Challenging Dogma - Fall 2009

Thursday, December 17, 2009

Critique of Partnership for a Drug-Free America’s Anti-Crystal Meth Campaign Targeting the Latino Community – Ramon Gómez

In 2001, Latinos surpassed African Americans as the nation’s largest minority. Today, Latinos account for roughly 15% of the United States population and the number is expected to grow since 63% of Latinos are below age 34 (1).

Corporations are eager to target this demographic since future growth of a company’s sales and market penetration will depend on how well they are able to understand this segment and built brand loyalty (2, 3). Public health practitioners must also get to know this demographic intimately in order to effectively tailor interventions. While the Latino community faces many of the same health issues that are of concern to the broader population, health disparities mean that they suffer from a disproportionate burden of disease and also have fewer resources to address these needs (4).

As corporations have grown to understand the Latino community better, they’ve tailored ad campaigns that break through cultural and language barriers. The most successful firms have learned how to tailor messages that speak to the Latino experience. Unfortunately, many public health organizations have not sought to similarly understand the Latino community in order to best tailor interventions. Some public health messages written and produced in English are translated into Spanish with the assumption that the word-for-word message will be just as effective in Spanish. For example, the U.S. Department of Health and Human Services recently launched a Shrek themed “Be a Player” anti-childhood obesity campaign in 2007. To target the Latino community, HHS simply translated the same ads into Spanish (5). Direct translation into Spanish may seem beneficial when an organization is working with a limited budget (6). Although such approaches are cost effective in the short term, they are not so in the long term. Direct translation of public health announcements into Spanish are an inefficient use of an organization’s limited resources because the messages won’t resonate with Latino values, aspirations, or experiences.

In this paper, I will critique an anti-crystal meth public health campaign targeting the Latino community. I will discuss how the ads in the campaign, although not a direct translation from English to Spanish, are equally ineffective because they demonstrate a lack of understanding of the Latino community and speak to the experiences of a community that is almost exclusively non-Latino.

Partnership for a Drug-Free America – A Través del Cristal Meth
In the summer of 2009, The Partnership for a Drug-Free America launched A Través del Cristal Meth, a public health intervention campaign aimed at educating Latino parents and youth about the dangers of crystal meth use. The Partnership cited research that identifies crystal meth use as a growing concern for the Latino community. 1 in 3 Latino youth reports having a friend that uses crystal meth. Almost half of Latino youth don’t see great risk in using crystal meth (7).

The campaign’s goals are to provide the community with tools necessary for combating this growing threat. The campaign’s website provides online education and training tools as well as the personal stories of Latino teens that have battled addiction and recovery. The cornerstone of the campaign is a set of television ads aimed at educating Latino families and youth on the dangers of crystal meth use. The current campaign consists of four public health ads. Links to the videos and brief descriptions for readers who don’t speak Spanish are below.

A Través del Cristal Meth – Ad Campaign Videos (8)
Crystal Meth Doll - Video
This video depicts a doll being lowered into a vat of an unidentified liquid. While submerged in the liquid the narrator asks, “What happens when you use crystal meth?” As the doll is pulled out of the liquid, she is disfigured, burned, and damaged. The narrator confirms that crystal meth use will burn one’s body, physical and mental health, and one’s life.

Crystal Meth Latina Teen – Video
This video depicts an interview with a Latina teen in a public park. Most of her face and body is covered with large sunglasses, a scarf, and a long sleeve blouse. She admits to using crystal meth recreationally with her friends and boyfriend but she denies being addicted and downplays the extent to which she is dependent on the drug. As the interview progresses, an unidentified woman removes her sunglass, scarf, and blouse to reveal lesions on her neck, face, shoulders, and arms, presumably from crystal meth use.

Crystal Meth Lab - Video
This ad takes the viewer into a dark basement where crystal meth is presumably produced. We are shown a dirty unattractive location and a poisonous-looking assortment of chemicals used in crystal meth production. The video is designed to look like an undercover video shot in a real meth lab. An ending caption warns the viewer that what you typically don’t see is what you’re getting when you use crystal meth.

‘You Helped’ Crystal Meth – Video
This video reads like a Mad Libs commercial for parents with a teenager experimenting with crystal meth. It presents a story with one beginning and two possible plots and endings depending on how a parent chooses to address their teen’s growing crystal meth problem. In one scenario, a parent chooses to talk to their teen about drug use and associated dangers. The teen goes on to earn high marks in school and becomes successful. The second scenario is one in which a parent chooses to fight with their teen. The teen continues to experiment with crystal meth, gets arrested at school, and throws his life away. Both stories end with the caption Tu Lo Ayudaste (You Helped), meaning that the parent is ultimately to blame for the success or failure of their son.

Critiques on the Overall Campaign
The Partnership should be applauded for identifying a public health issue relevant to the Latino community. Corporate America has begun to market to this demographic because it represents a growing portion of their customer base. Similarly, public health organizations have also begun to address the public health needs of this community in a targeted way. The Partnership shied away from directly translating English-language advertisements from the mainstream anti-crystal meth campaign into Spanish.

However, by neglecting to understand the Latino community in developing its anti-crystal meth message, the campaign believes that a cookie-cutter approach that replicates mainstream anti-crystal meth messages will be effective in the Latino community. The campaign has numerous flaws, including employing an individual-level intervention for a community-wide problem, assuming that decision-making is rational, and making use of traditional health behavior models such as the Health Belief Model. However, I will focus my criticisms on those aspects of the campaign that make it a poor example of public health marketing, mainly by failing to understand three important elements of the Latino community, the campaign’s target market.

First, the delivery of the campaign is flawed because it ignores the digital divide in the Latino community as ignores the effectiveness of informal immigrant social networks in information sharing. Second, the campaign overlooks the cultural values held by Latinos in parenting techniques as well as the important role of the extended family in the lives of Latino teens. Last, barriers that prevent the Latino community from addressing public health concerns are ignored.

The current A Través campaign is largely based online with some television presence in Spanish-language television. Some educational materials are only available online if one signs up to receive email correspondence from The Partnership (29, 30). Because of the digital divide and lower levels of computer literacy, the anti-crystal meth campaign would be most effective with enhanced visibility in the community (31).

Cultural Values in Latino Parenting
A lack of cultural values in Latino parenting is apparent for two reasons. First, the campaign ignores the realities of parent-child relationships in Latino families. Second, the campaign ignores the important role that the extended family and even community members play in the upbringing of a child in a Latino community.

Realities of Parent-Child Relationship in Latino Families
The “You Helped” video was the only video that spoke exclusively to parents. The ad encourages parents to talk to their teens at the first sign of a drug problem. Building a relationship of trust, understanding, and friendship can empower a teen to avoid drugs and focus their attention on attaining academic success. (9)

Although second and third generation Latino Americans adopt many mainstream American values and traditions, most Latino parents are first generation immigrants (10, 11). Latino families, particularly those headed by parents born in Latin America, are very hierarchical where children (no matter how old they are) lack autonomy (12, 13). Parents (usually the father) are the ultimate authority in decision-making and rule-setting (14). Parents rarely develop partnerships or “friendship-like” relationships with their children that would facilitate the discussions suggested by this ad. In addition, research suggests that acculturation of Latino youth into mainstream American culture further divides them from their parents (15).

While an authoritarian style of parenting may be valued and effective in Latin America, teens raised in the United States are influenced by the broader American culture that values freedom, autonomy, and a healthy level of youthful rebellion. Rather than submit to these American values, Latino parents are more likely to raise their children similarly to the way they were raised. If The Partnership believes that parent-teen communication is the best method for preventing crystal meth use in the Latino community, the A Través campaign neglected to build the necessary community acceptance of this non-Latino value.

If The Partnership had taken the steps necessary to better understand the Latino community, its values, and its challenges, they would have included a communication skill-building component in the intervention. Instead, The Partnership assumed that this community is part of a broader homogenous American culture that faces specific population health concerns simply because of a language barrier that keeps them uninformed.

In order for Latino families to effectively speak with their teens about drugs, the entire Latino parent-teen relationship must be changed. Parents will need to give up some of their authority and share this with their children in order to build a baseline level of trust and friendship necessary for teens to listen to their parents.

The Role of the Extended Family
Further research would have demonstrated that the Latino family extends beyond parents (16, 17). The campaign is focused on the individual and ignores the importance of community and extended family as an influential support system for Latino youth. Distal relatives such as grandparents, aunts, and uncles have some degree of parental authority that’s rarely seen in mainstream American families. Having a broader pool of adults to intervene in a teen’s drug-related decisions provides an opportunity that The Partnership overlooked.

This is apparent in the “You Helped” video. In this video, parents are blamed for their child’s success and/or failure. The extended family (much like in mainstream American families) shares none of the blame or responsibility. The other three videos in the campaign speak directly to Latino youth and not to other members of the community.

By choosing to target just youth and their parents, the campaign equates Latino culture with mainstream American culture in which youth value their and freedom and independence and parents bear the sole responsibility in setting limits on that freedom. Distal relatives are ignored and a baseline level of parent-youth “friendship” and trust is assumed.

Latino Community Barriers to Addressing Public Health Problems
Similar to the 5 A Day fruits and vegetables campaign and efforts to curb HIV infection and transmission in the gay community discussed in class, the A Través campaign assumes that telling someone not to do something will be enough to make them do it (19). Without considering language barriers and the effects of poverty on individual and community self efficacy, such an approach is wishful thinking.

Language Barriers
A little over 50% of Latinos who reported speaking Spanish at home, many of whom are first generation American, reported speaking English “less than very well”. Close to 28% of Latinos, most of them younger second generation Latinos, reported not speaking Spanish at all or not well (20). Language barriers may prevent parents from speaking with their teenagers when teenagers are not comfortable speaking Spanish and parents are not comfortable with English. Although many Latino youth are bilingual, most are most comfortable with English, especially with their peers. Therefore the interview with a Latina teen speaking in Spanish about her crystal meth addiction targets are small percent of Latino youth.

The Effects of Poverty on Self Efficacy and Community Efficacy
Latino households are of lower socio-economic status than the average American household. Thirty eight percent of Latinos age 25 years or older have not graduated from high school (21). Twenty three percent all Latino families are at or below 100% of the federal poverty level. Just over forty percent of women-headed Latino households are 100% below the federal poverty level (22). Roughly thirty four percent of Latinos were uninsured in 2008 (23). Consistent with a community with lower incomes and lower levels of education, Latinos are more likely to have more than one job in order to meet regular household expenses (24).

The Partnership’s A Través campaign did not take these realities into account. Communication and relationship building is made more difficult in the Latino community if parents are working multiple jobs and have elevated stress levels brought about by poverty, racism and discrimination, and sometimes even their own drug or alcohol addiction (25, 26, 27). The video depicting a doll being dipped into an unidentified liquid (a throwback to the This is Your Brain on Drugs campaign) and the video of a secret meth lab-basement were generic and not tailored to a Latino audience. Latinos living in poverty, coping with depression, stress, or other mental conditions are unlikely to have the self esteem or self-worth necessary to reject crystal meth based on its physical effects or chemical composition (28).

The Doll and Meth Lab videos wrongly assume that people will make rational decisions about their health. But poverty and institutional racism over time can drain an individual’s and a community’s self-efficacy which can impede a person’s ability to make rational decisions that are in their best self-interest in favor of potentially harmful behavior. . To present a public health intervention in simplistic terms is unwise when one is targeting a community that lacks individual and community resources. For non-English speaking Latino parents living in poverty, the “You Helped” video lacks an empowering message and may only reinforce feelings of hopelessness and despair. For Latino parents who find it difficult to communicate with their teens while coping with everyday life, the message in the “You Helped” video would be interpreted as “It’s Your Fault.”

Developing a Latino-Focused Anti-Crystal Meth Campaign
An enhanced anti-crystal meth campaign would be tailored to the Latino community by containing three Latino-centric elements missing in the current A Través campaign:
1. Understand the digital divide and leverage Latino-based resources to deliver crystal meth education
2. Rather than fight engrained cultural parenting values, identify existing cultural moments as ideal “teaching moments” for parents to communicate with their teens. Encourage and empower extended family and community members to fill the gaps when language or cultural barriers cannot be overcome.
3. When societal and social factors impede a community’s ability to support one another, community organization’s ability to deliver ant-crystal meth message must be enhanced.

Using these three themes, I would develop a holistic approach to an anti-crystal meth campaign for the Latino community consisting of two components: an ongoing public education campaign and a parent-child communication improvement initiative.

Leverage Latino-based Resources to Deliver Crystal Meth Education
The major differentiator between this new educational campaign and The Partnership’s A Través campaign is an increased likelihood that the message will reach its intended audience.

In order to reach the intended audience, the appropriate mediums must be employed. Although the internet allows for a message to be communicated worldwide, many Latinos do not have home internet access and many Latino parents don’t understand how to use the internet.

Unlike mainstream American communities, news in the Latino community spreads through more traditional and informal channels such as newspapers, radio, and even word of mouth.

In order to keep costs low, the campaign would strategically place anti-crystal meth educational messages in communication channels of key cities. Certain cities and regions have large clusters of Latino communities. Because Latinos have extended family members living and working in multiple cities, money, news, and information travels quickly and often. Thus the Latino community is a cultural community rather than one that’s bound by geographic borders. Such a dynamic lends itself to the nudge theory and social influence theory lessons (32).

Working Around the Engrained Latino Parenting Style
Fostering Parent-Child Communication Through Existing “Teachable Moments”
An anti-crystal meth educational campaign that does not teach parents how to use this information to discourage crystal meth use will be just as effective as no campaign. Because language and cultural barriers prevent Latino parents from speaking with their teens about drug use, the revised campaign would consist of a long-term initiative to improve parent-child communication. Effective parent-child communication regarding drug use can reduce the risk for Latino adolescent drug use (33, 34).

In an enhanced campaign, social service agencies will teach communication techniques tailored to the Latino experience. For example, Latino immigrant families with low levels of American acculturation have strict gender roles. These roles, along with cultural traditions, are learned and passed down from parents to their children. These teaching moments, already engrained in the culture, provide the ideal medium for parents to open discourse around drug use with their children (35, 36). According to Tipping Point theory, over time, new community standards will be silently adopted that will integrate parental drug use conversations into the Latino cultural experience without attempting to disrupt existing and engrained parental values.

Empower Extended Family and Community Members to Fill Gaps in Parent-Child Communication
Because a cultural and language barrier exists between many Latino parents and their children, an effective campaign would have to engage the entire community, especially those that interact with youth on a daily basis such as educators, clergy, law enforcement, coaches, and especially their peers.

According to the Theory of Reasoned Action, people are likely to consider what others will think of a decision and the importance of these opinions. Cultural barriers to parent-child communication are easier to break down if language barriers don’t exist. But as previously stated, immigrant and first generation Latino parents are finding it difficult to communicate with their children.

For the many teens that experience a language barrier between themselves and their parents, other community leaders will have to step in and fill the gaps. This will be easier to do in the Latino community than in other American cultures because of the role the extended family plays in the upbringing of a child. In addition, informal social networks should be included in an outreach campaign to empower more adults to talk to Latino youth about drug use.

The role that numerous adults play in the upbringing of a Latino youth has important public health policy implications for interventions such as an anti-crystal meth campaign. Most importantly, public health interventions targeting this community will have to empower not only parents to build stronger parent-child communication skills, but also other adults in the community, including those that have no children.

Enhanced communication is the cornerstone of this enhanced campaign. Public health professionals need to learn how to effectively target Latinos through improved understanding of this community. Parents must also learn that communication with their teens regarding drug use is not a threat to their authority as parents. Community members must also remember that they will continue to play a role in the upbringing of youth in their community.

But racism, poverty, and discrimination will impede a community’s ability to support each other. In this case, community organizations will play an important role in delivering and spreading the enhanced parent-child communication Gospel. These organizations are best able tio to deliver this message because it is more easily meshed into existing community support programs.

Campaign managers would recruit key influential community leaders who already provide advice and support to Latino parents and extended family to promote the proposed parent-child communication improvement initiative. Community leaders will integrate the communication improvement initiative lessons into existing social and human services already provided to the community. Agencies that already deliver social and human services to Latino communities must reinforce the benefits of fostering regular communication between Latino parents and their teens.

A major shortcoming of the Partnership’s A Través campaign is its lack of understanding of Latino culture and values. Unlike for profit corporations that invest heavily in understanding the Latino market, public health organizations continue to operate under the assumption that the only things separating Latinos from better health are a lack of education and a lack of English.

Given the exponential growth of the Latino population in the United States and the health disparities experienced by this community, the inability to develop effective Latino public health interventions will likely mean increased burden of disease and an increased societal burden of healthcare costs. Rather than working against well-established cultural norms and forcing Latino parents to adopt a new parenting style, the new campaign would encourage parents to use existing cultural teaching moments to talk to their children about drug use. Over time this would help to address many Latino-specific disparities, including the growing prevalence of crystal meth drug use among Latino youth.
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