Challenging Dogma - Fall 2009

Thursday, December 17, 2009

Anti-Steroid campaigns: Improvement Needed - Amanda Barbeau

Growing up, I remember hearing my teachers discuss the concepts surrounding body image disorders, and the horrifying coping mechanisms many young women engage in to battle these diseases – such as anorexia and bulimia. Conversations were always gender biased; “women have body disorders, brought on by heavy influences in the media, perpetuated by the strong pull of social acceptance amongst peers” in middle school and high school. The thought that men may also be strongly affected by the media to the point where they would chemically alter their physique never really crossed my mind. It wasn’t until I reached high school and college that I began to observe the shift from body image disorders solely being a female concern, to now also affecting males. I saw some of my male athlete friends morph through the changes brought on by steroids and performance enhancing drugs. They were perceivably larger in muscle mass, but they also tended to have lots of acne, mood swings, anxiety, depression, and the occasional “roid rage”. The wall in the weight room dawned the names of guys in my high school that could bench press certain high amounts of weight. With this kind of social motivation to be stronger, I would imagine it would be hard not seek something to get that extra edge; especially when most of your other peers are doing the same thing.
The emphasis towards bigger, faster, stronger on athletes in high school, college, and professional sports is a lofty one. It has already heavily infiltrated the professional sports realm with the controversy surrounding Barry Bonds and his dealings with BALCO (Bay Area Laboratory Co-Operative) and its owner Victor Conte. As a result of these indiscretions, Bonds new title as home run leader is overshadowed in controversy. For males active within the sports arena, it is hard to escape the flawless male athletic physiques plastered on ESPN commercials and practicing within the sports world. At present, male forms are likened to that of a Greek god – and almost as unattainable… unless you have a little bit of help from the pharmaceutical industry.
Once thought to be a problem surrounding only body builders and Gold’s Gym fitness buffs, the abuse of steroids have become more prevalent and widespread within our society. Some people are taking dietary supplements, and “performance enhancing drugs” (that are hormones acting as precursors for steroids, with the common misconception that these are “safer” than the traditional steroid), and others are taking substances that are classified as actual steroids. These are easily obtained either through the internet, at health food stores, and by mail order (Hoffman et al, 2008). 9th-12th graders are using them. College students are using them. And we all know that professional athletes are using them (Volkow, 2006).
According to a survey performed by the National Institute on Drug Abuse (2005), the annual prevalence of steroid use among males in 8th grade was 1.25%, 10th grade 2.25%, and 12th grade 3.25% and anecdotal evidence suggests that 20-90% of athletes are using steroids. In a survey conducted by Hoffman et al (2008), use of at least one supplement was reported by 71.2% of athletes surveyed. This included vitamin supplements and anabolic steroids. In 2007, the federal government seized 56 underground steroid labs in the U.S., resulting in the confiscation of 11.4 million doses (Ad Council, Anti Steroids, 2009). With the use of steroids being banned, the frequency with which performance enhancing drugs are used has increased. In colleges, students are using anabolic steroids earlier in their career, with over 40% of athletes using them while in high school and between 65-85% of intercollegiate students are using performance enhancing drugs (Hoffman et al, 2008).
The recent media attention surrounding the use of anabolic steroids and performance enhancing drugs within the world of baseball has certainly brought the steroid issue to the public’s attention. However, the use of these substances within the adolescent population for athletic or aesthetic purposes is of great concern, and one is left to wonder what the strongest catalyst has been for this rise.
The ad campaigns to address these issues:
In light of the recent media attention given to the sports world on the issues of performance enhancing drugs, and the evidence that these substances are being used among teens and college students, the Ad Council, and Major League Baseball and Partnership for a Drug Free American have launched ad campaigns to dissuade teens from the use of such substances (Studio Daily, 2006; Ad Council, 2009). Each campaign takes a separate approach to achieve the ends of this goal. Each designed to bring awareness, but focus on distinct frames - one combines shame and isolation, the other the traditional public health approach to educate about the harmful side effects resulting from steroid and performance enhancing drug abuse.
Most baseball fans remember the controversy surrounding the Barry Bonds home run record and his alleged use of performance enhancing drugs towards the middle and end of his major league career. His connection to BALCO and his “unknowing” use of the performance enhancing substance - “the cream” given to his trainer by Victor Conte, of BALCO was all over the media the past few years (Walker, 2009). As a result, his homerun record will forever be overshadowed by this allegation. The public and some sports historians have unofficially placed an asterisk next to his home run record, meant to symbolize that he is a fake within the baseball world, and it serves as a footnote alluding to his steroid use. This was likely the inspiration behind the Ad Council and the U.S. Olympic Committees launching of the “Don’t Be an Asterisk” campaign in 2008. This campaigns was designed to emphasize the notion that when you use steroids and performance enhancing drugs in sports, you will forever be followed by that shameful asterisk- to denote that you are in essence, a cheat, a fake, and a footnote of success if you use steroids and performance enhancing drugs (Don’t Be An Asterisk, 2009). The campaign has its own website, called Don’ where parents and student athletes can go to get information on the harmful effects of steroids, watch the public service announcement, hear testimonials from former athletes and Olympic stars, and read news articles about steroid and performance enhancing drug use. The public service announcement (PSA) itself is from the perspective of a high school jock, excelling at his sport as a result of steroid use; But as the ad progresses, you will notice that the success is bittersweet. Something that looks to be a pimple grows on his forehead for all his peers to see, and so does his secret of using steroids. The ad comes to a close with a fully developed asterisk right on his forehead, paired with the fully developed realization that he is a false success, facing his peers that now see it to, and look on in disdain. The concept behind this ad is to frame steroids as being socially unacceptable amongst adolescents through a negative message.
In contrast to the technique of the aforementioned campaign, but also influenced by heavy media attention on baseball and steroid use, is an ad designed by the Major League Baseball and the Partnership for a Drug Free America. It was launched in 2006 and targeted towards America’s youth and the adults that influence them (PDFA, 2006). This campaign is similar to the traditional public health ad approach in that it is designed to educate the public by emphasizing the health risks associated with the use of performance enhancing drugs and steroids. The tactic often used by ads designed to educate using a negative frame, can be likened to the “scare tactic”. One of the first and most popular ads released by this campaign was called “shrinking”; targeted towards males. The ad is described as taking a “proactive” approach, by showing a series of sports “balls” shrinking, as a narrator lists the negative physiological effects that are resultants of the abuse of these substances (PDFA, 2006). After the narrator lists how the use of these substances effect bones, muscles, and the major organs, it ends with “not to mention, something else it can do to a guys body”. The second ad, entitled, “Fade” shows a series of disappearing sports accomplishments as a result of steroid use. This ad was designed to galvanize adolescents and their parents to the risks of these substances. A third ad, called “Statue” portrays a crumbling statue as a narrator talks about steroids and the destruction of athletes, not the “building of them”.
The Ad Council and Partnership for a Drug Free America PSA’s differ in the concepts they seek to emphasize and the feelings they choose to elicit, but they are similar in their execution. Both campaigns use media to get their messages across – in the form of TV videos, print, and radio. Each also tries to incorporate the community, through various approaches. The asterisk campaign has created the interactive website, while the partnership campaign has recruited high school coaches to begin a poster campaign.
Critique of the campaigns:
To the untrained eye, these campaigns may appear to make an effective stab at combating the use of steroids and performance enhancing drugs, and enact the social change necessary to curb their use in the sports world. However, to the keenly trained public health professional, it is apparent that these campaigns will prove to be ineffective and unsustainable in the long run. Both campaigns are rooted in archaic health belief models that are stagnant and focus on individualism. And at the core of each campaign, the basics of marketing theory are violated.
The asterisk campaign appears to be rooted within the Theory of Reasoned Action. This theory holds its focus solely at the level of the individual, and leaves little room for environmental influences. It operates under the assumption that the individual weighs outcome expectancies and pairs them with what others think. Once these two parts are determined, a decision is made, and a behavior results. The Don’t Be an Asterisk campaign plays upon these two components. First, it focuses on ones attitude towards the outcome of using steroids. You can readily see that the character within the campaign is conflicted; he enjoys the acceptance and success, positive reinforcement from his peers, and social recognition, but guilt is looming closely behind. Then the campaign heavily emphasizes the perception of his peers– before and after knowing he used performance enhancing drugs. Prior to having knowledge of his substance abuse, peers are encouraging and congratulatory of his athletic accomplishments. However as the “Asterisk” keeps growing, their positive perception of his success begins shrinking. In the end, he stands shamefully before them as their cheers quickly turn into gasps of disgust and stares of disapproval. The character’s beliefs about not deserving this recognition (that he is a cheater, and a fake) paired with his peers thinking the same thing, should ultimately result in him (and the teens watching the commercial, making the same assumptions themselves) deciding not to use steroids, and thus not using them.
This campaign would yield success in a world operating within a vacuum, but in a dynamic world - a world constantly interacting and changing with the environment in which it operates, the campaign (like the model that it was built upon) will remain ineffective. Lacking the ability to be dynamic, the campaign does not take into account the environment in which many of these decisions to take steroids operate within. For example, a student may come from an extremely economically disadvantaged background, and the only option to rise above these stifling circumstances, are to go to college on an athletic scholarship. Facing those pressures, one may not see it as an option to not take substances to get that extra edge.
The MLB/Partnership for a Drug Free America campaign does not fare much better in effectively reaching its target audience. This campaign is operating under the assumption that its viewers – the adolescents using steroids and their parents- are making their decisions to do so guided by the health belief model. This model is similar to the model used in the Asterisk campaign in that it is an outdated health model focused on the individual acting as an agent separate from the world within which they operate. This model does not leave any room for social or environmental factors, it is irrational, and it does not explain any spontaneous behavior. It is based on the notion that individuals have perceived susceptibilities and severities to a health behavior that lead to perceived benefits to a particular health related behavior. This then interacts with perceived barriers, which leads to intention and thus a decision to do the behavior.
It is apparent that that the health belief model sits at the backbone of the “shrinking”, “statue”, and “fade” ads because each focuses on the basic physiological negative health risks associated with taking steroids and performance enhancing drugs. In essence, it’s assumed that adolescents will see the commercial and do a basic cost benefit analysis. E.g. they may ask themselves, “Is it worth it to tear tendons, break bones, compromise my heart and liver, just to get that little bit edge over my competition?... No, that doesn’t sound rational, therefore, I will choose to not take performance enhancing drugs” This sounds like a logical and simple decision to make, however, there are many outside factors that heavily influence this actually complex decision. Adolescents that take supplements or cycle anabolic steroids will most likely not see the negative effects of steroids so readily. Therefore, the adolescent mentality of “I’m invincible” and “it won’t happen to ME” is ever so emphasized within the context of steroids. Why not take them when all you see are positive results, and the negative results you keep hearing are far far into the future – if they even happen to you, right? This paradigm is in heavy conflict with the health belief model, and any campaign that decides to adopt it to change social behavior, will be appealing to those rationally cogent individuals (probably not likely to take steroids anyway), but will not appeal to adolescents.
In addition to both ad campaigns adopting outdated and constrictive health models to frame their anti-steroid message, they have not fully adopted the cardinal rules of advertising theory, which in the marketing world is sure to result in the inevitable failure of your campaign. Marketing theory requires two simple concepts: 1. the message must have a Promise, and 2. the message must have support for that promise. Promises of campaigns can be reduced to, “if you do this ____, then you will _____” statements. They illustrate the product and its benefits. Supports support the promise. This can be accomplished through telling a story, showing images the target audience can relate to, applying music, and giving metaphors and symbols for something else. These seem likes simple tasks, but in order to send the message you intend to send, one must portray the appropriate promise and appropriate support. For example, both campaigns make promises, and provide supports for them, but are these promises going to resonate with the target audience? The Don’t Be an Asterisk campaign promises that if you use steroids, you will have a large mark on your forehead that resembles the shape of an asterisk (supported by a story, music, and images of course). The MLB/PDFA campaign promises that if you use steroids, you will break bones, tear tendons, compromise heart and renal health, among other health risks (supported by metaphors of disappearing athletes, statues crumbling into pieces, and deflating/shrinking sports equipment). This seems closer to our goal, but the fundamental problem of whether or not adolescents can relate and adopt these campaigns to the point of enacting their own social change, remains.
Proposed Interventions:
Both campaigns have facets of more modern health belief models, so they are not complete failures. They just need a little bit of push in the right direction. The Asterisk campaign appears to make an honest try at the conformity model and social expectations theory – portraying the main characters peers as being disapproving of athletes who use steroids. However, it becomes un-relatable in the end when he has a large asterisk on his forehead. The MLB/PDFA campaign appears to be working towards the model of diffusion of innovations, by recruiting coaches at local schools to adopt the campaign, but is this the appropriate “early adopter” figure to foster the needed change? Neither PSA is a complete failure in its design, however, adopting the more modern health belief models, and slightly modifying the frame within which each operates, these campaigns can be dynamic and effect group behavior rather than simply individual. Furthermore, because these models take advantage of irrationality models, behaviors are more likely to change in a sustainable manner.
The modern public health model of conformity focuses on affecting change in groups of individuals at the same time. With steroid and supplemental use occurring among adolescents in high school and college, this group level of change is needed to have an effective PSA. The theory of social expectations/social norms change can also be applied to improve this campaign as it also employs group change on a massive scale. Furthermore, it takes into account the social norms present within that group, and changes those to effect change within the group. It’s apparent that for steroid use to be perpetuated, the current social norm within the world of athletics must consists of something similar to turning a blind eye to steroid use to get that extra edge in the game. If this current social norm can be re-framed, and steroid use is deemed socially unacceptable effectively, there will be a decrease in the use of steroids. The Asterisk campaign does attempt to do this by portraying the characters peers as being disapproving. However, the relate ability of the commercial is lost when he has an actual asterisk appear on his forehead. The campaign could benefit, by altering the way in which his peers see his steroid use. This could be done through changing the story to have one of his peers catching him using before the game. That peer could then tell other peers they caught him using, and the story would spread throughout school – as most high school gossip (true or untrue) perpetuates. The peers would react as they did in the original commercial. By portraying his peers reacting in this manner, the PSA is nudging its viewers to conform to the group of students portrayed in the commercial – not using steroids.
Diffusion of Innovations theory is also a modern public health model, aimed at group level change. This model has characteristic patters of change, and those patterns of change are catalyzed by the point at which some concept “tips” the momentum towards the point of change (Siegel lecture, 2009). The MLB/PDFA campaign has traces of this model in it. By taking its campaign to the community and recruiting coaches to adopt posters and the campaign at their schools, they are attempting to recruit those who play pivotal roles in these adolescent’s lives. However, more is needed to make this campaign a successful one in the long term. In order to have a diffusion of innovations theory, there needs to be effective messengers – referred to as “early adopters” (Siegel Lecture, 2009). Coaches are influential people in a teen’s life, however not as influential to adolescents as peers are (PATS Survey, 2008). Therefore, the real early adopters need to be influential peers within these academic institutions, and then transitioned to individuals who are highly influential that adolescents idolize - such as sports figures, followed by coaches, and then parents. Once this occurs, the diffusion of the anti steroids concept will perpetuate to its “tipping point”, and usher in the new age of making steroid use in sports socially unacceptable.
In order for any ad campaign to be successful and sustainable as a result, advertising agency’s stick to the cardinal rules of advertising theory. Traditionally, public health service announcements have stuck to the basics – limiting ads to the health risks or benefits of a particular behavior. These types of ads tend not to resonate with the public, are easily ignored, and overcome by heavily engrained human behavior. It’s not enough to simply list the health risks and benefits of a particular behavior, because it operates on an individualist level, utilizing an outdated health model. Human behavior is complex, and there are many outside influences to motivate behavior – social, environmental, as well as physiological. The advertising theory helps bring in all of these factors when designing effective ads.
Effective ads must make promises to their audiences, and give some support for the promise. The larger the promise made, the more effective the ad. The promise should also resonate with the target audience. E.g. if your target audience values small town feel, and family tradition, your ad should have that in its promise. Support can be in the form of an image or story, symbols and music. A combination of these is usually most effective. Neither the Asterisk ad nor the MLB/PDFA ads were absolute failures, because since these ads have aired, teens report having a greater understanding that steroid use is dangerous, perception of risk has increased and steroid use has decreased slightly (PATS Survey, 2008) but they could have benefitted from stricter adherence to the advertising theory.
The Asterisk campaign makes the promise that if you use steroids, your peers will be disappointed in you (effective), you will feel like a fraud (somewhat effective), your peers will see you as a fraud (somewhat effective), and you will develop a scared tissue like asterisk on your forehead (what!?). Now, the first three concepts seem to be effective promises, however, isn’t it better to make a positive promise, than a negative one? The last promise is so unrealistic, the momentum of influence the ad may have had going prior to that point was lost. These are the parts of the ad that need great improvement. Rather than framing this issue in a negative light, it should be framed in a positive light, with a relatable outcome. This can be achieved by telling a story from the perspective of an athlete deciding to be a rebel, go against conformity, by NOT taking steroids or performance enhancing drugs. The commercial would challenge its adolescent viewers to do the same (we all know how much teens love to rebel against convention and authority). The promise – if you DON’T take steroids, you will be considered a trail blazer, a rebel, and a non-conformist. You will also feel good about yourself knowing that you didn’t need a performance enhancing substance to excel in your sport – it was “ALL YOU”. In doing so, the Don’t Be an Asterisk Campaign should then be renamed the “All You” campaign; playing on the adolescent notion of self centrism.
The MLB/PDFA campaign reeks of health belief model. The promise made in this ad is strictly health related. However, if adolescents are taking supplements or cycling steroids, the health risks are not so readily seen, especially not early on. Most of the decisions to take steroids lie in the benefits accrued in the present – almost instant muscle gain, increased speed, and endurance. Delayed effects don’t happen until much later, and most males can easily get over the symptoms of acne, and roid rage for that college sports scholarship. The support is in the form of metaphors – which are actually quite representational. The “shrinking” ad – meant to represent testicle shrinkage, shows a series of shrinking sports equipment. This ad would benefit by calling greater attention to the positive promises of not using steroids, rather than focusing on the negative promises of using steroids. Furthermore, the ad would benefit by focusing on what is important to athletes (and adolescents in general) in the present – not the distant future. A survey or focus groups could be administered to teens to determine what they value in their lives, and as why anyone would decide to – or feel they need to- take steroids. These steps would make the campaign more sustainable, rooted in the core values of today’s teens. After all, to get a message through to a teen, you must think from the perspective of a teen. Furthermore, it is important to incorporate the community as an intervention in conjunction with these advertising campaigns, to reinforce the issues presented in the ad. According to a community based intervention designed to decrease steroid abuse, Teens who participated in the Adolescents Training and Learning to Avoid Steroids (ATLAS) program had less belief in media promoting anti-steroid use, among other positive anti-steroid conceptions (Goldberg et al, 1996).
The media plays a large role in our lives as we are almost constantly bombarded with images and advertisements. It would be foolish to say it doesn’t nudge our behavior in some way, or shape concepts we hold for ourselves. It makes sense then to take an advertising approach to decreasing the use of steroids, as it effects a wide population of people in a short amount of time. However, it is important to remember that when designing these advertising campaigns, such as the Asterisk campaign and the MLB/PDFA campaigns that we keep in mind the complex social and environmental underpinning of behaviors.
By using modern group level models and the advertising theory to guide our design processes when creating these PSA’s, we can more effectively reach the teen population. Knowing teens, and knowing their motivations behind taking steroids will elucidate the complex socio-behavioral world they operate within. If this can be accomplished, we can all look forward to a sports future free of steroids and performance enhancing drugs.

Works Cited
Ad Council, Retrieved December 3rd, 2009 from
Don’t Be an Asterisk campaign website, Retrieved December 3rd, 2009 from
Hoffman, et al (2008), National Supplementation and Anabolic Steroid Use in Adolescents, Medicine & Science in Sports and Exercise, Journal of the American College of Sports Medicine, January 2008 - Volume 40 - Issue 1 - pp 15-24 doi: 10.1249/mss.0b013e31815a5181
Linn Goldberg, Diane Elliot, Gregory N. Clarke, David P. MacKinnon, Esther Moe, Leslie Zoref, Christopher Green, Stephanie L. Wolf, Erick Greffrath, Daniel J. Miller, and Angela Lapin, Effects of a Multidimensional Anabolic Steroid Prevention Intervention: The Adolescents Training and Learning to Avoid Steroids (ATLAS) Program, JAMA, Nov 1996; 276: 1555 - 1562.
MLB and the Partnership Launch Second Phase of Anti-Steroids Initiative, The Partnership for a Drug Free America, March 20, 2006, News Release, Retrieved December 3rd, 2009 from
Partnership Attitude Tracking Study (PATS) – Teens 2008 Report, Partnership for a Drug Free America, February 26, 2009, pg. 12
Studio Daily; Press Release, Anti-Steroid Campaign (watch), Retrieved December 3rd, 2009 from
Volkow, Nora D., Research Report Series – Anabolic Steroid Abuse, National Institute on Drug Abuse (NIDA research report series), National Institutes of Health, August 2006, 06-3721
Walker, Ben, ATHLETE OF THE DECADE: Like him or not, Bonds drew all eyes – and MVP votes, The Canadian Press, Retrieved December 8th, 2009 from

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