Failure of “Above the Influence”, an Anti-Drug Campaign – A Critical Analysis - Yash Mehta

In 1998, the Office of National Drug Control Policy (ONDCP) launched the National Youth Anti-Drug Media Campaign, the largest of its kind with the overall goal “to educate and enable America’s youth to reject illegal drugs, to prevent youth from initiating use of drugs…and to convince occasional users of these…to stop using drugs” (1-3).

Initially designed as a five year-one billion dollar campaign the movement continues to this day and has been subject to a lot of critique (4). The use of brand in the NYADMC for teens first took shape as “My Anti-Drug,” which entailed messages encouraging youth to avoid drugs. In 2005, the NYADMC was rebranded “Above the Influence (ATI)”, a brand that incorporates greater information about the social influences, exposure, and pressures that may play a critical role in the initiation and continuation of adolescent drug use (5).

The “Above the Influence” campaign reaches out to adolescents via an official online website (www.abovetheinfluence.com), a collection of television commercials, and magazine commercials which were all designed to make teens in America more aware of which factors most strongly influence the decisions they make (6). The campaign also claims to reflect what teens nation-wide have reported is going on in their lives regarding peer pressure, stress, and self-control (6). However, despite the “Above the Influence” campaign’s attempts and efforts to minimize drug use among the American youth, ample evidence supports that the campaign has been ineffective and perhaps even counterproductive, “leading those exposed to an increased perception that others use marijuana” (7).

“Above the Influence”, an improved version of the original ‘My Anti-Drug’ campaign hasn’t produced the projected results; according to the results of the 2009 Monitoring the Future survey indicate that 15.7% of eighth graders, 32.3% of tenth graders, and 42.0% of twelfth graders reported lifetime use of marijuana. In 2008, these percentages were 14.6%, 29.9%, and 42.6%, respectively (8). One of the main reasons why “Above the Influence” campaign didn’t work was because of its combined reliance on Cognitive Dissonance and the Health Belief Model. These theories have received major criticism over the years and have not been able to accurately predict predicting or controlling people’s behavior (9). Another major flaw of the campaign is that it sends out are negative and mixed signals, the campaign focuses on the harmful effects of marijuana and alcohol use (both used excessively) and tries convey the message in a very cryptic way, which doesn’t help too much. Also, the prime gaffe they make is telling kids who are under the influence, ‘what to do’, which according to the Psychological Reactance theory is the biggest mistake public health campaigns make (10).

Research proving the campaign failed

Westat conducted a large study from 1999 to 2004 which looked at reported changes in attitudes, beliefs and behavior of parents and children with regard to drug-usage and compare these with self-reported measures of media exposure. They also wanted to investigate what kind of an association existed between the attitudes and beliefs held by the parents as compared to those of their children and look at what changes might be prevalent on the basis of the “Above the Influence” campaign. The study finally examined the effects of the campaign by comparing groups of people with high exposure to groups with low exposure to the commercials (11). They collected data longitudinally from a group of participants and assessed whether a relationship existed between usage of drugs and exposure to campaign advertisements and if there was any effect of the latter on the former. Their results showed that when non-drug-using youth in America were exposed to the “Above the Influence” campaign, “greater exposure to the campaign was associated with weaker anti-drug norms and increases in the perceptions that others use marijuana” (11). They found that there was a positive relationship between campaign exposure and the resulting effects on parental beliefs and attitudes; however it did not correlate with affecting the attitudes, beliefs or behaviors of the children. Their reported, thus suggested that the “Above the influence” campaign had been counterproductive. Houston also refers to campaigns within the White House’s Offices of National Drug Control Policy such as the “Above the Influence” campaign as “wasteful, misleading, and ineffective anti-marijuana campaigns” (12). With all the converging evidence proving that this campaign has only been flawed and not useful for the context in which it was meant to affect the behavior regarding drug use, it is important to look at different ways to reform the same campaign and recognize the pitfalls and work on improving them to make a stronger campaign that will reach out to the intended consumer and bring about the desired change.

Why did “Above the Influence” campaign fail?

Use of wrong theories

Among many other reasons, the reliance on the combination of the Theory of Cognitive Dissonance and the Health belief Model has been a reason in the failure of the “Above the Influence” campaign. While the Theory of Cognitive Dissonance forms the basis of the television and the advertising through various media, the online site lays its foundation on the Health belief model.

Leon Festinger, created the Cognitive Dissonance Theory. This theory states that when a person’s attitude is different from his behavior about something, there is a state of dissonance. This dissonance causes the person to either change his attitude or his behavior to reduce that dissonance. To try and understand this dense statement, we should know that Festinger believed that deep in their psyche, humans needed to be in line with their attitudes and behaviors. We humans want to be unified in “thought and action”. When we counter disharmony or inner conflict between what our beliefs we strive to decrease this tension by either “changing our original thought, giving strength to the opposing thought, or letting go of the behavior” (13). On these lines the current commercials are not promoting a product but rather trying to encourage a behavior change, instead of an attitude change.

The main mistake the campaign makes is that while trying to sell the idea of ‘not doing drugs’ and to make a child take the right decision of choosing to remain sober, they create confusion and vaguely even de-motivate the child from changing his behavior and adapting an attitude change.

The Health Belief Model is psychological and attempts to predict and explain human health behaviors by focusing on an individual’s attitudes and beliefs (14). According to the Health Belief Model, an individual’s health behavior is motivated by four factors: perceived susceptibility (of a health problem), perceived severity of the potential health problem, perceived benefits of an action, and perceived barriers of taking that action (15). One of the biggest problems with the HBM theory is that it primarily focuses on individual decisions and doesn’t address social and environmental factors. What HBM assumes in an internal, rationale process where individuals assess their degree of risk and make a cost-benefit calculation about whether or not to engage in certain behavior, for e.g., intake of alcohol or drugs (16). But these behaviors will vary based on different kinds of information, motivation, interpretations made and the maturity of the individual. For example; a teenager’s intake of alcohol or drugs even after knowing the harmful side effects does not explain the Health Belief Model (16). This is where HBM fails miserably. In reality, it has been observed that people behave in predictably irrational ways and make decisions spontaneously (17). HBM fall flat in addressing to a larger population because it pre-dominantly focuses at an individual. The website of “Above the Influence” campaign is pre-dominantly based on the health belief model. The website provides an individual with all the information about alcohol and drugs and also schools them in the adverse effects of all these drugs. The website goes to the extent of mentioning the street names of all these drugs, which is not of the better things about the website.

A failed ad-campaign

Many of the messages designed by “Above the Influence” (such as the commercial where the girl who is high has a dog that talks to her, and begs her to quit using ), seem to be aimed at middle school aged youth. Talking dogs and flattened people are not realistic, and savvy teens know this and see these commercials as yet another scare tactic commercial, such as the egg “and this is your brain on drugs ” commercial from a decade ago (18). In order for these commercials to be effective, they should not exaggerate the truth, because when they do, they are alienating their target audience.

The Pete’s couch commercial shows three boys sitting on a couch, one of them starts talking into the camera. As the commercial progresses the back drop keeps changes according to the subject the boy talks about.

“I smoked weed and nobody died. I didn’t get into a car accident; I didn’t drown in some swimming pool, I didn’t OD on heroin the next day. Nothing happened. The boy describes how he felt like Pete’s couch is safe and he isn’t really going to die on it. Also, he says how it keeps you safe from the truly scary things out in the world, those being simple pleasures of life like playing with friends, or taking a girl out. But, instead you choose the safe way out. He ends it with saying that he smoked weed but did not die, but in the bargain missed out on the actual important things in life (19).

Again, the problem with this ad is that teens will counter act saying that they love this feeling of sitting on the couch and being in trance. They might react by saying this ad doesn’t apply to help because they are not frequent users of these drugs. Some teens more experienced users might say that those eleven hours are the best of their lives (20). ‘Take my chances in the real world’ gives rise to an instant feeling of poetic sarcasm (which makes me smile), but it doesn’t really strike as something that would make someone not do ‘weed’. The logical reaction by any non-frequent user would be that there is enough time to play basketball and ice-skate even after wasting those eleven hours. But then again, eleven hours is a little too extreme, isn’t it? Also, some might find their freedom to choose under threat and hence react by doing just the opposite i.e., doing weed (21).

The "Stage Hands" commercial is the one where most of the people at a party are attached to strings and some music starts which causes all of the stringed people to dance while a few who aren't attached to strings watch. Then all the dancers fall to the ground and the commercial ends with the logo and website address (22). Again, even in this commercial tries to show such radical effects of drug/alcohol intake that it is almost unbelievable. From a creative point of view the commercial does make a lot of sense, but these commercials are made to manipulate, force or motivate teens out of something they find ‘cool’ and ‘relieving’; intake of drugs and alcohol. Also, this might lead to psychological reactance, and motivate teens to intake drugs only to prove a point; that they are not like the puppets shown in the commercial. At the end of the ad after all the so-called under-influence ‘stage-hands’ fall down leaving only four people (presumably not under the influence of drugs), a voice says “If you are not in control, who is?” This could also be interpreted as “if you are not under the influence, you might be left alone, because everyone is doing it!”

Website gone wrong

A third example of a mixed message sent out by “Above the Influence” is their list of reasons why people do drugs, which can be found on the campaign’s website (23). This message is counterintuitive in that teens are being told not to use drugs, yet they are being bombarded with reasons why people their age are using drugs. If teens are on the website and come across this long list of reasons, even if the reasons are negative and/or do not necessarily apply to their own personal life, teens will be more likely to believe that lots of people are using drugs, which was previously confirmed in Westat’s study (11). If public health campaigns aim to successfully reach out and send a message across to youth in efforts to manipulate their knowledge, beliefs, attitudes and behavior, these campaigns need to do more than merely provide health facts and negative, mixed messages. The message should be positive, clear, and concise. The underlying reasons behind why company brand products are noticed, retained and popular are hidden within the message of the company’s advertisement. Figuring out what type of message attracts the American public to a particular brand product advertisement is crucial to designing or improving a public health campaign.

Above the influence campaign (A failure) - Conclusion

Teenagers smoke weed. They smoke weed because it makes them feel good. They know about the harmful effects of weed and alcohol. As mentioned in this paper the information about the harmful effects of drug use and alcohol consumption are present all over the internet. Above-the-Influence advertisements take the information and creatively try to portray drugs and alcohol as something completely negative and bad in an attempt to try and get kids to avoid using either.

Anti-Drug Campaign improved through the Psychological Reactance Theory

Research and evaluations of the on-going public health programs have affirmed the value of using specific communication strategies to promote health and prevent disease(24). Effective strategies combine theories, frameworks, and approaches from behavioral sciences, communication, social marketing, and health education (25).

The biggest problem with the current “Above the Influence” campaign is that the social influence has backfired (21, 26). Social influence can threaten people’s freedom to decide autonomously, to form their own opinions, to hold various attitudes (or none at all), and do what they feel free to do. When people feel that their freedom is threatened they experience reactance, a motivational state aimed at restoring the threatened freedom (21). This is why all public health campaigns are a pain to design, because all campaigns deal with telling people what to do, which as demonstrated by psychological reactance will have adverse effects on people. Trying to generate a social influence will not help here because congruent with reactance theory, a large literature shows that social influence is more successful when it does not threaten important freedoms (26, 27). Hence using Psychological Reactance Theory is going to help develop a successful campaign because the fundamentals of the theory lie in the effort to reduce reactance and improve compliance (28, 29).

In persuasion models, psychological reactance is presented as a mediator between communication and attitude/behavior (30). Direct restoration of freedom involves doing the forbidden act. In addition, freedom may be restored indirectly by increasing liking for threatened choice, derogating the source of threat, denying the existence of threat or by exercising a different freedom to gain feeling of control and choice (30).

Persuasive attempts of all sorts, including public health campaigns, often fail to produce the desired effect. In some cases, they even produce results directly at odds with their intents. The theory of psychological reactance provides one theoretical perspective through which these miscarriages might be understood. The theory contends that any persuasive message may arouse a motivation to reject the advocacy. That motivation is called reactance36. From this inception to the present, the theory may be called upon to explain resistance to long-term commitment. For reactant people, any lack of alternatives, high switching costs or long term contracts represents a threat to their freedom.

Proposed campaign; CHOICE

I would like to propose an Anti-drug campaign called the ‘Choice’ campaign. The target population of this campaign will be similar to that of “Above the Influence”, the adolescent youth of America. However, the essence of the ‘Choice’ campaign will be derived from the Reactance Theory. The campaign will be focused on minimizing any chances of reactance from the target population. At the same time, the campaign will attempt to plug all the loopholes of the “Above the Influence” campaign.

‘Choice’ will be a positive campaign which will be contrary to the current anti-drug movement.

The most important aspect of this campaign will be that it will not tell anyone what to do. The ad campaign will try and imbibe the spirit and the motivation in an individual to stay sober i.e., not to be under the influence of alcohol or drugs.

‘Choice’ will be a dual campaign i.e., it will feature two different kinds of advertisements and media campaigns; Choice–A & Choice–B.

Choice-A will on real life stories. They will not focus on any kind of research or models or numbers. The ad-campaign will have relatives of people who have either lost someone to alcohol or drug abuse or people who have sobered up themselves. The people on screen will not talk about how ‘everyone should stop drinking alcohol or doing drugs’, because it will induce reactance. These advertisements will focus on the lives of these people; they will talk about how they lost someone to drug / alcohol abuse or how one of their relative came out of it. Former drug/alcohol addicts will come on air to talk about their own stories. This approach is going to help score a lot of points because adolescents are going to be able to relate to the victims and survivors of alcohol / drug abuse.

Commercials – This part of the campaign will feature four commercials, which will try and add the perfect blend of celebrities and ‘the common man’. The first scene will have relatives, manager and colleagues of George Best [a Northern Irish professional soccer player, best known for his years with Manchester United. He was a winger whose game combined pace, acceleration, balance, two-footedness, goal scoring and the ability to beat defenders. He was one of the first celebrity footballers, but his extravagant lifestyle led to problems with alcoholism which curtailed his playing career and eventually led to his death in November 2005 at the age of 59. His cause of death was multiple organ failure brought on by a kidney infection, a side effect of the immuno-suppressive drugs he was required to take after a liver transplant. (31)] His colleagues will talk about how great a player he was and talk about the great times they had. Mid-way into the scene they will talk about George Best becoming the best player, comparing him to the likes of Pele, if he hadn’t been a slave of his alcoholism. This will be said with the truest of emotions, because Best was actually that good.

The second commercial will showcase the families, friends and coaches of a group of high school and college athletes who lost out on glory because they gave into their temptations. This commercial will again begin with short interviews of the important people in the lives of those players. Talking about the moments they cherished with them and then how they felt during the downfall of those players. This is also include some of the success stories of people who were under heavy and moderate influence of alcohol and drugs and how they fought their temptations and emerged victorious on the other side.

The third and the forth commercials will be based on common people; the boy next door, the girl next door or any person who an adolescent child will be able to relate to. Similar to the previous commercials, there will be stories of victories and losses, but all the stories will be captured in such a way that they reflect true and genuine emotion.

True and genuine emotion will help garner the trust of anyone who watches the commercials.

Choice-B will be a ‘happy campaign’. Advertisements in this part of the campaign will be positive, bright and in high spirits. These advertisements will be focused on showing the positives of being sober, without actually ever mentioning the harmful effect of alcohol or drug abuse. This campaign is going to focus on commercials which project a very happy and bright picture of life.

The commercial for this campaign will be more or less on the lines of the Pepsi commercial which featured during the Super Bowl 2009. The one with Bob Dylan’s forever young. The commercial will compare two ages; around forty years apart, it shows happy people, children hugging their fathers/mothers (who have returned from Vietnam and Iraq respectively), people dancing to roll and roll and to the tunes of house music in a club respectively, and comparing various other things from two different generations. The only common thing between the two generations will be happiness and the soberness (not under the influence of alcohol or drugs). The foundation of this commercial will be derived from the psychological reactance theory (21) and hence, there will be no mention of what the viewer of this commercial should do. But the commercial sure will indirectly link happiness with soberness.

Another part of the “Choice” campaign would be to completely upgrade and revamp the website. The website (abovetheinfluence.com) will be changed to ‘www.yourchoice.com’. The website will air the commercials and give stories in greater detail of all the characters spoken about in the “Choice-A” commercials. The website will give out information about drugs, but only the amount of information which is needed. The website won’t be about facts or research or number of people under the influence, it won’t say how dangerous being under the influence is, it won’t talk about the population, but it will talk about ‘one child who died last week’, it will talk about the sorrow and grief of his parents, his relatives and everyone. This the website will be converted into an online portal where visitors will be able to relate to the things mentioned and they will react to it in a positive way because they are not striped of their freedom to decide.

Choice – Tackling what failed

Choice, the campaign will try and plug in the loop-holes that the current campaign has. Choice, uses three things; motivation, logic and positivity to try and influence the viewers to stop using drugs and drinking alcohol. In contrast to the current campaign that uses information and the portrayal of drug and alcohol use as something that is terribly bad. Choice will acknowledge the fact that so many teenagers indulge in drugs and alcohol abuse because they “increase or decrease the release and the synthesis of endogenous opioid peptides -- endorphins released during excitement, pain and orgasm -- in distinct brain regions important for drug addiction”. The campaign will be such that teens will be able to relate to it and they will be motivated to stop the abuse. The focus of the campaign would be to help teens understand that, drug and alcohol abuse might feel good and even great right now, but it might be more than harmful “we (the teens)” can anticipate in the long run. And since this will come from people they look up to and respect they will be motivated to make a life-style change.

Conclusion

Alcohol and Drug abuse is a major problem in the United States, as shown in this paper, and it needs to be looked in a much more efficient and scientific manner. The ‘Choice’ campaign has everything that is missing in the current anti-drug campaigns going on in the United States. “Choice” tries to get into the psyche of the adolescent mind and manipulate it into generating the desired behavior without generating any reactance.

References –

1. Journal

Kelder SH, Maibach E, Worden J, et al. Planning and initiation of the ONDCP National Youth Anti-Drug Media Campaign. J Public Health Manag Pract. 2000;6: 14–26.

2. Report of Other Document

Office of National Drug Control Policy. National Youth Anti-Drug Media Campaign. Available at: http://www.mediacampaign.org. Accessed December 28, 2005.

3. Report or other Document

Office of National Drug Control Policy. National Youth Anti-Drug Media Campaign: campaign overview. Available at: http://www.mediacampaign.org/newsroom/ factsheets/overview.html. Accessed December 28, 2005.

4. Report or other Document

Office of National Drug Control Policy. National Youth Anti-Drug Media Campaign: marijuana initiative. Available at: http://www.mediacampaign.org/marijuana/marijuanainitiative.html. Accessed December 28, 2005.

5. Hansen W.B., Graham J.W. (1991). Preventing alcohol, marijuana, and cigarette use among adolescents: peer pressure resistance training versus establishing conservative norms. Preventive Medicine, (20), 414-430.

6. Website,

www.Abovetheinfluence.com

7. Report or Other Document

Amentano, Paul: "Must Not See TV: Stoners in the Mist", page 18. High Times, September 2008

8. Report or Other Document

National Institute on Drug Abuse/University of Michigan, 2009 Monitoring the Future Study Drug Data Tables, December 2009

9. Book Chapter

Glanz, K., Rimer, B.K. & Lewis, F.M. (2002). Health Behavior and Health Education. Theory, Research and Practice. San Fransisco: Wiley & Sons. Individual health behavior theories (Ch. 4). In: Edberg M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers, 2007, pp. 35-49.

10. Book Chapter

Dillard J.P. & Shen L. (2005). On the Nature of Reactance and its Role in Persuasive Health Communication. Communication Monographs. 72 (2), 144-168.

11. Report or Other Document

United States Government Accountability Office. Contractor’s National Evaluation Did Not Find That the Youth Anti-Drug Media Campaign Was Effective in Reducing Youth Drug Use. Washington, DC:GAO 06-818, 2006.

12. Houston A. Marijuana Policy Project. “Above the Influence”of Wasteful Spending. District of Columbia: Marijuana Policy Project. http://www.mpp.org/library/above-the-influence-of-1.html

13. Report of other document

(http://www.colorado.edu/communication/metadiscourses/Papers/App_Papers/Jean.htm)

14. Book

Glanz, K., Rimer, B.K. & Lewis, F.M. (2002). Health Behavior and Health Education. Theory, Research and Practice. San Fransisco: Wiley & Sons. Individual health behavior theories (Ch. 4). In: Edberg M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers, 2007, pp. 35-49.

15. Report

Choi K, Yep GA, Kumekawa E. HIV prevention among Asian and Pacific Islander men who have sex with men: a critical review of theoretical models and directions for future research. AIDS Education and Prevention 1998; 10(Supplement A): 19-30.

16. Book Chapter

Essentials of Health Behaviour. Social and behavioural Theory in Public Health.

17. Website

http://www.abovetheinfluence.com/the-ads/default.aspx?path=nav

18. Website

http://www.youtube.com/watch?v=nl5gBJGnaXs

19. Report

http://www.uk.sagepub.com/upmdata/19262_Chapter_5___Mapping_the_Internal_and_External_Environments.pdf

20. Website

http://www.waytoomany.com/forum/viewtopic.php?f=45&t=54689

21. Journal Article

Brehm J.W. (1966). A theory of Psychological Reactance. Academic Press, NY.

22. Website

http://www.youtube.com/watch?v=wd7hCDACkW8

23. Website

www.abovetheinfluence.com/

24. Report

http://cancer.gov/pinkbook

25. Report

http://www.cdc.gov/communication/cdcynergy.htm)

26. Book

Brehm J.W. & Brehm S.S. (1981). Psychological Reactance. Wiley and Sons, NY.

27. Book

Clee MA. & Wicklund R.A. (1980). Consumer behaviour and psychological reactance. Journal of Consumer Research. 6 (March), 389-405.

28. Journal Article

Brehm, J. W., &Cole, A. (1966). Effect of a favor which reduces freedom. Journal of Personality and Social Psychology, 3, 420–426.

29. Journal Article

Brehm, J. W., & Mann, M. (1975). Effect of importance of freedom and attraction to group members on influence produced by group pressure. Journal of Personality and Social Psychology, 31, 816–824.

30. Journal Article

Dillard J.P. & Shen L. (2005). On the Nature of Reactance and its Role in Persuasive Health Communication. Communication Monographs. 72 (2), 144-168

31. Website http://en.wikipedia.org/wiki/George_Best

Website http://www.upi.com/Health_News/2009/03/20/Alcohol-releases-feel-good-endorphins/UPI-89031237564899/#ixzz1LVAqEaHF

The Family Smoking Prevention And Tobacco Control Act: Destined To Be Ineffectual

Introduction

Corpses, tracheotomies, screaming babies in incubators, oxygen masks, and visibly indisposed, presumably terminal stage cancer patients: these are just a few of the proposed warning images that will soon appear on cigarette packages and advertisements in an effort to deter Americans, specifically minors and young adults, from smoking. The unsettling graphics are a feature component of the Food and Drug Administration’s Family Smoking Prevention and Tobacco Control Act, which gives the FDA jurisdiction over tobacco product contents, labels, sales and marketing. New changes include manufacturer restrictions on placing terms such as “low,” “light” and “ultra-light” on cigarette packages, which may suggest decreased health risks; debarment of flavored tobacco sales, which are attractive to youths; and more prominent disclosure of harmful cigarette ingredients and health consequences, with warnings comprising 50% of package surfaces. Further, the FDA now has the authority to adjust nicotine levels in tobacco products (1).

Though certainly well intentioned, I feel that the Act will do very little, if anything, to change the habits of smokers. None of the provisions address the obstacles to smoking cessation, such as the presence of powerful social influences and an all-too-common lack of strong self-efficacy. The Act also assumes that people are able to think and behave rationally, when in fact, this is oftentimes not the case.

This paper seeks to explain why the Family Smoking Prevention and Tobacco Control Act will ultimately fail in its efforts to reduce tobacco use. After a thorough analysis of the policy’s shortcomings, alternative solutions addressing the fundamental challenges to smoking cessation will be explored. The solutions presented embody a greater understanding of human behavior and will therefore be much more effective in reducing tobacco consumption than those proposed by the Act.

Flaw #1: Assuming That People Think and Behave Rationally

Jacob Van Zanten, one of the world’s most experienced and accomplished pilots, made the decision to take off without clearance, resulting in the largest airline disaster in history (2). Black pearls, which were originally undesirable, became a coveted commodity after their prices were dramatically increased (3). Teenage girls who see that other teenagers are pregnant are more likely to become pregnant themselves (4). Despite a vast body of conclusive evidence that humans are prone to behaving irrationally, health policy makers, among others, often assume that people can and will make sensible decisions for themselves. The legislators who wrote the Family Smoking Prevention and Tobacco Control Act were of no exception; they, too, fell victim to this prevailing assumption.

The Family Smoking Prevention and Tobacco Control Act, in its efforts to change smokers’ behaviors, relies heavily on the Health Belief Model. The Health Belief Model is one of the oldest and most widely used theories in public health (5). The model presumes that people weigh out their options before making health-related decisions, taking perceived susceptibility of a disease or condition, severity of its outcomes, and the benefits and barriers associated with changing their behaviors (to avoid the condition) into consideration (6). The model therefore assumes a rational decision process.

In displaying gruesome health effect images on cigarette packages, removing “light” and “ultra-light” labels and making tobacco ingredients and health effects more prominent, legislators are trying to increase the perceived severity of the potential health implications of smoking. They believe that if the dangers of smoking are made more apparent, people will work this information into their decision and will be less likely to smoke in accordance with the Health Belief Model.

In reality, however, decisions are usually made on the spot without detailed, methodical consideration (7). If offered a cigarette, a person does not typically pause to reflect on the potential health issues that they may one day be faced with, nor do they think through any perceived benefits that come with the cigarette. This is especially true among minors and young adults, the main targets of the Family Smoking Prevention and Tobacco Control Act, who have a tendency to make decisions more impulsively (8). Recent studies have shown that teenagers’ prefrontal cortexes are not capable of the same reasoning that allows older adults to make rational decisions (9). Thus, if a teen is offered a cigarette by a friend, he or she may not be able to use the information they know about the negative effects of smoking to resist.

The graphic image approach is also flawed in that its persuasive efforts are fear-based. The sole purpose of the images is to scare smokers of the detrimental health effects of tobacco consumption, again, in an attempt to increase the perceived severity of the consequences of smoking and sway people to quit. This approach is problematic in several ways. First, minors and young adults often feel that they are invincible (10). They typically do not worry about the future, and believe that such extreme consequences are unlikely to happen to them. Use of fear in anti-smoking campaigns has also been shown to be inconsistently effective (11). In fact, some researchers believe that repeated use of fear tactics will result in desensitization to the message (12).

An even more compelling argument against the use of fear tactics in anti-smoking campaigns comes from a study from the University of Missouri. In the study, student smokers were given questionnaires that prompted them to think about either failing an exam or their own mortality. The participants were then offered cigarettes and the volume and duration of each puff taken was measured. The researchers found that heavy smokers responded with longer drags of their cigarettes when prodded to think about their own mortality than those prompted to think about failing an exam. Psychologist Jamie Ardnt suggests that the smokers may have been subconsciously attempting to purge their negative moods with an activity they enjoy, smoking (13). The study therefore implies that the startling cigarette package graphics may have a reverse effect on those who see them, actually prompting smokers to smoke more.

Another reason this Act is destined to be ineffective is that it fails to take into account that Nicotine is habit-forming. Nicotine is a highly addictive stimulant that enters the bloodstream upon the inhalation of cigarette smoke. The body becomes accustomed to nicotine over time and requires certain amounts of it to function normally. Nicotine is physically and psychologically challenging to give up (14). The Health Belief model does not take addictive substances into consideration, despite their potential to influence decisions. Since nicotine interferes with the nervous system, cravings inhibit the ability to think rationally (15). It is also very difficult for smokers to deal with smoking withdrawal effects long enough for them to actually quit, even if they have strong intentions to do so (16).

Finally, research has shown that persuasive health campaigns may be vulnerable to psychological reactance (17). Psychological reactance is an aversive reaction to perceived threats to freedom, and has been observed in humans from a very young age. Thus, a person may desire to smoke simply to exercise their legal right and freedom to do so in the face of a bombardment of anti-smoking messages.

Flaw #2: Failing to Address Social Influences to Smoking

There are powerful social reasons why people choose to smoke. The Family Smoking Prevention and Tobacco Control Act does not address – or even appear to recognize – any of these reasons.

One of the greatest causes for concern regarding youth tobacco use is the effect of peer influences. People, particularly adolescents, have a tendency to conform to the behaviors of their peers (18). If their peers are smoking, then adolescents will be more likely to smoke, especially if they are trying to be accepted into a circle of friends that smokes (19). This is a major risk factor to smoking among minors and young adults, regardless of whether or not they are aware of the dangers associated with the habit (20). Why, then, does the Act focus so much on scaring people of the effects of tobacco use but do virtually nothing to challenge its underlying social causes?

Peers are not the only ones to influence minors; family members have considerable impact on a child’s decision to smoke as well. Children are more likely to smoke if their family members smoke (21). They are also more likely to smoke if their parents are unsupportive or are uninvolved in the child’s life (22). These important social contexts appear to have been deemphasized by the Family Smoking Prevention and Tobacco Control Act, while disproportionate emphasis has been placed on dispositional factors. This is exemplary of the fundamental attribution error, a common misconception in judgment resulting in a gross misunderstanding of why people behave as they do (23). A more effective anti-tobacco campaign would also consider external, social causes of the problem, rather than proposing solutions that over-attribute the behavior of people to their character.

Another important social element to consider is that of belonging. According to public health researcher David Dubois, belonging is “one of the strongest human motivational needs” (24). For many, smoking provides a sense of belonging that anti-smoking policy makers do not consider. Smoking is a way for people to interact and bond with one another through social cigarette breaks. It is also an opportunity for striking up conversation and meeting new people in instances where one smoker is seeking a light or a spare cigarette from another. For those who have developed strong ties through smoking, the potential loss of these relationships may act as a deterrent to smoking cessation (25). Further, the creation of anti-smoking laws may be helping to strengthen the bond among the smoking community. As smoking is becoming more and more discouraged, smokers may find the need to band together to smoke outside of the realms mainstream society.

Some people, especially minors and young adults, chose to smoke simply because it is discouraged and against mainstream society. They believe that if they do so, they will come off as rebellious, edgy, sexy and cool (26). Tobacco advertisements frequently target insecure minors offering false promises of appearing more attractive and bold with a cigarette in hand. These advertisements have unfortunately been extremely effective among kids (27).

Lastly, some people smoke because they are smokers. They have been repeatedly labeled as so by society, and although they may very well recognize that smoking is detrimental to their health, they have accepted it as a part of who they are and have come to embrace it. Some smokers continue to smoke because of the self-fulfilling prophecy (28). They have developed a sense of ownership of that habit and it has thus gained more value than its worth. As a result of loss aversion, the habit of smoking subsequently becomes even more difficult to give up (29).

In short, there are a multitude of social factors that contribute to tobacco consumption. Smoking, for many, is a social phenomenon. Any anti-smoking measure that does not directly address these issues is bound to be inadequate.

Flaw #3: No Consideration for Self-Efficacy

Most people know that smoking is bad for their health (30). The majority of smokers would like to quit (31), but many do not possess the confidence that they can indeed do so (32). Therefore, anti-smoking endeavors should include efforts to boost self-efficacy, rather than trying to scare smokers, most of whom already want to quit, of the effects of smoking.

Alburt Bandura’s Theory of Self-Efficacy contends that a person’s health behavior is determined by two expectancies. The first is that the person must truly believe that engaging in a behavior will lead to better health outcomes. Second, the individual must believe that they are capable of successfully performing that behavior. Bandura believes that self-efficacy is predictive of a variety of attempted behavioral changes, including inhibition of behaviors, such as smoking cessation (32).

There is substantial research to back up Bandura’s claim. In 1995, Mudde, et. al demonstrated the predictive value of self-efficacy among smokers attempting to quit (33). A similar study conducted by Gritz et al. found the same results among a group of female smokers in forecasting long-term tobacco abstinence (34). Self-efficacy is a good predictor of success for other attempts at health behavior change as well, including weight loss, dieting, and coping with stress (35). The predictive ability of self-efficacy for smoking cessation, however, appears to be most impressive. In nearly every study examining self-efficacy and smoking cessation, self-efficacy has either been a strong indicator or the strongest of potential indicators examined (36).

Since self-efficacy is closely linked with successful quit attempts, anti-smoking measures should address efficacy issues. The Family Smoking Prevention and Tobacco Control Act does not do so. The cigarette boxes merely offer reasons why not to smoke, reasons that most smokers are already fully aware of. The packages do not provide any kind of encouragement or support. The majority of smokers want to quit and have tried to quit before, but have been unsuccessful (37). Why, then, is the Act still focusing on trying to convince people to quit? For many, the desire to quit is there; it is the efficacy that is lacking.

An Alternative Approach is Needed

The Family Smoking Prevention and Tobacco Control Act requires that cigarette ingredients and health effects be made more prominent. While it is important that smokers understand the dangers of tobacco use, studies suggest that most already do (38). Rather than trying to reinforce the dangers of tobacco use, anti-smoking campaigns should concentrate on the fundamental causes of smoking commencement and obstacles to smoking cessation. Additionally, strategies employed should not presume reasoned decision making. Some possible approaches to reducing tobacco consumption are as follows:

Solution #1: Assume that People Think and Behave Irrationally

The Health Belief Model is inappropriate for anti-smoking campaigns as it assumes that people think and behave rationally. A more effective strategy would instead assume that people behave irrationally. Research has shown that the Labeling Theory can be very influential. The theory, developed by Howard Becker, contends that peoples’ behaviors are a product of how they are labeled (39). Multiple studies have demonstrated the power of labeling, such as the Hypertension Labeling and Sense of Well-Being study conducted by J. Bloom and S. Monterossa. In this assessment, individuals were mislabeled as hypertensive and subsequently developed poorer health (40).

According to the labeling theory, those labeled as non-smokers will not smoke. I think that we need to develop a strong, comprehensive program that attempts to designate young Americans as non-smokers so that they will continue in this role throughout their lifetime. Such a program has already been implemented in Massachusetts called the84.org. The number “84” represents the percent of children in Massachusetts who are tobacco-free (41). The organization has a very straightforward and powerful slogan: “It’s not just a number, it’s who you are.” The number is plastered throughout the organization’s website, constantly reminding visitors that youth in Massachusetts do not smoke in a strong attempt to utilize labeling theory. The campaign also shows great potential for success in that it takes a much more positive, refreshing approach to addressing youth smoking than that of the Family Smoking Prevention and Tobacco Control Act. Rather than trying to scare children of the effects of tobacco, it celebrates and promotes non-smokers. Grewal, Gotlieb and Marmorstein have found that positive messages, like this one, tend to be more effectual than those which hone in on the negative (42) like the Act. Although it is too soon to determine whether or not the84.org has been able to reduce youth tobacco consumption in Massachusetts, the approach is a promising one as it is not based on the assumption of reasoned thinking.

Solution #2: Harness the Power of Social Influences

National anti-smoking campaigns should disseminate the fact that most kids in the United States are tobacco-free. By doing so, we can harness the power of the Theory of Herd Behavior, which suggests that people are inclined to “follow the herd” (43). According to the theory, just knowing that most kids do not smoke is apt to encourage others to behave the same way. Effective campaigns would devise means to communicate that most children do not use tobacco products, be it through advertisements, hosting public events for non-smokers, distributing anti-smoking pins and t-shirts or by allowing youth to connect and reach out to one another on websites. The state of Montana has developed an initiative like this to address drinking and driving among college students. Montana’s state-wide approach utilizes the Herd Theory by dispersing knowledge through billboards. The billboards read that the majority, or 70% of college students in the state, do not drink and drive. This strategy has helped to correct the social perception that drinking and driving is more common in Montana and has also resulted in a decrease in alcohol related car accidents (44).

Anti-smoking organizations should offer a way for kids to get involved and appeal to their innate desire to belong (45). Kids seek groups to associate with so that they can feel like they are a part of something (46). We need to make sure that healthy, attractive options are available, so that youth have an alternative choice to joining smoking cliques. Anti-smoking organizations such as the84.org, which host fun events and encourages non-smoking youth to connect with one another, should be established and advertised in communities.

It is also important that we consider who is delivering anti-smoking messages. As the Theory of Communication suggests, the message deliverer can have considerable power on whether or not the audience is impacted by the message. People are more likely to be influenced by those who they perceive as similar to themselves (47). They are less likely to be influenced by people they see as distant, commanding, or dissimilar to themselves, which is why the Family smoking Prevention and Tobacco Control Act will not be effective. Nobody likes being forced to listen to Big Government. The most influential people in getting a person to change his or her behavior are that person’s friends and family. A study conducted by Robert Murray et. al. demonstrated that social support is linked with successful quit attempts (48). Thus, an alternative anti-smoking program might instead provide advice and support for friends and family members of smokers to encourage them to quit. Hotlines, pamphlets and support groups could be used to help distribute information on how to talk to smokers and get them to quit. The focus of these approaches would thus not be of the effects of smoking, but rather of how to influence people to conquer their tobacco dependence.

Solution #3: Improve Self-Efficacy

Lastly, anti-smoking campaigns should address efficacy issues as perceived self-efficacy and quit attempts are strongly correlated (36). Rather than portraying images of detrimental health effects, perhaps we could take a more positive approach and show colorful, attractive images of cheerful non-smokers on cigarette packages. We could instead show non-smokers living happy, healthy long lives; something that smokers may not get to do if they continue with their habit. Cigarette packages could have profiles of real people who were able to quit. The profiles would include people of all ages, sexes and races. The cigarette boxes would have a picture of an ex-smoker on the front, some background information as to how much tobacco the ex-smoker once consumed, how they were able to quit, and how it affected their life for the better. The packages would end with the message “I could do it, and so can you” and a smoking cessation hotline and/or website would be listed. This solution would be likely to be effective for several reasons. First and foremost, it would help to improve smokers’ self-efficacy. Studies have shown that peoples’ self-efficacy can be improved by witnessing or hearing about others who have triumphed in similar situations (49). Additionally, the message conveyed by the cigarette boxes would now be a positive one and not a negative one, and thus would be more likely to be influential as discussed previously (42). This method would also employ the Herd Theory, which is demonstrably effectual (44), in that it would make successful quit attempts appear more common and encourage more smokers to follow suit. This approach, unlike the one proposed by the Act, would offer support and resources.

Conclusion

Although well intentioned, the Family Smoking Prevention and Tobacco Control Act attempts to reduce tobacco consumption among minors and young adults in all of the wrong ways. The Act relies on the ill-fated belief that people can make rational decisions for themselves. Further, self-efficacy and social influences play a huge role in determining an individual’s decisions regarding smoking, yet the Act does nothing to address either of these areas. In order to successfully reduce tobacco consumption, greater attention must be paid to external factors that contribute to smoking and to improving a person’s belief that he or she can, indeed, quit.

REFERENCES

1. U.S. Food and Drug Administration – Department of Health and Human Services. Proposed Cigarette Warning Labels. http://www.fda.gov/
TobaccoProducts/Labeling/CigaretteProductWarningLabels/default.htm

2. Brafman, Ori and Brafman, Rom. Sway: The Irresistible Pull of Irrational Behavior. New York. Broadway Books. 2008: 10-15.

3. Ariely, Dan. Predictably Irrational. New York, New York. Harper, 2009:26

4. Thaler, Richard and Sustein, Cass. Nudge: Improving Decisions About Health, Wealth and Happiness. Caravan Books. 2008: 234

5. Salazar, Mary Kathryn. Comparison of Four Behavioral Theories: A Literature Review. American Association of Occupational Health Nurses Journal. 39(3)128.

6. Theory at A Glance: A Guide for Health Promotion Practice. National Cancer Institute. NIH Publication 2005:160

7. Edberg, Mark. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Jones and Bartlett Publishers, Sudbury, MA, 2007:137-141

8. Gardner, M., & Steinberg, L. Peer influence on risk-taking, risk preference, and risky decision-making in adolescence and adulthood: An experimental study. Developmental Psychology. 41(4): 625-635

9. Wendelken C, Donohue SE, Crone EA, Carter CS, Bunge SA. ‘Brain is to thought as stomach is to…?’ – specifying the role of rostrolateral prefrontal cortex in analogical reasoning, Journal of Cognitive Neuroscience. 20(4):682-693

10. Ravert, Russel et al. Sensation seeking and danger invulnerability: Paths to college student risk-taking, Personality and Individual Differences. 47: 763-768

11. Choi, Yoonhyeung, Cameron, Glen. and Leshner, Glenn. Defining Fear Appeals-Based Antismoking PSAs Using Izard’s Differential Emotions Scale.

http://www.allacademic.com/meta/p90143_index.html

12. Hastings G, and M. Stead. Fear Appeals in Social Marketing: Strategic and Ethical Reasons for Concern. Psychology & Marketing. 39(3) 961-986.

13. Schrock, Karen. How Smokers Think About Death. Scientific American Mind. 2010:12

14. Fielding, Jonathan E. Smoking: Health Effects and Control. New England Journal of Medicine, 1985: 491-498

15. One Care Medical Center. Stop & Quit Smoking Guide. Santa Monica, CA.

http://stopsmokingshotguide.com/quit-smoking-in-one-care-medical-center-santa-ana-ca/

16. A.D.A.M. Nicotine Addiction Withdrawal In-Depth Report. http://health.nytimes.com/health/guides/disease/nicotine-withdrawal/print.html

17. Rains, Stephen A, and Turner, Monique Mitchell. Psychological Reactance and Persuasive Health Communication: A Test and Extension of the Intertwined Model. Human Communication Research, 2007: 241-269

18. Brown, B. Brandford, Clasen, Donna Rae, and Elcher, Sue Ann. Perceptions of Peer Pressure, Peer Conformity Dispositions, and Self-Reported Behavior Among Adolescents. Developmental Psychology, 22-4:1986 :521-530

19. Ennett, Susan T and Bauman, Karl E. The Contribution of Influence and Selection to Adolescent Peer Group Homogeneity: The Case of Adolescent Cigarette Smoking (21-36) In: Levine, John and Moreland, Richard. Small Groups: Key Readings in Social Psychology. New York, New York: 2006

20. Wang, Min Qi, et. al. Family and Peer Influences on Smoking Behavior Among American Adolescents: An Age Trend. Journal of Adolescent Health, 16-3 :1995:200-203

21. Shamsuddin, K and Abdul Haris, M. Family Influence on Current Smoking Habits Among Secondary School Children in Khota, Bharu, Kelantan. Singapore Medical Journal: 41-4:167-171

22. Krohn, Marvin; Massey, James; Zielinsky, Mary. Role overlap, network multiplexity and adolescent deviant behavior. Social Psychology Quarterly. 1988;51:346–356

23. Tal-Or, Nurit. and Papirman, Yael. The Fundamental Attribution Error in Attributing Fictional Figures' Characteristics to the Actors. New York, New York City, NY. http://www.allacademic.com/meta/p13476_index.html

24. DuBois DL, Holloway BE, Valentine JC, Cooper H. Effectiveness of mentoring programs for youth: A meta-analytic review. American Journal of Community Psychology. 2002;30:157-197
25. Mermelstein, Robin et. al. Social Support and Smoking Cessation and Maintenance. Journal of Consulting and Clinical Psychology: 1986: 54-4: 447-453
26. Luke, D. et. al. Teens' images of smoking and smokers. Public Health Rep. 2001; 116 (Suppl 1): 194–202.
27. Pierce, John et. al. Does Tobacco Advertising Target Young People to Start Smoking? Journal of American Medicine. 226-22: 3154-3158
28. Grossarth-Maticek R, Eysenck HJ. Is media information that smoking causes illness a self-fulfilling prophecy? Psychol Rep. 1989; 65-1:177-8
29. Lehrer, Jonah. How We Decide. Mariner Books. New York, New York. 2009: 76-77.
30. William L. Weis, Chauncey Burke. Media Content and Tobacco Advertising: An Unhealthy Addiction. Journal of Communication: 36-4:59-69
31. Lynch, Jonathan. Survey Finds Most Smokers Want to Quit. CNN Health. http://articles.cnn.com/2002-07-25/health/cdc.smoking_1_black-smokers-smoking-cessation-cdc?_s=PM:HEALTH
32. Lawrance, Lyn and Kenneth McLeroy. Self-Efficacy and Health Education. Journal Of School Health:1986, 56-8: 317-321
33. Mudde, A., Kok, G., & Strecher, V.(1995). Self-efficacy as a predictor for the cessation of smoking: Methodological issues and implications for smoking cessation programs. Psychology and Health, 10, 353-367.
34. Gritz, E., Berman, B., Bastani, R., & Wu, M. A randomized trail of a self-help smoking cessation intervention in a nonvolunteer female population: Testing the limits of the public health model. Health Psychology, 11, 280-289.
35. DiClemente, C.C., Fairhurst, S., & Piotrowski, N. Self-efficacy, adaptation, and adjustment: theory, research, and application. Healthy Psychology. 22-2: 210-2-19
36. DiClemente, C.C. Self-efficacy and the addictive behaviors. Journal of Social and Clinical Psychology 4(3), 302-315.
37. DICLemente, CC. Self-Efficacy and Smoking Cessation Maintenance: A Preliminary Report. Cognitive Therapy and Research. 5-2: 175-187
38. Watson, N.A. et. al. Filthy or fashionable? Young people’s perceptions of smoking in the media. Health Education Research. 18(5):554-567
39. Goode, Erich. On Behalf of Labeling Theory. Social Problems. University of California Press. 22(5): 570-583
40. Bloom, J and Monterossa, S. Hypertension labeling and sense of well-being. American Journal of Public Health. 71(11): 1228-1232
41. The 8ighty 4our.org: It’s Not Just a Number, It’s Who You Are. http://The84.org
42. Grewal, Dhruv; Jerry Gotlieb and Howard Marmorstein. The Moderating Effects of Message Framing and Source Credibility on the Price-Perceived Risk Relationship. The Journal of Consumer Research. 21(2):145-153
43. Earls, Mark. Herd: How to Change Mass Behaviour by Harnessing Our True Nature. John Wiley & Sons Ltd. West Sussex, England. 2007
44. Thaler, Richard and Sustein, Cass. Nudge: Improving Decisions About Health, Wealth and Happiness. Caravan Books. 2008: 66
45. Osterman, Karen. Students' Need for Belonging in the School Community. Review of Educational Reseach. 70(3): 323-367.
46. Wiist, W.H. and G. Snider. Peer Education in Friendship Cliques: Prevention of Adolescent Smoking. Health Education Research. 6(1):101-108.
47. Nelson, Thomas and Zoe Oxley and Rosalee Clawson. Towards A Psychology of Framing Effects. Political Behavior. 19(3):221-246
48. Murray, Robert et. al. Social support for smoking cessation and abstinence: The lung health study. Addictive Behaviors. 20(2):159-170
49. Smedslund, Jan. Bandura's theory of self-efficacy: A set of common sense theorems. Scandinavian Journal of Psychology. 19(1):1-14.