The Effectiveness of Mass Media Campaigns: Youth Substance Abuse

1. The Effectiveness of Mass Media Campaigns: Youth Substance Abuse Bill Bukoski, Ph.D., NIDA Robert Orwin, Ph.D., Westat June 7, 2006

2. OVERVIEW • 1. Youth’s Exposure to Mass Media. • 2. Possible Risks of Mass Media. • 3. Possible Benefits of Mass Media. • 4. Findings From Westat’s Evaluation of ONDCP’s Anti-drug Abuse Campaign for Youth and Parents.

3. TV, radio, music, magazines, movies, video games, cell, internet, e-mail, IM, cds, dvds, MP3, etc. Youth (8-18) – 6.5 hrs per day or 44.5 hrs per week – all forms of media. 30% multi-task: phone+IM+music++TV+surf the web. 53% - families have no rules - TV. 51% - use web daily. 32% - use IM daily 2.25 hrs - parents; 1.5 hrs exercise; 50 min – homework. 1. Mass Media is Pervasive in the Lives of Youth(Kaiser Report, 2005)

4. 2. Risks of Mass Media - Youth • Research – an overwhelming presence of alcohol, tobacco, illicit drugs in mass media viewed by youth (Thompson, 2005). • Mass media portrays unhealthy behaviors as glamorous and risk-free (Brown and Witherspoon, 2002). • Mass media poses a significant public health risk for youth (Am. Acad. Ped., 1995; 1996; 1999; 2001a; 2001b; 2001c.)

5. Examples of Risk: Alcohol • From 2001-2004, the ave. number of TV alcohol ads seen by youth increased 32% - 209 to 276 (CAMY, 2006). • The top 15 TV shows with the largest youth (12-17) audience had alc. ads (CAMY, 2005). • Nat’l long. survey (15-26): on ave. more al. ads (TV, radio, mags, billboards)- more drinking. Each ad seen increased num. of drinks consumed in past month by 1% ; holds also for greater al ad expenditures by market area (Snyder et al., 2006).

6. Examples of Risk: Alcohol • Ellickson et al. (2005) studied exposure effects of al ads (TV, mags, in-store displays, beer concessions) on drinking initiation and drinking freq. for 7-8-9th graders. • Multivariate analyes - increased exposure to al. ads in 8th grade for 1) 7th grade nondrinkers - predicted al initiation by 9th grade; 2) 7th grade drinkers- predicted increased drinking freq. by the 9th grade.

7. Examples of Risk: Smoking • In a nationally representative random digit phone survey of 10-14 year olds, Sargent et al. (2006) found a positive association between increased exposure to smoking in movies (N=524 hits) and smoking initiation. • In comparison to the lowest Quartile of smoking in movies (Q1), Adjusted OR for having tried smoking was 1.7 for Q2; 1.8 for Q3; and 2.6 for Q4. Attributable Risk = 38%. • Exposure was primary risk of smoking initiation for 38% who tried smoking.

8. Examples of Risk: Drug Use • A recent study of more than 1200 films rated G, PG, PG-13, and R, and released between 1996 and 2003 reported that 95% of films depicted substances (drugs, alcohol, tobacco) while the Motion Picture Association referenced drugs and alcohol in only 18% of its ratings (Thompson, 2005). • NIDA’s PRISM award promotes accurate depictions of drug, alcohol, tobacco use in film, TV, video, music, and comic books (NIDA Press Release, 2006).

9. “Just a Click Away”: Drug Use Web Sites • Wax (2002) indicates that the internet provides free, unedited, and nonrefereed information about “recreational” drug-taking behavior. • While anti-drug web sites exist, the web sites that espouse “risk reduction, safe and responsible” drug use are easily accessible by children.

10. Internet Drug Sales • Forman (2006) reports that the Internet conducts drug business transactions 24 hours a day, across the globe with relative anonymity. • The sale of prohibited Schedule I drugs (marijuana, heroin, crack cocaine) and Schedule II-V drugs (sedatives, analgesics, stimulants, steroids, etc.) can be obtained on-line from “no-prescription” web sites by anyone with access to a credit card to include youth.

11. 3. Benefits of Mass Media • Promotes messages that value rather than devalue youth (Klein et al., 1993). • Help youth make better decisions about health risks they face (Klein et al., 1993). • Multiple components: TV-radio ads, web, videos, print, school/comm./parents, policy. • Mass media “campaigns” have been studied for over 5 decades (Wartella et al., 1991). • Meta-analysis indicate effect sizes are small and can be negative or positive (Snyder et al., 2004).

12. Theories for Mass Media(NCI, 2005) • Behavior is mediated by cognitions – what people know and think drives actions. • Knowledge is necessary but not sufficient for behavior change. • Beliefs, Attitudes, Intentions, Perceptions, Motivation, Skills, Social Environment, Ad Exposure and Message Saliency influences behavior change.

13. Theories (cont.) • Theory of Reasoned Action (Fishbein & Ajzen, 1975). Beliefs, Attitudes, Intentions, Behavior. • Theory of Planned Behavior (Akzen, 1991). In addition --- Intentions are influenced by perceived behavioral control. • Social Innoculation Theory (McGuire,1964). Small doses of pro-ads are analyzed to promote negative responses.

14. Theories (cont.) • Psychological Reactance (Brehm & Brehm, 1981). If freedom to engage or not engage in a behavior is threatened or denied, motivational arousal is prompted to restore lost freedom. • Social Marketing (Zimmerman, 1997). Ads that appeal to the target audience’s norms, attitudes, motivations – does not try to change them. A focus on changing the social environment as well. Incorporates commercial marketing principles of product, price, place, and promotion.

15. Theories (cont.) • Sensation Seeking Targeting-SENTAR(Palmgreen & Donohew, 2003). Focus is on “sensation seeking” – a personality trait that represents a need for novel, complex, ambiguous, and emotionally intense stimuli; associated with drug use. Media campaigns target high sensation seeking youth, include messages that are fast paced and elicit arousal, and match viewing habits of high sensation seekers.

16. Observation: Media Health Communication Effects • In 2003, 83.6% of youths 12-17 (20.8M) reported exposure in past year to an alcohol or drug message: poster, pamphlet, radio, TV, etc. (NSDUH Report, 2005). BUT… research findings on behavior are mixed. • Mendelson (1968) described “mass communication as a sort of an aerosol spray. As you spray it on the surface, some of it hits the target; most of it drifts away; and very little of it penetrates.”

17. Meta-Analysis of Media Health Campaigns on Behavior • Mediated health campaigns in the U.S. have small effect sizes in the short-term. ES = average correlations (Synder et al., 2004). • ES = .15 - seat belts • ES = .13 - oral health • ES = .09 - alcohol • ES = .05 - heart disease prevention • ES = .05 - smoking • ES = .04 - sexual behaviors

18. Meta-Analysis of Substance Abuse Campaigns(Derzon et al.,2002) • Substance Use ES = .036 (pre-post) • Knowledge ES = .049 (pre-post) • Attitudes ES = .024 (pre-post)

19. Mass Media Effects on Substance Using Behaviors

20. Summary of Mass Media Benefits (Crano, 2002) • “…the results do not suggest that the mass media represents the magic bullet…which will end drug-abuse in adolescents…” • “…most media researchers today recognize that the media alone are not likely to turn the tide of drug abuse…” • “…mass media are better viewed as part of an arsenal of weapons that may be directed at the problem.”

21. Recent Promising Findings • The National Legacy Foundation launched a national “truth” anti-smoking campaign for youth – 2000 to 2002. Costs: $100 M per year with paid media ads. Based upon effective “truth campaigns” in Fl, Calif, Mass., etc. • Truth ads were hard hitting to reveal deceptive marketing by tobacco industry, e.g. promoted only glamour of use; ignored: multiple causes of death; nicotine addiction, targeting teens to replace dying adults.

22. Truth Campaign (cont.) • Hersey et al. (2005) reports on a national random digit dial phone survey of 16,000 youths 12-17 (before, 8 months and 15 months after launch) that youths in television markets with higher campaign exposure by comparison had: • Significantly more negative beliefs and attitudes about tobacco industry; lower intentions to use, and lower receptivity to pro-tobacco ads and marketing practices, e.g. brand merchandise, etc.

23. Truth Campaign (cont.) • Farrelly et al., 2005 reports a dose-response relationship between exposure to truth ads and youth smoking prevalence. • The study compared Gross Rating Points (GRPs) for the truth campaign in each of 210 U.S. television markets for schools in those markets that were involved in MTF 1997-2002 (MTF controls –1997-1999).

24. Truth Campaign (cont.) • Farrelly et al., (2005) reports that: • Smoking prevalence for youth in grades 8, 10, 12, declined on average from 25.3% (1999) to 18%(2002) with the largest decline occurring for 8th graders. • Exposure to the “truth campaign” accounted for 22% of this decrease in smoking prevalence. • The decline in prevalence as of 2002 was equivalent to having 300,000 fewer youth smokers as a result of the truth campaign.

25. Recent Promising Findings: In-School Media + Community • In a national RCT, Slater et al. (2006) tested in middle schools a media program (print, posters, T-shirts, book covers, water bottles) with the positive theme of “Be Under Your Own Influence” in combination with related community activities. • Findings: Dramatic and significant drug reductions were reported for treatment vs. comparison students. • OR – Marijuana .50; Tob. .49; Alcohol .40

26. Mass Media+School Programs • In a RCT (1997-2002) with 45 high schools and feeder schools, Longshore et al. (2006) tested the effects (on 9th graders) of ONDCP’s Anti-Drug Campaign in combination with a drug prevention program - ALERT Plus (in 7th and 8th + boosters 9th and 10th). • Findings: 1) Sign. lower monthly marijuana for ALERT Plus “and” weekly exposure to ONDCP’s media campaign - synergistic effect; • 2) No comparable main effects for ALERT PLUS or ONDCP’s media campaign.

27. Mass Media and High Sensation-Seeking Youth • Palmgreen et al. (2005) reports on an “interrupted” time-series analysis of exposure to ONDCP’s media campaign (Marijuana Initiative) in two counties in Kentucky (Oct. 2002 –June 2003) that compared High Sensation-Seeking (HSS) vs. Low Sensation-Seeking youth (LSS). • Findings: 1) Sign. reductions in 30 day marijuana use for HSS teens; 2) Sign. increase in perceived negative consequences of marijuana (HSS); 3) No campaign effects for LSS.

28. 30-day Marijuana Use Regression Plots for HSS and LSS Youth

29. Mass Media for Youth + Parents (NSDUH Report, 2005) • In 2003, 14.6 M youth 12-17 (58.9%) talked with parents over the past year about the dangers of tobacco, alcohol, or drug use. • Youth who talked with parents were sign. less likely to report past month alcohol use, binge drinking, and illicit drug use. • Youth who reported seeing anti-drug media messages over the past year were sign. less likely to report past month binge drinking and illicit drug use.

30. Dual Mass Media – Youth and Parents: ONDCP’s Campaign • Major Goals: 1) enable youth to reject illegal drugs; 2) prevent initiation of marijuana; 3) promote drug cessation for occasional users. • 1998–2005, campaign costs = $1.325 Billion. • Dual Media Campaigns: 1) Youth (9 to 18); 2) Parents/Caregivers --- Westat’s evaluation of Phase 3 of campaign - September 1999. • Campaign: paid ads on TV+PSAs, radio, ads in magazines and newspapers, billboards, movie spots, video rentals; web site; press. • Partnership for a Drug-Free America--- media