The End of an Error: New Frontiers for Social Norms

1. The End of an Error: New Frontiers for Social Norms Clayton Neighbors University of Washington Presented at the 2008 National Conference on the Social Norms Approach, Burlingame, CA July 2008

2. Acknowledgements • Special thanks to: • Jim Turner, Jennifer Bauerle, Adrienne Keller, Shirley Cauley for all of their work at the National Social Norms Institute • Ann Doyle, Social Norms Conference Event Planner • Drew Hunter and everyone at the BACCHUS Network 2

3. What is “Social Norms”? • Social norms means different things to different people. • With respect to the utilization of social norms information as a persuasive health communication, two traditions evolved: • Social Norms Marketing • Individual Norms Feedback in Therapeutic Interactions (e.g., Project Match, Motivational Interviewing, Cognitive Behavior Therapy)

4. Historical Background Sherif, M. (1936). The psychology of social norms. New York: Harper. Asch, S. E. (1951). Effects of group pressure upton the modification and distortion of judgement. In H.Guetzkow (Ed.), Groups, leadership, and men. Pittsburg, PA: Carnegie Press. Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7, 117-140. Perkins, H. W. & Berkowitz, A. D. (1986). Perceiving the community norms of alcohol use among students: Some research implications for campus alcohol education programming. International Journal of the Addictions, 21, 961-976.

5. A good idea! Following the Perkins & Berkowitz article a number of independent investigations consistently revealed that college students overestimated the drinking of their peers and overestimation was associated with heavier drinking. Normative misperceptions also became documented for a number of other behaviors and extended to high school students. In general, people seem to overestimate the prevalence and acceptance of negative health/risk behaviors (e.g., alcohol, smoking, drug use) and underestimate the prevalence of positivel/protective behaviors (e.g., exercise, condom use). Correction of misperceptions was suggested as a way to reduce negative health behaviors. This became the Social Norms Approach.

6. Not social norms marketing

7. Not social norms marketing 7

8. Not social norms marketing

9. Social Norms Marketing

10. Social Norms Marketing

11. Social Norms Marketing

12. Social Norms Marketing

13. Social Norms Marketing Studies 1996-2004: It totally works! Glider, P., Midyett, S. J., Mills-Novoa, B., Johannessen, K., & Collins, C. (2001). Challenging the collegiate rite of passage: A campus-wide social marketing media campaign to reduce binge drinking. Journal of Drug Education, 31, 207-220. Gomberg, L., Schneider, S. K., & DeJong, W. (2001). Evaluation of a social norms marketing campaign to reduce high-risk drinking at The University of Mississippi. American Journal of Drug and Alcohol Abuse, 27, 375-389. Haines, M. & Spear, S. F. (1996). Changing the perception of the norm: a strategy to decrease binge drinking among college students. Journal of American College Health, 45, 134-140. Numerous other studies supporting the approach were conducted and disseminated in book chapters and project reports. 13

14. Social Norms Marketing Studies 1996-2004: It totally works! 14

15. Social Norms Marketing Studies 1996-2004: It doesn’t work! Carter, C. A. & Kahnweiler, W. M. (2000). The efficacy of the social norms approach to substance abuse prevention applied to fraternity men. Journal of American College Health, 49, 66-71. Clapp, J. D., Lange, J. E., Russell, C., Shillington, A., & Voas, R. B. (2003). A failed norms social marketing campaign. Journal of Studies on Alcohol, 64, 409-414. Werch, C. E., Pappas, D. M., Carlson, J. M., DiClemente, C. C., Chally, P. S., & Sinder, J. A. (2000). Results of a social norm intervention to prevent binge drinking among first-year residential college students. Journal of American College Health, 49, 85-92. Wechsler, H., Nelson, T. E., Lee, J. E., Seibring, M., Lewis, C., & Keeling, R. P. (2003). Perception and reality: a national evaluation of social norms marketing interventions to reduce college students' heavy alcohol use. Journal of Studies on Alcohol, 64, 484-494. 15

16. It doesn’t work! Wechsler article gets too much press! 16

17. Reprisals 17

18. Reprisals 18

19. Reprisals 19

20. Research continues to provide support… Mattern, J. L. & Neighbors, C. (2004). Social norms campaigns: examining the relationship between changes in perceived norms and changes in drinking levels. Journal of Studies on Alcohol, 65, 489-493. Perkins, H. W. & Craig, D. W. (2006). A successful social norms campaign to reduce alcohol misuse among college student athletes. Journal of Studies on Alcohol, 67, 880-889. Perkins, H. W., Haines, M. P., & Rice, R. (2005). Misperceiving the college drinking norm and related problems: A nationwide study of exposure to prevention information, perceived norms and student alcohol misuse. Journal of Studies on Alcohol, 66, 470-478. 20

21. A pretty definitive test… DeJong et al (2006) evaluates a controlled trial of social norms marketing on 18 campuses. Social norms marketing associated with reduced misperceptions and less heavy drinking on intervention campuses compared to control campus. There is a dose-response relationship.

22. Social Norms Marketing Studies Practice versus evaluation: Lessons from DARE The importance of dissemination Peer reviewed versus non-peer reviewed 22

23. What we know now… Social norms marketing works provisionally! It is not a magic bullet and it doesn’t always work. 23

24. Cars and Social Norms Marketing Cars don’t always run. Some cars are more likely to run than others. Henry Wechsler’s study was a 1978 Chevette. Bill DeJong’s study was a 2006 Ford Ranger. Ford products are better than Chevrolet products. Even good cars need gas. 24

25. Ingredients for success A pre-existing misperception A good message (acceptable, believable, consistent) High dosage Few competing messages 25

26. Where are we now and where are we going. Social norms marketing done well works. Social norms has and is being applied to a wide range of health related behaviors. • Domestic violence and dating violence • Seat belt use • Drinking and driving • Bullying • Celebratory events • Risky sex • Alcohol • Tobacco • Substance use • Body image • Bystander interventions • Body image 26

27. Where are we now and where are we going. Social norms is being evaluated in larger and smaller populations: General population and community based interventions. Population norms from NESARC are available: Chan, K. K., Neighbors, C., Gilson, M., Larimer, M. E., & Marlatt, G. A. (2007). Epidemiological trends in drinking by age and gender: Providing normative feedback to adults. Addictive Behaviors, 32, 967-976. Work by John Cunningham in Canada 27

28. Where are we now and where are we going. Specific groups: Freshman, fraternity/sorority, athletes, residence halls, service organizations, specific subpopulations (IV drug users, MSM, IPV perpetrators, etc). Event specific (e.g., 21st birthdays, Spring Break) 28

29. Where are we now and where are we going. Social norms is being evaluated and implemented in other ways that have been found efficacious: • Peer theatre (Dolores Cimini) • Health pamphlets (John Cunningham) • Wireless keypad technology aka “clickers” (Linda Hancock; Joe Labrie) • In person norms feedback as part of more comprehensive interventions and treatment • Personalized normative feedback

30. SNAP R01AA014576 Year 2-4: 811 heavy drinking students randomly assigned to: Single exposure to Gender Non-specific PNF Single exposure to Gender Specific PNF Repeated exposure to Gender Non-specific PNF Repeated exposure to Gender Specific PNF Assessment only Year 5: A smaller trial evaluating PNF with abstaining and light drinking students. 30

33. Conclusions We have come a long way in the past decade or so! We have passed the controversy of whether social norms marketing works. It works as long as we have gas and aren’t driving a 1978 Chevette. We are learning to use social norms in new ways for new behaviors and in new populations and we are finding successes more often than failures. The future looks very bright for the social norms approach 33

34. Thank you! 34