The Effectiveness of Mass
Media Campaigns: Youth
Substance Abuse
Bill Bukoski, Ph.D., NIDA
Robert Orwin, Ph.D., Westat
June 7, 2006
OVERVIEW
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1.
2.
3.
4.
Youth’s Exposure to Mass Media.
Possible Risks of Mass Media.
Possible Benefits of Mass Media.
Findings From Westat’s Evaluation of
ONDCP’s Anti-drug Abuse Campaign
for Youth and Parents.
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:
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.
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.)
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).
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.
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.
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).
“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.
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 online from “no-prescription” web sites by
anyone with access to a credit card to include
youth.
3. Benefits of Mass Media
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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).
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.
Theories
(cont.)

Theory of Reasoned Action

Theory of Planned Behavior

Social Innoculation Theory
(Fishbein &
Ajzen, 1975). Beliefs, Attitudes, Intentions, Behavior.
(Akzen, 1991).
In addition --- Intentions are influenced by perceived
behavioral control.
(McGuire,1964).
Small doses of pro-ads are analyzed to promote
negative responses.
Theories (cont.)

Psychological Reactance

Social Marketing
(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.
(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.
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.
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.”
Meta-Analysis of Media Health
Campaigns on Behavior

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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
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)
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 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.”
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.
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.
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).
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.
Recent Promising Findings: InSchool 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
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.
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 SensationSeeking 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.
30-day Marijuana Use Regression Plots for HSS
and LSS Youth
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.
Dual Mass Media – Youth and
Parents: ONDCP’s Campaign

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

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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