Challenging Dogma - Spring 2008

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

Friday, April 18, 2008

DARE To Keep Kids Off Drug Abuse Resistance Education: Misusing The Health Belief Model--Harlyn Sidhu

The Drug Abuse Resistance Education program, commonly known as DARE, was created in 1983 by Los Angeles Police Chief Daryl Gates as an educational measure to combat drug use in accordance with the United States “War on Drugs” (1). In this zero tolerance program, elementary, middle, and high school students pledge to refrain from using illegal drugs, obtaining tattoos, or participating in violent acts of bullying, crime or graffiti, all of which are treated as equally dangerous. At the present time, 80% of school districts in the United States and 54 countries use this lecture-based program to educate students about the risks surrounding tobacco, inhalant, alcohol and drug use, as well as the role of peer pressure in influencing such behaviors. The DARE program uses law enforcement officials as instructors, who undergo 80 hours of basic training to teach elementary school students, and 40 hours of extra training to reinforce the basic training to high school students (1). While the program appears to have well-defined goals and motives, numerous studies (35-39) have demonstrated that it is ineffective at curbing substance abuse within the target populations. Specifically, these studies have demonstrated that the percentage of DARE graduates who admit to abusing drugs or participating in violent acts is not significantly different than those who have not participated in the DARE program. The failures of the program can be explained due to deficiencies at the individual, group, and societal levels. By overlooking individual, social, and societal factors that influence one’s behavior, the DARE program fails in its mission to keep children and young adults from using illegal drugs or violence.
The Unpredictability Of Irrational Behavior
DARE incorrectly presupposes that one’s actions are driven by sound decision-making; yet, in reality, individuals often find irrational ways to rationalize their behavior. Derived from the Health Belief Model, the DARE program assumes individuals logically weigh the costs and benefits of a particular health behavior when making a decision. This sense of balance allows one to rationally determine the intention of one’s acts, which is ultimately utilized in the implementation of an expected behavior. Oftentimes though, individual emotions impede such rational decision-making, specifically as epicurean pleasures are known to infiltrate one’s thought process. Such hedonic decisions may sometimes be rooted in logic, such as when one desires the effects of self-medication (30), but they may more frequently be irrational. When provided with time for deliberation, one is more likely to use logic in making his/her decision. However, when pressed for time, it has been proven that one will rashly choose what will provide him/her the most pleasure (2). More specifically regarding the DARE program, if an individual, specifically an adolescent, is given the time to consider the various costs and benefits of going against the program’s curriculum, the costs will most probably outweigh the benefits. Most adolescents, however, are not given the opportunity to reflect over such choices, as such scenarios typically occur without warning. In such cases, the adolescent may make an irrational decision regarding his/her behavior, as external factors not accounted for by a program based on the Health Belief Model may also bias one’s decision.
Furthermore, the passage into adolescence provides one with a sense of autonomy, specifically when making decisions surrounding personal health (3), such as physical health, i.e. dieting and exercise, or sexual health, i.e. abstinence or use of protection when engaging in sexual activities. The DARE program assumes that adolescents possess the ability to make rational decisions even when provided with the time needed for deliberation. Yet, one’s personal choices surrounding rational decisions are often related to one’s own personal morals and surroundings. Because morals are learned, they can also be influenced (4), as demonstrated through both the social network theory and the social learning theory. If an adolescent’s knowledge is only limited to the DARE program, which treats all substances as equally harmful, one may see, for example, a friend or family member socially drinking an alcoholic beverage and notice that the friend/family member appears to be in control of him/herself. The adolescent may then be provided with something much more harmful than alcohol, such as cocaine, and impulsively decide to try this more dangerous substance. While this scenario may appear to be unlikely, if one is only provided with the information presented by the DARE program, then one may make an extremely detrimental choice simply because of his/her rashness allowed the benefits to outweigh the perceived costs, which were thought to be minimal by the individual (34).
Complying With Social Influences
The above scenario not only displays the deficiencies present in the DARE program at an individual level, but it also demonstrates how social factors also influence one’s decisions regarding their actions. The adolescent may have been presented the cocaine at a social function, and feeling pressed for a decision, he/she may have attempted to conform to social expectations in order to maintain his/her own pleasure in feeling accepted. According to the social network theory, group actions often dictate individual behavior, however irrational they may be. The DARE program, completely overlooks such cultural, environmental and social pressures (15), simply providing its simple slogan, “Just Say No”, as the all-encompassing solution.
By solely following the traditional Health Belief Model, the DARE program fails to account for the influence of social networks on its target population. Many studies demonstrate that social networks, particularly those based at home and in school, influence adolescent decisions surrounding substance use (12, 14, 18). Adolescents often look to both family members and friends role models. As adolescents model their behavior through observation of such role models, those whose social networks engage in substance use are more likely to imitate such actions (30), while those who possess greater social support will be less likely to use such substances (14). In regards to one’s familial social network, both parental and sibling drug use are genetically and environmentally associated with higher drug use in children (24, 30). Specifically, children of parents who partake in substance use are likely to be dependent on such use, or even display certain behavior disorders (17). Difficult family conditions, such as lack of parenting or socioeconomic challenges, also increase youth drug use (26). Moreover, one’s social network at school also greatly influences one’s behavior, as, outside of the home, the majority of the day is spent on school grounds. In fact, adolescents look to their peers as their most influential source for choosing to participate in health-risk behaviors (3); hence, adolescents whose friends use drugs are more likely to also partake in such behaviors than those whose friends do not use such substances (15). In various studies, the perception of peer substance use not only caused non-users to start using drugs, but it also resulted in an increase in use by current users (7). Furthermore, adolescents who were part of networks that favored drug use also increased their own use after they underwent lecture-based prevention curriculums such as DARE (20). Rather than encouraging students to resist such pressure, the DARE program neglects to consider social factors and attitudes that influence drug use and violent behavior.
With regards to one’s peer group, it is important to note that peers normalize drug use for adolescents (7). Although one may intend to avoid drugs, one is extremely susceptible to peer pressure, specifically as an adolescent and will most often allow others to influence one’s behavior during that time of life. The DARE program fails to address peer pressure and attitudes, instead looking to intention as the most influential factor on behavior outcome. The program does not even include current users; in essence, the program condemns such adolescents, prohibiting them from signing the DARE pledge of abstinence from substance use and violence. Yet, these students are the peers that introduce and exacerbate the drug use of other adolescents (7). In this instance, the DARE program stringently ignores such social attitudes through its simplicity. Such an outlook effectively alienates the impressionable adolescents the program hopes to reach.
Normalizing Behavior Through Societal Factors
The DARE program also neglects to account for societal factors that reinforce the negative health behaviors the program condemns. Specifically, society’s use of repetition and propaganda normalizes negative health behaviors condemned by the DARE program. With regards to these societal factors in particular, the social learning theory model demonstrates that each individual establishes his/her behavior on the unique societal influences surrounding him/her throughout life (16). This theory accounts for irrational behavior by demonstrating that, oftentimes, repetition and propaganda, as those illustrated through popular media sources like movies, magazines and the Internet, may influence and subsequently prevail over one’s intention to carry out a certain behavior. For example, adolescents are exposed to explicit references regarding substance use approximately 84 times a day through music (6) and watch about 3 to 4 hours of television daily even though more than 60% of television programs contain violence (33), These allusions are met positively by youth (6), thus bringing such behaviors into the mainstream. Additionally, while Internet sites such as Facebook and MySpace mainly serve as a means for social networking, they are increasingly being used as forums for Internet harassment. One such instance, which occurred in November 2007, resulted in the suicide of a 13-year-old girl (31). The popular video sharing website, YouTube, has also become an avenue for cyberbullying (32). Although many are knowledgeable that such sites exacerbate negative behaviors, adolescents are increasingly using these webpages day by day (32). Even popular movies regularly depict negative health behaviors, including smoking, intoxication, and drug use, in a positive light, as is demonstrated through a 2005 study analyzing the top 200 films chosen by the American Film Institute; in this study, only one in four movies analyzed included behavior condoned by the DARE program (27). Furthermore, many magazines, TV shows, and websites glamorize the risky behavior of celebrities, many of who serve as idols for a countless number of adolescents. Although mass media reinforces negative health behavior in individuals, the DARE program fails to acknowledge the importance of such societal factors in influencing one’s behavior.
Overall, adolescent behavior is influenced by many factors, the majority of which the DARE program disregards. Many school-based programs that solely utilize didactic learning, such as DARE, fail because they are not based on quantitative analysis of the pressures facing adolescents (21). Interestingly, even after pledging to follow the DARE curriculum, many adolescents still use the substances prohibited by this program. (10). For example, a study looking at intervention and control of cigarette, alcohol, or marijuana use during 7th grade 1 year after and 5 years after implementing the DARE program demonstrates that the curriculum effects of the program decline with time (8).
Additionally, DARE incorrectly assumes standardized behavior among all adolescents. The most effective programs for adolescents, which are comprised of individual, social, and societal components, promote age appropriate personal and social growth and knowledge that can be tailored to each adolescent (9). Such programs successfully achieve their purposes because they are directed at normative perceptions (7) and implemented through one’s social groups (20). Furthermore, because of its zero tolerance policy, DARE is essentially an abstention program; yet, as demonstrated through abstinence in relation to sexual activities, indoctrinating adolescents about the relationship between their behavior and the program may prevent them from currently participating in such behavior, but they will be less cautious once they do begin the behavior (11). Hence, abstinence, which is the central theme of the DARE program, is not realistic, and a more focused program explicitly targeting different primary risk factors is necessary to combat these negative health behaviors.
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  • At May 1, 2008 at 7:02 AM , Anonymous PAB said...

    I think that the "Just Say No" slogan makes it sound like not doing drugs is simple. For adolescents saying no is not something you "just" do.

    I enjoyed the seminar discussion of this topic. I agree that the timing of this intervention does not take into account the specific needs of different communities. The program may be needed in elementary in some areas and not until junior high in others.


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