The Effectiveness of Mass Media Campaigns: Youth Substance Abuse

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The Effectiveness of Mass Media Campaigns Youth
Substance Abuse

• Bill Bukoski, Ph.D., NIDA
• Robert Orwin, Ph.D., Westat
• June 7, 2006

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OVERVIEW

• 1. Youths Exposure to Mass Media.
• 2. Possible Risks of Mass Media.
• 3. Possible Benefits of Mass Media.
• 4. Findings From Westats Evaluation of ONDCPs
  Anti-drug Abuse Campaign for Youth and Parents.

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1. Mass Media is Pervasive in the Lives of Youth
(Kaiser Report, 2005)

• 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 phoneIMmusicTVsurf 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.

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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.)

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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).
• Natl 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).

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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.

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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 (N524 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.

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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).
• NIDAs PRISM award promotes accurate depictions
  of drug, alcohol, tobacco use in film, TV, video,
  music, and comic books (NIDA Press Release,
  2006).

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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.

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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.

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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).

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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.

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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.

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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 audiences 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.

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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.

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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.

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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

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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)

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Mass Media Effects on Substance Using Behaviors
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Summary of Mass Media Benefits (Crano, 2002)

• the results do not suggest that the mass media
  represents the magic bulletwhich 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.

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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.

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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.

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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).

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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.

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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

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Mass MediaSchool Programs

• In a RCT (1997-2002) with 45 high schools and
  feeder schools, Longshore et al. (2006) tested
  the effects (on 9th graders) of ONDCPs 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 ONDCPs media
  campaign - synergistic effect
• 2) No comparable main effects for ALERT PLUS or
  ONDCPs media campaign.

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Mass Media and High Sensation-Seeking Youth

• Palmgreen et al. (2005) reports on an
  interrupted time-series analysis of exposure to
  ONDCPs 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.

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

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Dual Mass Media Youth and Parents ONDCPs
Campaign

• Major Goals 1) enable youth to reject illegal
  drugs 2) prevent initiation of marijuana 3)
  promote drug cessation for occasional users.
• 19982005, campaign costs 1.325 Billion.
• Dual Media Campaigns 1) Youth (9 to 18) 2)
  Parents/Caregivers --- Westats evaluation of
  Phase 3 of campaign - September 1999.
• Campaign paid ads on TVPSAs, radio, ads in
  magazines and newspapers, billboards, movie
  spots, video rentals web site press.
• Partnership for a Drug-Free America--- media