setting and a scenario that a high-risk group can identify with.

Even with all its positive qualities, the ad is still fundamentally flawed due to two main reasons. The first issue has nothing to do with framing; it has to do with issues related to the target audience. The target audience here is specifically young males. In the study ‘Evaluating an Anti-Drinking and Driving Advertising Campaign with a Sample Survey and Time Series Intervention Analysis,’ they evaluated the incidences of drunk driving between an intervention and a control group. The intervention group was exposed to 6 months of anti-drinking and driving campaigns while the control group received no advertising treatment during that same time frame. Outcome measures included the frequency of drinking-driving pre-intervention and post-intervention stratified on the number of drinks ingested. Results showed that the intervention had a significant effect in decreasing drinking-driving behavior when both sexes were included in the analysis but a non-significant effect when only males were included (7). This shows that it is even more difficult to tailor effective media campaigns when the target is the young male population so more research and effort should be spent before putting forth a campaign targeting this population.

The second problem with this ad is the framing method used to target this difficult-to-effect population. This ad is basically relaying a threat from law enforcement by using the slogan ‘you will get caught.’ Realistically, that is a very ineffective because it is commonly known that young adult males do not conform to authority. Quite the opposite, young males tend to bend against authority and push the limits when it comes to risky behaviors. Many young adult males who have driven drunk or have friends who drove drunk were never caught or convicted with a DUI. For those individuals, this slogan is just a meaningless, empty threat. They might even laugh when they see this ad and think, ‘they’ll never catch me.’ “They” in this sentence refers to the cops on the roads. Young males tend to have a rebellious, disregarding attitude towards authority. They might take pride to the fact that they haven’t been caught and that pride could further encourage the behavior. NHTSA should consider changing their methods of framing away from an authoritative tone. An effective framing method would mean framing the issue in a way that the target population can positively relate with. The ad should not take on a parental role, but instead, take on the role of a fellow peer, and utilize slogans that are framed more specifically for the target population. ‘Over the limit, chill out, or you will get caught.’ Adding just three words ‘chill out’ and ‘or’ has changed this slogan from an authoritative threat into peer advice. It’s obvious that the original slogan writers wanted to keep the slogan short and to the point but in doing so, made the overall message harsh and ineffective.

Future strategies of Anti-Drunk driving campaigns
A major detail that is ignored in the media campaigns described above is the fact that the target population is strongly influenced by the attitudes and behaviors of their peers. Regardless of whether or not a behavior is risky, people in the target population will continue to engage in the behavior as long as they believe that the behavior is typical among their peers. This is the basic principle that guides the Theory of Social Norms. Therefore, ads targeting this population should all acknowledge and incorporate the social attitudes around the intended issue. The journal article ‘Social context, perceived norms and drinking behavior in young people’ attempted to study the relationship between various social variables and its effect on drinking intensity among middle/high school and college students. They found that drinking intensity was closely related to several social context variables as well as perceptions of close friends’ drinking intensity (4). Results from this study strongly suggest that alcohol drinking and activities involving alcohol are socially influenced among this age group. Also, a lot of studies on social norms have found that people have exaggerated views of the risk-taking behavior of their peers. In other words, many young adults might believe that drunk driving is more prevalent among their peers than it really is in reality. In the article ‘A social norms approach to preventing binge drinking at colleges and universities,’ they found that informing college students of their over-exaggerated views of the prevalence of heavy drinking led to a decrease in drinking over a 6-month time frame (5). Therefore, identifying and targeting the disparity between perceived and actual norms should be a dominant theme in future anti-drunk driving campaigns.

The history of tobacco campaigns is a good illustration of how social norms dictate individual behavior. Tobacco companies have used social norms theory to sell their product for decades now. They glamorized the act of smoking and made it into something sexy and cool. Young adults saw these ads and tried to emulate them believing that they would also be sexy and cool. In contrast, early public health campaigns attempting to combat tobacco smoke were focused primarily on individual behaviors and choices (2). They did not employ the social norms theory and therefore lost out to tobacco companies for a long time in the fight against smoking. The success of the anti-tobacco campaigns in recent decades can be attributed to an increase stigma associated with smoking. Today, the act of smoking is increasingly viewed as a sign of poor self-discipline and insensitive disregard for other people. This stigma was due to an increase in education and awareness through effective campaigns and interventions. It is the driving force behind the decline in smoking rates among young adults because it is no longer ‘cool’ and accepted among their fellow peers to smoke. Anti-drunk driving campaigns should focus on developing ways to increase ‘stigma’ associated with that behavior as a basic goal for their prevention campaigns.

Billions of dollars and innumerable efforts have been exhausted in media campaigns to decrease drinking and driving among the 16-24 year olds; to date the rewards are minimal. More effort should be taken to re-evaluate current strategies being used, and also evaluate strategies from other prevention campaigns that seem to be working. An example of an effective prevention campaign is the anti-tobacco campaign, which employed the social norms theory in fighting the war against teen smoking. Anti-drunk driving activists should implement similar interventions, which will hopefully yield comparable results as the anti-tobacco campaigns. With persistence and modifications in current campaign strategies, it is possible to win the fight against drunk-driving fatalities among young adults.

(1)Office of Applied Studies. Traffic Safety Facts 2005 Data. National Highway Traffic Safety Administration. 2005.
(2)Rice, R. Atkin, C. Public Communication Campaigns 3rd Edition: Sage Publications
(3)Adnsager JL., Austin, Pinkleton BE. Questioning the value of realism: young adults’ processing of messages in alcohol-related public service announcements and advertising. Journal of Communication March 2001; 51:121-142
(4)Thombs, D. Wolcott, B. Farkash, L. Social context, perceived norms and drinking behavior in young people. Journal of Substance Abuse. 1997; 9:257-267
(5)U.S. Department of Education. A Social Norms Approach to Preventing Binge Drinking at Colleges and Universities. Newton, MA: The Higher Education for Alcohol and Other Drug Prevention.
(6)Phelps, C. Risk and Perceived Risk of Drunk Driving among young drivers. Journal of Policy Analysis and Management, 6: 708
(7)Murray J. Stam, A., Lastovicka, J. Evaluating an Anti-Drinking and Driving Advertising Campaign with a Sample Survey and Time Series Intervention Analysis. Journal of the American Statistical Association. 88: 50
(8)Jacqueline Saburido’s story:
(9)NHTSA website:

Labels: , , ,


Post a Comment

Subscribe to Post Comments [Atom]

<< Home