Challenging Dogma - Fall 2009

Monday, December 21, 2009

Parents: The Anti-Drug – A Critique and Rethinking of Parent-focused Anti-Drug Campaigns

– Kevin Delaney

Introduction

The United States government has long sought to control and eliminate drug use by its citizens, particularly by adolescents. Traditionally, this has been done through the criminal justice system, in the announcement of the “War on Drugs” by President Nixon in 1971 (1). These efforts focused on instituting harsh penalties on users of drugs, hoping to create a strong negative incentive, by which users would rationally choose to abstain. However, over the last thirty years, there has been a move to use public health initiatives to accomplish this goal. The anti-drug messaging ramped up in the 1980’s with Nancy Reagan’s “Just Say No” campaign and the establishment of the D.A.R.E. campaign, two public health initiatives to reduce and eliminate drug usage amongst teenagers that showed limited effectiveness (2,3). These measures focused on creating awareness amongst teenagers of the health risks of drug use through education, and focusing on kids making rational choices. However, particularly with the D.A.R.E. campaign, the emphasis was still on the negative incentives of drug use, as the education program is done in conjunction with local police forces (4). Recently, the federal government’s initiatives have focused more on the social aspects of teen drug use and acknowledging the strong social forces that influence it.

In this vein, the government has created the “Parents: The Anti-Drug” campaign. This initiative is aimed at taking advantage of the parent-child relationship to curtail drug use: “TheAntiDrug.com was created by the National Youth Anti-Drug Media Campaign to equip parents and other adult caregivers with the tools they need to raise drug-free kids” (5) Since parents are so integrally involved in the lives of their children, it would make sense to use them as a resource for anti-drug messaging. In addition, parents have a natural incentive to protect their children from the harmful effects of drug use. In a lot of ways, this initiative makes good sense. Indeed, there are studies that indicate that the level of monitoring that parents perform does have mitigating effects on their children’s drug use (6). However, when viewing this campaign within the framework of certain behavioral theories, the claim of parents being the “anti-drug” is exaggerated, and the potential effectiveness of this campaign is dubious.

Peers Have More Influence Than Parents – Social Expectations Theory

Despite the wishes of their parents, teenagers are often much more influenced by the behavior of their peers than the rules or guidelines of their parents. A constant theme throughout history is the adolescent who acts out against the strictures of his parent: the rebellion of the child. This social phenomenon, while causing much angst to the parents of America, has its roots in a well-established behavioral construct: social expectations theory.

While most of the population of the United States believes that freedom and autonomy guide their decisions, and that rational choices can be made, there is a lot of evidence that human behavior is as much determined by the social environment of the group as by the inner thought processes of the individual. Within society, social norms, roles and expectations guide how people make decisions. “Roles permit people acting collectively in a coordinated manner to accomplish goals that could not be achieved if each member acted independently” (7). Indeed, it seems that socialization is an adaptive trait that enhanced the evolution of humanity. However, it can have some maladaptive qualities.

Within the context of teenagers and drug use, there are powerful social dynamics that make drug use more common. As teenagers create social bonds, they do so in schools with their age-stratified cohort. As anyone who has survived the American high school experience can attest, cliques arise, within which there are heavily stratified social roles. Some members have a powerful role and set the norms of the group, whereas others strive to mitigate their dissonance from the group by performing compliant behavior (8). As drugs are seen as a dangerous and “bad,” they become the way that teenagers are allowed to rebel against their parents. From there, social dynamics take over. The powerful of the group can set the agenda for the others by using drugs. The members of the group that react in a compliant way will either feel overt pressure to take part, or will do so without any prodding. The influence of the peer taking precedence over the influence of the parent in drug use has been well established (9)

Within this social dynamic, there is no role for the parent. They are generally not part of the social group, and therefore do not have much influence over the behavior during the time that the group is using drugs. In fact, while at home, teenagers can perform an entirely different role within the family social group, one that can be entirely dissonant to the role within the peer group. Because of this, the Parents: The Anti-Drug” has major barriers to overcome to be effective. The campaign’s main drive is to communicate to parents to take a more active role in their child’s lives, which is supposed to result in decreased drug use. The main tool is a series of commercials reminding parents of their role. There is also a website that gives parents a lot of information about drugs and advice about how to talk to their kids about drugs. While this information is critical for any parent to know, there is only little mention about how influential the social interactions that teenagers have within their peer groups. There is a section of the website devoted to chronicling the “pressure to fit in,” but there is no mention of what to do about it (10). The only advice that parents have to relate to their teenagers is to learn how to “talk teen.” However, this advice can backfire if parents attempt to transform their social role from parent to friend without authenticity (7).

Marketing the Anti-Drug Message to Parents Subverts Teenager Autonomy

Another potential misstep by this campaign is that it has the potential to communicate the wrong values to teenagers. The tenets of marketing theory hold that in order for a messaging campaign to be successful, it must appeal to the values of its target audience (11). In the “Parents” campaign, the target audience is the parent. In this respect, the campaign is successful, in that it appeals well to the values that parents hold: that they are integral to the behavior of their children. By making parents feel that they have some level of control over the drug use of their children, the campaign gives them hope and should be successful in getting parents to have a greater level of involvement in their children’s lives. This will no doubt have a certain level in reducing the drug use of children, as there is evidence that decreased parental monitoring of children is associated with increased health risk behaviors (6).

However, this has the large potential to backfire in the true intention of the “Parents” commercials, which is to curtail the drug use of teenagers. While parental monitoring does have an effect on the behavior of teenagers, as mentioned above, the effects of peer groups have a larger effect on these behaviors (9). In addition, teens strive to increase their autonomy as they get older. In fact, this desire for autonomy is a crucial factor in their rebellious behavior: teens can demonstrate their autonomy by acting in a way that their parents forbid. Most of the marketing messages that are aimed at teenagers by consumer product companies create a feeling of freedom and autonomy in the brands. The strength of the “truth” anti-smoking campaign was in its ability to portray tobacco companies as agents of control over the lives of teenagers. The “truth” brand was successful in creating a feeling of rebellion against tobacco companies and smoking (12). The “Parents” commercials may have the opposite effect, as there should be no doubt that teenagers see these messages on television. While they are aimed at parents, teenagers may associate their parents as agents of control over their decisions to use drugs.

The Campaign Communicates the Wrong Message of Who Controls Drug Use

Closely associated with the other two failings of this campaign is the issue of control, which is a subtle relation to autonomy. By marketing the concept of teenage drug use to parents, the campaign ignores the role that teenagers have in controlling drug use. It puts the decision to not use drugs in the purview of parents, who are in a different social group, so that teenagers have no control over it. This creates an incentive problem for teenagers to participate in their own abstinence from drug use. As Langer writes in explaining the illusion of control, “[p]eople are motivated to control their environment” (13). In fact, the issue of control is very often a motivation for teenagers to begin using drugs, as it is one way that they can express their personality.

Children have very little legal standing, as they are the responsibility and the dependents of their parents. For very good reasons, parents control a lot of what their children do. However, teenagers most likely do not understand this legal argument, and only understand that they are not in control of many aspects of their lives, as many decisions are made for them. Therefore, the areas that they can control are very important to them. This is why teenagers focus a lot of energy on their friends and their personal products. The decision to use drugs is also an area that they can manage. Therefore, using drugs in reaction to their parents’ wishes is a way to feel that they make their own decisions. Even though, as mentioned above, people make their decisions within a social context, they still feel as if they are autonomous. By communicating to parents, the campaign inadvertently subverts the autonomy of teenagers and bypasses them in the anti-drug message.

Currently, the National Youth Anti-Drug Media Campaign, which is run by the Office of National Drug Control Policy and is in charge of the “Parents” campaign (14), has a concurrent marketing message named “Above the Influence” (15). This campaign is geared towards teenagers and attempts to use the tools of social networking that they utilize in their peer groups. While there are some good items on this website, and in this campaign, the intervention can be strengthened. Mostly, this website focuses on giving teenagers information about what to do with friends who use drugs and empathizing over the pressures that they face:

Our goal is to help you stay above the influence. The more aware you are of the influences around you, the better prepared you will be to stand up to the pressures that keep you down. We're not telling you how to live your life, but are giving you another perspective and the latest facts. You need to make your own smart decisions.

You might even consider this Web site an influence. We know that you're very smart when it comes to the messages you see and hear. That's great and you should question us, too. One way to do that is to review our sources. The numbers at the end of many of the facts are footnotes. You can click on them to find out where we got the information. (16)

Unfortunately, this website and the concomitant ads still rely on the messaging that drugs are bad and for teenagers to make individual decisions based on facts. While this may appear to give teenagers a level of control, it relies on the individual health belief model to weigh choices (17). It doesn’t offer a social solution to replace the feeling of being part of a group and controlling the social outcomes of losing the control of drug choice.

The Proposed Intervention

In order to effectively combat teen drug use, teenagers need to feel empowered to make decisions that affect their lives, and given the autonomy to do so. In addition to this, the aspects of social interactions amongst teenagers need to be incorporated in any campaign. In a paradoxical way, the empowerment of teenagers to control their decisions has to be created at the group level. Therefore, the proposed intervention will be a social media campaign that is focused on reaching and targeting the intended audience: teenagers. It will act as a revision of the “Above the Influence” campaign and will supersede the “Parents” campaign. Instead of targeting parents, which might have a deleterious effect, the campaign will be a positive outreach effort that will take advantage of the social roles and norms that occur within teenage groups. In addition, the campaign will attempt to create a movement using social networks to make the anti-drug message a “teen thing.”

Utilize Social Norms and Roles To Propagate Anti-Drug Message

As mentioned above, Social Expectation theory states that individuals often make choices based on the roles and norms of the group of which they are a part. The traditional method to combat teen drug use, which is utilized by the “Above the Influence” campaign, is to enable teens to stand up to these roles and norms. In other words, teenagers should break out of the role of reactance behavior and make an active decision based on facts that agencies provide. Unfortunately, while this approach may be laudable, it will have limited effectiveness, as it is asking teenagers to go against their natural instincts. Instead, public health agencies should use those instincts in their campaign.

In a study conducted to research the social dynamics of smoking, researchers found that social networks play a large part in health behaviors, both in the decision to smoke as well as the decision to quit. “This finding suggests that decisions to quit smoking are not made solely by isolated persons, but rather they reflect choices made by groups of people connected to each other both directly and indirectly at up to three degrees of separation” (18). This dynamic should be used in crafting a mechanism for an anti-drug campaign. If the members of the social group that set the agenda are recruited into a potential anti-drug movement, then there will be a cascading effect through social groups. In the smoking cessation study, it was found that “connected clusters within the social network stopped smoking roughly in concert” (18). This effect can be duplicated if social networking sites are used to bring in entire groups into the movement. As upperclassmen in high school have a large influence on the social norms on younger students, there should be sponsored programs that recruit seniors for this message. In addition, key media influencers, such as teenage movie stars, should be recruited to be a part of this movement. Of course, this has been used in the past to convince kids to not use drugs, so the actual messaging is very important.

Create a Movement that Emphasizes Freedom and Autonomy

Simply putting out a traditional anti-drug message will not work any better, even if it is using modern social networking sites. Therefore, the message needs to change. Traditionally, anti-drug messages have focused on how bad drugs are for kids, e.g., the brain on drugs message. While this is true, these scare tactics have not been effective, and should be abandoned. Using Marketing theory, a movement emphasizing freedom and autonomy, while de-emphasizing the actual anti-drug message, should be created. This message will focus on emphasizing the positive aspects of a teenager’s life without drugs, as opposed to how drugs limit one’s autonomy. Presenting positive images of a movement that is led by teenagers will go a long way to establishing new social norms.

In addition to this new message, the public health agency should establish partnerships with consumer product companies that advertise to teenagers. In the partnership, the commercials that are advertised to teenagers should show how the products that teenagers consume are part of a drug-free life. This message should be subtle and not overwhelm the message of the product ad.

Another way to capture the effects of Marketing theory would be to be to capitalize on the success of the “truth” campaigns against tobacco companies. While there aren’t any illegal drug companies to target, the current unrest in Mexico over the drug trade could offer a way to produce outrage in teenagers. This message cannot emphasize that teenager drug use kills people in Mexico, which would cause guilt feelings. Similar to the “truth” campaign, teenagers should be seen as leaders of outrage against crimes that are committed by Mexican drug lords. There is a tenuous balance here, as the drug war is a very dangerous affair, but if used effectively, teenagers could see that their use of drugs is a limit of their autonomy by drug cartels. These messages should not be in concert with the positive messages described above.

Create a Feeling of Control of the Anti-Drug Message by Teenagers

The main failing of the “Parents” and “Above the Influence” campaigns is that there is the sense that adults are creating the message and teenagers are simply participants in the battle over drug use. While there is reason for this dichotomy, teenagers should be empowered to feel control over the anti-drug / positive-life movement. Not only are they empowered to make individual decisions, but there should be messaging that they to have the power to influence the decisions of other teenagers. In other words, instead of “Parents: The Anti-Drug,” it should be “Friends: The Anti-Drug.” The focus of this new message should be on helping teenagers realize that they have influence over others, and that they be a source of positive changes in the lives of others.

Conclusion

While the “Parents” campaign has laudable goals, its targeting and labeling of parents as the anti-drug is misdirected. This message, in concert with the weak “Above the Influence” campaign, reinforces social norms and roles that propagate drug use amongst teenagers. Campaigns to dissuade teenagers from using drugs are now 30 years old, and the message that these campaigns have used have only been revised slightly in that time period. While there has been some variation in teen drug use from the early 1980’s, it is hard to say that these campaigns have been successful (3). It is hard to deduce that these campaigns have done anything at all.

In order for the stated goals of the media campaign to be successful, the entire message and approach must be overhauled. The hackneyed reiteration that drugs are bad and will ruin your life, while dubious in truth as it lumps all drugs together, should be shelved, and approaches that emphasize teenage freedom and control in positive lifestyles should be adopted.

References

(1) National Public Radio. (2007 2-April). Timeline: America's War on Drugs. http://www.npr.org/templates/story/story.php?storyId=9252490

(2) United States General Accounting Office. Youth Illicit Drug Use Prevention: DARE Long-Term Evaluations and Federal Efforts to Identify Effective Programs. Washington, DC, 2003.

(3) Hornik R, Jacobsohn L, Orwin R, Piesse A, Kalton G. Effects of the national youth anti-drug media campaign on youths. American Journal of Public Health 2008; 98:2229-2236.

(4) Drug Abuse Resistance Education. About D.A.R.E. http://www.dare.com/home/about_dare.asp

(5) Parents: The Anti-Drug. About Us. Washington, DC: The Office of National Drug Control Policy. http://www.theantidrug.com/about.asp

(6) DiClemente, R; Wingood, G; Crosby, R; Sionean, C; Cobb, B; Harrington, K; Davies, S; Hook, E; Oh, M. Parental Monitoring: Association With Adolescents’ Risk Behaviors. Pediatrics 2001; 107:1363-1368.

(7) DeFleur ML, Ball-Rokeach SJ. Theories of Mass Communication (5th edition), Chapter 8 (Socialization and Theories of Indirect Influence), pp. 202-227. White Plains, NY: Longman Inc., 1989.

(8) Silvia PJ. Deflecting reactance: The role of similarity in increasing compliance and reducing resistance. Basic and Applied Social Psychology 2005; 27:277-284.

(9) Grube, J; Morgan, M. Attitude-Social Support Interactions: Contingent Consistency Effects in the Prediction of Adolescent Smoking, Drinking, and Drug Use. Social Psychology Quarterly December 1990; 53: 329-339.

(10) Parents: The Anti-Drug. Pressures on Teens. Washington, DC: The Office of National Drug Control Policy. http://www.theantidrug.com/advice/teens-today/navigating-the-teen-years/pressures-on-teens.aspx

(11) Siegel M. Marketing social change: An opportunity for the public health practitioner (Chapter 3). In: Siegel M, Doner L. Marketing Public Health: Strategies to Promote Social Change (2ndedition). Sudbury, MA: Jones and Bartlett Publishers, 2007, pp. 45-71.

(12) Hicks JJ. The strategy behind Florida’s “truth” campaign. Tobacco Control 2001; 10:3-5.

(13) Langer EJ. The illusion of control. Journal of Personality and Social Psychology 1975; 32:311-328.

(14) National Youth Anti-Drug Media Campaign. Resources. Washington, DC: The Office of National Drug Control Policy. http://www.mediacampaign.org/resources.html

(15) Above the Influence. Above the Influence. Washington, DC: The Office of National Drug Control Policy. http://www.abovetheinfluence.com/

(16) Above the Influence. About Us. Washington, DC: The Office of National Drug Control Policy. http://www.abovetheinfluence.com/

(17) Rosenstock IM. Historical origins of the health belief model. Health Education Monographs1974; 2:328-335.

(18) Christakis NA, Fowler JH. The collective dynamics of smoking in a large social network. New England Journal of Medicine 2008; 358:2249-2258.

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