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.

REFERENCES:
(1)Office of Applied Studies. Traffic Safety Facts 2005 Data. National Highway Traffic Safety Administration. 2005. http://www.drugabusestatistics.samhsa.gov/NSDUH/2k5NSDUH/2k5results.htm
(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: http://www.npr.org/programs/atc/features/2002/oct/texas_dwi/index.html
(9)NHTSA website: http://www.nhtsa.com/

Evaluating The Anti-Underage Drinking STOP Campaign-Vanessa Vazquez

Historically, in terms of alcohol control policies, the Minimum Legal Drinking Age Law (MLDA) has been credited with lowering the alcohol related morbidity and mortality rates in the United States (1). However, MLDA did not eliminate the ongoing problem of underage drinking itself. Underage Drinking continues to be a problem in all 50 states. Not only is underage drinking illegal, but it is also known to pose a threat to the individual and to society (2). Not surprisingly, alcohol is the most commonly used and abused drug amongst adolescents (3). A 2003 research study discovered that, on average, adolescents are 14 years old when they take their first drink (4). Age is of concern primarily because early initiation of drinking has been linked to alcohol consumption problems later in life (3).

In response to the escalating trend of underage drinking in the United States, Congress passed the Sober Truth On Preventing Underage Drinking Act or STOP ACT in 2006. The STOP Act has both federal and state provisions; the federal Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD) was established. The responsibility of (ICCPUD) is to ensure that the states are implementing laws and programs to counter underage drinking. As part of the STOP Act, the STOP media campaign was created to raise adults’ awareness of underage drinking through the use of information pamphlets, meetings, and other forms of advertisement.

The advertising campaign that accompanies the STOP Act shows promise with its focus on raising awareness in the community about teenage drinking. However, the campaign fails, because it relies on a rational model of behavior change, focuses only on increasing knowledge about risks, rather than dealing with the emotional and social reasons teenagers drink, and ultimately targets adults rather than teens.

1. Campaign Assumes Knowledge of Risk Factors Will Prompt Change
The STOP campaign tries to influence adolescent behavior by focusing on their intellect with facts, instead of focusing on their emotions, which can make more of an impression. The campaign uses a myth or fact pamphlet aimed at increasing the perceived risk of underage drinking intended to encourage adolescents to change their behavior. The campaign also assumes that people make rational decisions, not allowing the campaign to account for spontaneous teenage behavior and irrational decisions. Basically, the campaign is using the overused Health Belief model that focuses on behavioral change at the individual level and has been proven to be an ineffective model of behavior change (5). Some known determinants of behavioral change are perceived norms and self-efficacy, however the role of perceived risk is inconsistent to intention and behavior (6).

The STOP campaign further assumes that the causes of underage drinking are at the individual level instead of on a group level. By overlooking the impact of the social environment (peers, community, family) on behavior, the campaign is ignoring the role of others’ beliefs in shaping an adolescents’ own. The best method of sustaining prevention is not only to target the individuals but also their environment (7). Community involvement is also important in creating changes in institutional policies (schools, alcohol establishments, etc.) and public policies with regard to the underage access to alcohol (3).

The ineffectiveness of the traditional Public Health models should serve as a warning to the creators of the STOP campaign, who would be wise to use advertising models to reach their audience. In mass media campaigns, the group is more important than the individual. Considering a broad audience, messages are designed and audience segmentation, or targeting similar people, is ignored to achieve campaign objectives (8). Thus, the STOP campaign should not overlook the adolescents in delivering its campaign message of anti-underage drinking. Instead, the STOP campaign should try to incorporate framing theory, agenda setting theory, and social expectations theory to target teenagers.

According to agenda setting theory, “the media’s agenda sets the public’s agenda” and “the emphasis placed on issues in the mass media influences the priority [given to] these issues by the public” (9). The STOP campaign should use the media to influence what people think about, in this case, the problems facing America’s youth as a result of underage drinking. The STOP campaign can further use the media to put the issue of underage drinking on the public agenda. By doing so, the campaign will gain leverage by reaching out to the community, parents, and students themselves, helping to make everyone aware of the issue. Getting the underage drinking issue on the agenda and making society aware of the problem are the first steps to bringing about change in society.

Once the STOP campaign has made the underage drinking problem known to society, it is now time to target the teenagers themselves through the use of advertisements, such as commercials and print ads. Getting the message out to the public is important, but how the message is framed is what will determine whether or not adolescents will respond to it in terms of behavior (10).
Good framing will target the behavior that needs to be changed, in this case underage drinking, and frame the issue in a way that makes it look unfavorable for teenagers to do. Implementation of good framing will also require the STOP campaign to play on adolescents’ emotions with more images and fewer words or facts. In this arena, public health campaigns need to learn from the advertising industry in order to effectively reach teens.

Another strategy to consider is the use of social expectations theory, which says that people’s behaviors are affected by social norms, values, and roles. This theory defines how people are expected to interact with others in society and how to be integrated in the community (11). The STOP campaign should use this theory to advertise to teenagers that underage drinking is not the norm for people their age. For example, in a possible commercial, the STOP campaign can depict a fun party scene, but when one teenager brings alcohol in order to get the party started, everyone stops and looks at them in disbelief. Incorporating social expectations theory is vital because adolescents are primarily concerned with how others perceive them, which in turn is reflected in their behavior.

2. STOP Campaign Targets Adults Instead of Adolescents
Another flaw of the STOP Campaign is that the campaign is misdirected, targeting adults with the hopes that they will influence adolescent behavior, instead of targeting the adolescents themselves. Previous prevention programs have been successful by incorporating parents and the community, but ultimately targeting teens. One example of a successful prevention program is Project Northland, which is a multiyear youth intervention program. The program was first implemented in Minnesota in 20 school districts for three years from 6th to 8th grade, and was designed to address adolescent age appropriate concerns. In sixth grade, the program focused on adolescents’ skills to communicate with their parents about alcohol (12). Seventh grade education taught students to cope with peer issues and expectations about alcohol. Lastly, eighth grade taught students how to bring about community changes regarding alcohol programs and policies (12). A study later reported that at the end of the three years, when compared to the control communities, those in the intervention community reported a smaller percentage of students drinking or beginning to drink (3). The success of this anti-drinking program can be attributed to the fact that the program was designed specifically for teenagers’ needs during their adolescent years. Not only did the program try to change adolescents’ social environment, but also it allowed the students to be advocates of change by allowing them to write the newsletter “TEENSpeak.”

Another successful multiyear program is SADD, Students Against Drunk Driving or Students Against Destructive Decisions. SADD is an alcohol prevention program that primarily targets middle school and high school age adolescents. Chapters of SADD exist across the country and follow the philosophy “that young people, empowered to help each other, are the most effective force in prevention”(13). Therefore, it is the older SADD students who serve as mentors for younger adolescents in the group. Mentoring is vital to the programs’ success, because it is based on the idea that the most effective source for a message is the audience itself, in this case students educating other students about drinking. SADD also teaches students normative education, changing adolescents’ notions of peer alcohol use and provides peer discussion groups. The literature supports the use of such programs as SADD, stating, “the most effective programs utilize multiple years of behavioral health education, community-wide involvement and mass media complementing the school-based peer-led program” (14). Clearly, targeting teens is essential if the STOP campaign wants to promote behavioral change.

The STOP campaign’s insistence on targeting the parents of adolescents is ineffective because it ignores teenagers’ autonomy to make their own choices free of their parents’ beliefs. As stated before, the social environment does play a role in adolescents’ beliefs, but parental disapproval of drinking is not a key reason why teens abstain from alcohol (12). What the STOP campaign must consider is adolescents’ self-efficacy, or their confidence in being able to refuse the offer of alcohol and abstain from use. According to Bandura, it is perceived self-efficacy that influences behavior, from initiation of a new behavior to inhibition of another (5). One way to improve self efficacy is to change adolescents’ perceptions regarding their peers’ use of alcohol, making it known to them that it is not normal for kids their age to drink. By changing the adolescents’ norm perception, it will empower them to refuse alcohol, because they are not the only ones not drinking. The changing norm strategy relies on the value adolescents place on what others do and in turn how they are perceived.

Changing social norms, however, needs to involve parents of adolescents and, most importantly, how the parents perceive alcohol. Most adolescents report having been given alcohol by an adult or relative (15). Adults given adolescents alcohol might be explained by the fact that alcohol does not carry with it a social stigma like tobacco does, making it seem acceptable even for minors (1). Also, approval of underage drinking varies across households, primarily due to the difference in cultures and their acceptance of alcohol (15). Some cultures, such as the Hispanic culture, allow their children to drink wine at family functions or family dinners in order to share with the rest of the family. Cultural differences should not be shunned, but taken into consideration when planning alcohol prevention campaigns for youth in order to reach the broadest possible audience.

3. Interventions Will Be More Effective If Underage Drinking Is Viewed As a ‘Developmental Framework’
According to the Surgeon General, public health interventions will be more effective if they look at adolescents’ underage drinking through a “Developmental Framework” approach. The Surgeon General encourages campaigns to take a multifaceted approach to solve the underage drinking problem by focusing on adolescent development. Adolescence is a time when kids transition from childhood to a pseudo adulthood stage, in which time they are made to cope with ongoing biological changes, social changes, and behavioral changes. In the quest to find their identity and place in society, adolescents are known to increase their sense of risk taking in order to further state their independence. Research shows, that the puberty stage itself, or the shift to adolescence, has been associated with alcohol use (4). The brain, in particular, at this time begins remodeling itself and continues well into the twenties. The creation of new connections between nerve cells, and the pruning of some existing connections can in turn affect an adolescent’s impulse control, planning process and decision-making (16). Social changes will also occur, during which adolescents are placed in unfamiliar situations due to their peers, and since they lack experience, they often make unhealthy decisions. The STOP campaign should try to counter unhealthy decisions by educating teens about the changes they are undergoing and building their self-efficacy to resist making risky decisions.

Not only are teens likely to drink because of the changes they are undergoing, but also alcohol itself appears to have a different effect on adolescents than it does on adults. As a result of the brain’s remodeling, how adolescents respond to alcohol is altered as well. Studies have shown that adolescent memory is greatly affected and this cognitive impairment is lasting (16). Adolescents are also able to consume larger amounts of alcohol because they are able to stay awake longer and be mobile at higher blood alcohol levels as opposed to adults (4). The most common reason why alcohol has a different effect on teens than adults is because adolescents expect the positive effects of alcohol in social situations in order to have a good time and it is because of this ideal that they are inclined to drink more (4).

Identifying factors that predict alcohol use are not enough to change behavior. The STOP campaign should deal with the reasons why teens drink. The social environment, in particular, peer influence due to perceived norms of the American culture, might explain underage drinking. Adolescents want to be accepted by their peers and if they think that others are drinking, they want to do it too. However, adolescents’ perception of the quantity of drinking their peers do is skewed primarily because they overestimate the drinking habits of others (16). Overestimating is a problem because adolescents want to be like their peers and try to drink as much as they think their peers are drinking. The STOP campaign in this case should implement a social norming ideal to correct the misconceptions of adolescents regarding peer drinking. The Northland Project succeeded in this arena. By the end of the 8th grade, those in the intervention district had lower scores on the Peer Influence Scale (12).

Other reasons why teens might drink are because of their upbringing, its easy access, and the expectancies that teens have regarding alcohol. Beliefs regarding alcohol are established early in life. The positive expectancies that adolescents place on alcohol such as sociability and sexual attractiveness make drinking a pleasurable experience (16). Common sense indicates that those who associate alcohol with a pleasurable experience are more likely to drink. The most common reason teens gave with regards to drinking is because they enjoyed it and it got them in the “party mood” (14). Wanting to get in the “party mood” again plays on the notion that social acceptance influences teens’ behavior making them want to be perceived as cool by their peers. Easy access to alcohol makes adolescents not think twice about drinking, because no one is stopping them (1). Adolescents can get alcohol from adults or relatives in their families, older siblings, and older peers. These enablers do not think what they are doing is harmful to the adolescent, because they just see it as a way to help the teen out. In the college culture it is seen as, when I was underage an older peer bought me alcohol, thus, when I am of age I will do the same. Some bold teens even use fake IDs to purchase the alcohol themselves. The consequences of getting caught do not deter the use of the ID. On the contrary, students just try harder to avoid getting caught (1).

An adolescent’s upbringing is one factor that might affect their belief regarding alcohol. Family disruption, conflict, low parental supervision, and being a child of an alcoholic are factors that are well known to influence alcohol use among teens (17). These teens might see alcohol as a coping mechanism to deal with their less than picturesque life, of which they are victims.
If the STOP campaign seeks to address all the issues influencing a teen’s choice about alcohol use, a media campaign alone is not going to solve the problem. Instead, a multiyear prevention program will have to be considered to give adolescents the foundation to change their perceptions and encourage the community to realize that underage drinking is harmful to America’s youth.

Implications
By not addressing many of the previously mentioned factors, the STOP campaign will fail. Thus, future research needs to be done regarding other prevention methods for teen drinking. Incorporating Social Expectation theory to change existing norms in the community is one way to sustain behavioral change (18). Normative re-educative strategies should also be implemented to reinforce the fact that most teens do not use alcohol. Realizing that underage drinking is a group level problem, parents, the community, and the government need to act to change the escalating drinking trend among teens.

The community can try to incorporate the adolescents and make them feel useful by engaging them in positive activities such as volunteering, participating in local functions, and by creating more youth hang out venues (17). The government can set new underage drinking laws that will further enforce the STOP Act Law in local communities. If enough resources are devoted to the enforcement of the new policies, underage alcohol consumption will be reduced (1). State enforcement can be ensured if the government penalizes the state for not controlling underage drinking by threatening to withhold state funding.

Conclusions
Underage drinking is a national problem that has been escalating over the years, and an effective public health intervention is well over due. After considering all the reasons why teens drink, from the biological changes to the social factors, it only makes sense that the most powerful prevention programs will be those that implement a multiyear approach that can address adolescents’ changes first hand, much like Project Northland. Other public health campaigns should take this information and use it when creating alcohol prevention programs and anti-underage drinking media campaigns in order to target teens effectively. The STOP campaign cannot be expected to make an impact if it is just delivering a message to parents and then letting them fend for themselves. The STOP campaign must focus on their target audience, the teenagers, not their parents. Also, the STOP campaign will not change behavior simply by increasing knowledge of risk through a 3-minute media clip and a pamphlet. Behavioral change can only come about through a lengthy process of helping individuals change, by changing their belief system, and, ultimately, sustaining this change by altering social norms. Encompassing all these attributable factors is a whole system approach that looks at underage drinking as a “developmental framework.” The STOP campaign is failing, because it relies on a rational model of behavior change, focuses only on increasing knowledge about risks, rather than dealing with the emotional and social reasons teenagers drink, and, ultimately, targets adults rather than teens.

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Hyperlinks
1. http://pubs.niaaa.nih.gov/publications/aa59.htm
2. http://pubs.niaaa.nih.gov/publications/AA67/AA67.htm
3. http://eric.ed.gov/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/13/d6/9e.pdf
4. http://www.sadd.org/value.htm

But What About The Binge Drinkers? How The Social Norms Campaigns Fail To Change Binge Drinking Behaviors On College Campuses. –Jackie Harvey

Binge drinking on college campuses is a matter of national concern (1). Despite many traditional public health attempts to change college student binge drinking behavior (2-3), the problem persists (4-5). Colleges began to adopt social norms campaigns to curb binge drinking en mass after research by Perkins and Berkowitz showed that students’ perceptions of alcohol consumption on campus presumed a higher level of consumption and higher rates of permissive attitudes towards substance abuse (6). The researchers suggested that correcting these misperceptions might reduce heavy drinking. The social norms campaign incorporates the social sciences and mass media to ensure that students have an accurate perception of the presence of alcohol consumption on campus. The theory behind the campaign is “the revelation of accurate information about the environmental context—in the form of group or population norms—to reduce individual problem behavior and enhance protective behavior (7).”
Colleges that adopt the social norms campaign are attracted to the very low cost-to-results ratio (8). In most programs, on-campus advertising is by far the largest expense (6). Research demonstrates the high efficacy of a mass-marketing campaign in changing students’ misconceptions of the rate of alcohol consumption on campus (9). In fact, there is little opposition to the findings that show a change in the students’ perception of alcohol consumption. Rather, the oversight with this intervention lies in the reduction of actual binge drinking on campus.
Changing Perception Does Not Change Behavior
The campaign incorrectly assumes that a change in binge drinking behavior is directly related to a corrected perception of the level of binge-drinking on campus. Additionally, research has indicated that students, specifically those in large universities (where the social norms campaign is touted as most effective), are not influenced by the behavior of the entire campus, but rather, their own smaller peer group (10). Furthermore, a campaign that seeks to reeducate students by showing that the rate of alcohol consumption on campus is actually lower than initially perceived runs the risk of normalizing underage alcohol consumption within the target population. Proponents of the social norms campaign are excited by the low-cost, high-results promise of correcting student perceptions, but colleges fail to realize that the campaign must be part of a larger, comprehensive program—not simply used to pacify parents worried about increasing binge drinking statistics on campus. While the social norms campaign succeeds in providing the truth about alcohol consumption on campus, it fails to significantly change the behavior of the target population- binge drinkers-on campus.
The goal of the social norms campaign is to use mass media efforts to correct the misperceptions of the level of alcohol consumption on campus. In theory, by correcting the perceived level of consumption, the students then would be less likely to feel supported in their binge drinking habits and/or would refrain from using their peers as a justification for increased alcohol consumption. However, an analysis of this behavioral model quickly shows that the correction of perceptions does not always directly link directly to a correction of behavior. The theory of reason action (11) shows perceived social norms and attitudes towards behavior directly affecting one’s intentions which, in turn, directly affect behavior. However, a main criticism of the very traditional theory of reasoned action is that intentions do not directly lead to behaviors (12-13).
Applied to a college setting, a student may be fully aware that the average number of drinks consumed per weekend night is actually only four drinks thanks to the social norms campaign advertising. She may therefore decide that she will not consume more than four drinks herself while getting ready to go out with friends on a Friday night. That is, of course, until there is a cute boy at a party who offers her a fourth…and then a fifth drink, which she gladly accepts. In this student’s case, behavior was not entirely reasonable- she did not need to consume the drink in order to gain the boy’s attention, but decisions are not always well reasoned! Another example of the disconnect between intention and behavior is the social cultures on college campuses. Despite an intention to remain sober on a weekend night, it is very likely that much of the social scene revolves around parties that have a lot of alcohol and other students drinking. Rather than stay in on the weekend, a student may find his or herself out with friends that insist on going out to parties on the weekend. Again, the student intended to remain sober, but the behavior was the result of a poorly reasoned belief that s/he must drink to maintain certain friendships, resulting in a weekend of binge drinking. There is significant research to support the lack of a connection between intent and behavior in young adults (13)
Not All Students Misperceive Consumption Levels
On many campuses, there is no misperception of the level of alcohol consumption on campus (14). In fact, campuses with more accurate perceptions of alcohol consumption had more drinking than campuses with less accurate perceptions (15). In these cases, according to the Social Norms institute, “if the needs assessment indicates that a campus has very few binge drinkers and/or those students do not misperceive the campus norm,” then the social norms approach would not be effective. Despite these statistics, the social norms marketing campaign is by far the most popular anti-drinking campaign on college campuses. Even in schools where the students are fully aware of the drinking habits of their peers, administrators fall back on the campaign.
Few Schools Succeed with Social Norms Alone
The National Social Norms Institute cites only six institutes of higher education in which there has been a change in alcohol consumption after the implementation of the social norms campaign. In several of these schools, the behavior change may be attributed to other programs used in conjunction with the mass media approach implemented by the social norms campaigns. Many schools that tout the social norms marketing on campus do not have any data to support its efficacy on campus. After investigating their elaborate social norms website, I contacted Southern Methodist University (SMU) in the hopes that they would have some insight into the success of their extensive campaign (16). The administration commented that there was no data available at the time, and, that there was no evidence that the levels of drinking have decreased on campus during the time of the program.
The failure rate of the social norms campaign in schools is unknown, since many schools, such as SMU do not perform follow-up evaluations of the program. Many articles have explored reasons for failures at particular schools, citing poor implementation of the program (17). A major study in 2003 sought to perform a national evaluation of the social norms marketing programs but did not detect a decrease in alcohol consumption (10).
Individual Peer Groups Are Most Valued
I challenge that the program is not suitable for the vast majority of schools in reducing the level of binge drinking. Young adults are not affected by what their peer group as a whole does in college. Why would one student out of 15,000 care what the average student consumes during one weekend? The first response would be “surely those numbers don’t refer to me and my friends.” Students are influenced by their own, smaller peer group (sports teams, sororities, organizations) far more than statistics about the school as a larger entity. Peer group influence over behavior is evidenced in the social networking theory, which explains that the most important predictor of behavior is what is happening in your own social network.
Research into the effect of the social norms campaign on specific campus groups shows that the reductions of the level of drinking in Greek members is very slight (18). Not only do Greeks have a reputation for high levels of alcohol consumption, but on many college campuses, Greek organizations have a huge impact on the social lives of the students.
By targeting the Greek organizations themselves, college campuses could be much more successful in changing student attitudes about drinking. Not only are Greek organizations powerful campus figures, they are also upperclassmen. Targeting older peer leaders to serve as role models would be significantly more effective. A 2003 study by Campo et. al found that drinking behavior was related to perception of friends drinking, but not to the campus norms. The research indicates that drinking behavior is “positively related to perceptions of friends' drinking as suggested by the theory of planned behavior, which emphasizes subjective as opposed to social norms” (19). The social network theory provides an explanation for the usefulness of targeting Greek upperclassmen in order to reduce the level of drinking. The social network theory also predicts behavior, not intention— a model that can predict a behavior of sobriety is far more effective than a model that can predict intention but not behaviors.
Reliable Sources are Key
In addition to believing that statistics refer to those outside of their own peer group, communication theory explains that the target population (college students) must be able to trust and have confidence in the source of the information. The social norms campaigns survey students in class in order to ensure participant in the study (6). However, what are the odds that students that have been drinking heavily are up in time for class the next day, much less willing to fill out a survey? Are students able to trust information that comes from the school administration? If the students do not believe that the information is reliable, their perceptions will not change.
Unintended Concequences
Similar to peers, students are affected by marketing. The social norms campaign is founded on the theory that mass media can change students’ perceptions of drinking on campus. However, what other perceptions are the media blitz changing? Social marketing can normalize underage drinking by advertising what most students are doing, not what they should do. Messages posted around campus advertise that having a ‘few’ drinks is normal, but five drinks is not. This type of advertising would be like putting up posters in a middle school saying that “most of your friends smoke three cigarettes per day, not twelve, like you think!”
In “A Social Norms Approach to Preventing Binge Drinking at Colleges and Universities,” a major limitation listed is that the social influence methods “may be ineffective or have minimal impact” (18). In fact, the guide shows that promoting a non-normative behavior such as drinking alcohol on a college campus, regardless of the legal status, may be “counterproductive and unintentionally reinforce the actual drinking norm.”
Even more telling is that the alcohol industry, including Anheuser-Busch, is a large financial backer of the social norms campaign on college campuses. The social norms campaign provides an easy venue for the alcohol industry to downplay the seriousness of the campus alcohol problems while continuing to provide an image of concern towards underage drinking. The campaign is not implying that students should stop drinking—simply that their peers may not drink quite as heavily as once thought.
Another aspect of the oversights of the social norms campaign involving the link between intention and behavior is the accessibility of alcohol on college campuses. An awareness that fewer of their peers binge drink than one originally perceived does not change the students’ access to the alcohol. One suggestion to preventing binge drinking is to implement a physical barrier between the students and the alcohol, such as an increase in monitoring liquor store sales, or preventing marketing campaigns from targeting college students.
More rigorous research is needed to put social norms marketing to the test, but the evidence to date has been encouraging. The social norms campaign should be commended for its new approach to solving public health problems. The campaign went beyond simply restating problem behaviors or positing what are believed to be good prevention practices, to documenting effective prevention results. Finally, social marketing campaigns need to be viewed in context, as part of a comprehensive approach to prevention (20). Campus and community officials have other means of clarifying for students that underage drinking is against the law. One approach would be stricter enforcement: undercover operations to catch retailers who sell to minors; parental notification when students break the rules; prosecution for using fake IDs or purchasing alcohol for minors. In essence, a social norms campaign, by making clear that students don’t have to drink heavily to fit in, can serve to decrease normative pressure to break the law against underage drinking.
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