Challenging Dogma - Spring 2011

Monday, May 23, 2011

Fear as a tool to promote healthy driving habits - Stephanie Reynolds-Bigby

Scope of the Problem
With nearly 260 million motor vehicles on U.S. streets, it is to be expected that there would be a number of deaths due to motor vehicle accidents in this country each year. (5) However, statistics show that the number of deaths due to this preventable situation is staggering. According to the CDC’s Web-based Injury Statistics and Query and Reporting System, unintentional injuries, including motor vehicle crashes, are among the leading cause of death for 5-34 year olds in the U.S. (1) The 30,797 fatal automobile crashes reported in the U. S. in 2009, resulted in 33,808 deaths. Of these deaths, about half (17,640) were drivers. The rest were passengers, pedestrians, motorcyclists and others who share the streets and highways. (4) In addition, 2.3 million adult drivers and passengers were treated in emergency rooms for motor vehicle related non-fatal injuries that same year. (2) The economic impact of motor vehicle accidents is also notable. In 2005, the lifetime costs of crash-related deaths and injuries for drivers and passengers amounted to near $70 billion. (3)
This problem remains at the forefront of public health efforts because of its preventability. Statistics show that seat belt use in motor vehicle accidents reduces the risk of fatal injuries by about 45% and the risk of serious injuries by about 50%. (6) Seatbelt use is also considered the most effective current intervention available for prevention of fatalities in motor vehicle accidents. (7) However, other interventions such as the use of air bags and motorcycle helmets and institution of minimum drinking-age laws are still known to save lives. (7) Thus, many current public health campaigns aimed at reducing the number of fatalities and injuries caused by motor vehicle accidents encourage the use of these interventions.

Current Initiatives
Current public health initiatives to reduce fatalities and injuries due to motor vehicle accidents primarily focus on seatbelt use, distracted driving, and impaired driving. Other initiatives involve proper use of child restraints, motorcycle helmets, and certain pedestrian safety habits. However, these initiatives address issues that have a smaller impact when compared to the primary initiatives. (7)
The CDC makes recommendations for governments to prevent impaired driving (driving while under the influence of drugs and alcohol). Such current recommendations include using ignition interlock programs to prevent any drivers above a certain blood alcohol content from starting a vehicle, enforcing minimum drinking law ages to reduce access to influential substances, and implementing sobriety checkpoints to actively identify drivers who are under the influence of alcohol or drugs as well as using public media to discourage driving while under the influence. (8) The CDC makes similar recommendations for addressing seatbelt use and distracted driving.
Social media campaigns are the primary means of informing the public of new efforts and enacting change in their behavior. Programs such as the Put it Down campaign against distracted driving, Buckle Up: Click It or Ticket to encourage seatbelt use, and the innumerable social media campaigns against drunk driving all act to inform the public of the efforts being taken by the government as well as to promote a particular ‘healthy’ behavior on the parts of individuals in the public.

Flaws of current practice
Each of these public health campaigns has a social media component that is intended to promote a certain behavior. The primary tactic used to encourage safer practices in motor vehicles uses fear of the consequences to spark change in behavior of motorists and their passengers. The use of fear as the primary motivating factor has flaws that reduce the effectiveness of the campaigns that use it. These flaws can ultimately be grouped as three particular issues: 1- lack of relatability, 2- showing statistics, and 3- telling the audience what to do. Yet, numerous campaigns contain these aspects which have been shown as ineffective and sometimes even counter-effective.
Many public health campaigns are ineffective because the intended audience is unable to relate to the message. In order to appeal to the intended audience, a campaign should take advantage of the similarity principle. This principle states that an individual is more accepting of a message from a source to which he can relate. The similarity principle is based on the idea that an individual can more easily trust a source to which he relates. The development of trust by relating visual or bonding over shared interests, morals, or values makes the use of this principle easily applicable to social media campaigns.
Current campaigns generally use adults or individuals in positions of authority to convey a message of fear of consequences. This is true of almost all campaigns aimed at promoting safe driving habits. Campaigns such as Click It or Ticket and You Drink and Drive. You Lose use police authority to threaten the public with fines and incarceration for not abiding by the law. Implementing fear tactics reduces the ability of the target audience to relate to the senders of the message. Since trust does not develop between the public and the police in these campaigns, the potential effectiveness of the campaign is not attained.
Another method that has been used in multiple campaigns to induce fear and enact change is the presentation of health statistics around the behavior of interest. The presentation of statistics relies on the health belief model. The health belief model suggests that if an individual knows the risks involved in a certain behavior, they will weigh the risks against the benefits and make a decision accordingly. It states that an individual’s health decisions are made based on the individual’s perceived seriousness of the danger, susceptibility to the danger, benefits of the behavior change and barriers to behavior change.
Many current public health campaigns still rely on this outdated model which encourages public health practitioners to inform individuals of their risk of disease in order to elicit a particular ‘healthy’ behavior. Studies show however, that when the behavior of interest is linked to the individual’s self esteem, reminders of risk encourage the very behavior it is intended to change. (9) This is due to the fundamental attribution error that generally occurs. In this instance, there is a de-emphasis of the context in which the behavior occurs and overemphasis on the flaws of the individual’s character. In these cases, the Terror Management Health Model is unintentionally used, reinforcing the behavior.
The use of statistics as a means of discouraging a particular behavior is one way in which the terror management model can inadvertently be used. Many of the campaigns used to encourage seatbelt use, or discourage distracted or impaired driving offer statistics of death and injuries related to these behaviors.
The third major flaw of current public health initiatives to encourage safe driving habits is that they take away the individual’s freedom to choose what behavior is best. Although it may seem necessary for a public health campaign to explicitly state the behavior that it intends to encourage, it often results in the opposite behavior. This is due to the Psychological Reactance Theory that results when an individual feels that their freedom to choose is threatened. In the 1981 study Psychological reactance and the attractiveness of unobtainable objects: Sex differences in children's responses to an elimination of freedom Brehm demonstrated this principle with toddlers by showing two toy options but limiting their access to only one of the toys. (12)
Other studies have shown that psychological reactance can be deflected by increasing the credibility of the message and rewording the message to have an open, positive connotation rather than a controlling, negative one. (11) Informing individuals rather than forcing opinions on them, allows them to choose the behavior in which they prefer to engage. By phrasing the message correctly, the campaign can take advantage of psychological reactance and encourage a particular behavior without infringing on the public’s sense of choice.
The similarity principle can also help to deflect psychological reactance by using a messenger that is similar to the target audience. (10) In this way the message is portrayed less as a loss of freedom and more as a positive social pressure. It is still important that the message have the proper framing in order to limit the loss of freedom.

Overcoming the Flaws
Fear is generally not an effective public health tool. Intimidation and control are two means of inducing fear. Each of the flaws of fear as a public health tactic can be addressed in numerous ways. The examples mentioned previously (using the similarity principle and removing the controlling tone of the message) are ones that should be implemented in every public health campaign to maximize the effectiveness of the campaign. However, other methods exist to correct for these flaws.
In order to make the message relateable to the audience, the campaign should contain individuals who are similar to the target audience. They can share a story that conveys the intended message and that individuals who see the message will be touched by and can relate to. This tactic will follow the similarity principle, but can still show the consequences of the undesirable action.
The flaw with showing statistics is that it can cause terror management in some individuals. This can cause the opposite of the desired behavior as a coping mechanism. In order to avoid this, the campaign can use the exchange principle in place of presenting statistics. Offering something in exchange for the desired behavior removes stress caused by labeling the negative behavior as a character imperfection.
The third flaw, psychological reactance, can be addressed by giving ownership to the individuals who hear the message. This can be done through the proper framing of the message to make it a choice. However, creating a community helps to reinforce the ownership of their decision. This method has been successfully implemented in other public health campaigns such as the movement in Massachusetts called The 84 which is a community of Massachusetts teenagers who choose not to smoke.

An Alternative Intervention
One way to implement all of these new interventions and avoid the flaws of inducing fear, is to create a community, like The 84, for people who choose to practice safe driving habits. For example, the organization can be called How I Ride, and have a website where people can maintain a social network, add their friends or make new ones, be informed about exciting How I Ride events, and purchase How I Ride gear, such as clothing, accessories, stickers, and other enticing trinkets.
In order to gain a strong following, the organization can use members of its target audience to create appealing commercials that encourage members of the public to join the movement. The format of the commercials can be a series of scenes in which each of the members of the community says, “this is How I Ride” and drives off while demonstrating the safe practices. But each individual would have to do something unique that is both appealing to the target audience and safe. For example, one scene can show a teenage boy in a car with his seatbelt fastened and a really attractive girl in the passenger seat, while another shows a teenage girl putting away her cell phone before getting in the car after a fun day at the mall. Similar commercials should also be made to target people in all walks of life: children, young professionals, heads of households, etc.
After the following grows to a certain point, recruitment may no longer be necessary if social pressures encourage those who have not yet joined to open up to these practices. This intervention can be particularly successful in the high risk age group (5-34 years) because of the importance of social acceptance to many individuals in that range.

The use of a new intervention to promote safe driving habits such as using a seatbelt and not engaging in impaired or distracted driving is necessary since a large number of preventable deaths still occur each year. The current initiatives employ scare tactics in an attempt to force the public to adopt these behaviors. Creating an open inviting community where these practices are part of the social norm and individuals have the option to join or not can employ different methods to coerce the gradual shift of these practices from being a stigmatized behavior to simply unrepresentative of the social norm.

CDC. WISQARS (Web-based Injury Statistics Query and Reporting System). Atlanta, GA: US Department of Health and Human Services, CDC; 2010. Available at

CDC. Vital Signs: Nonfatal, motor vehicle-occupant injuries (2009) and seat belt use (2008) among adults—United States. MMWR 2011; 59.

Naumann RB, Dellinger AM, Zaloshnja E, Lawrence BA, Miller TR. Incidence and total lifetime costs of motor vehicle-related fatal and nonfatal injury by road user type, United States, 2005. Traffic Inj Prev 2010;11:353-60.

National Highway Traffic Safety Administration. FARS (Fatality Analysis Reporting System) Data Tables. Available at

Bureau of Transportation Statistics. Research and Innovative Technology Administration. Table 1-11: Number of U.S. Aircraft, Vehicles, Vessels, and Other Conveyances. Available at _transportation_statistics/html/table_01_11.html.

National Highway Traffic Safety Administration. Final regulatory impact analysis amendment to Federal Motor Vehicle Safety Standard 208. Passenger car front seat occupant protection. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration; 1984. Publication no. DOT-HS-806-572. Available at

National Highway Traffic Safety Administration. Lives saved in 2009 by restraint use and minimum-drinking-age laws. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration; 2010. Publication no. DOT-HS-811-383. Available at

CDC. Injury Prevention & Control: Motor Vehicle Safety. Impaired Driving: Research & Activities. Available at

Taubman Ben-Ari, O., Florian, V., & Mikulincer, M. (1999). The impact of mortality salience on reckless driving--A test of terror management mechanisms. Journal of Personality and Social Psychology, 76, 35-45.

Silvia, P. J. (2005). Deflecting reactance: The role of similarity in increasing compliance and reducing resistance. Basic and Applied Social Psychology, 27, 277–284.

Miller, C. H., Lane, L. T., Deatrick, L. M., Young, A. M., & Potts, K. A. (2007). Psychological reactance and promotional health messages: The effects of controlling language, lexical concreteness, and the restoration of freedom. Human Communication Research, 33, 219-240.

Brehm, Sharon S. (1981). Psychological reactance and the attractiveness of unobtainable objects: Sex differences in children's responses to an elimination of freedom. Sex Roles, Volume 7, Number 9,937-949.

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