Avoiding the boomerang: testing the relative effectiveness of antidrug public service announcements before a national campaign

Psychiatrists as administrators: the perspective of a mental health department psychiatrist

This paper is adapted from the American Association of Psychiatric Administrators Annual Membership Luncheon Speech given at the meeting of the American Psychiatric Association in Toronto, Canada on May 23, 2006. The author discusses three experiences from his work for the New York City Department of Health and Mental Hygiene to illustrate how psychiatrists working as administrators are uniquely able to meet community mental health and substance misuse needs. The author describes public health interventions employed by psychiatric administrators to reduce morbidity and mortality from opioid and methamphetamine misuse.

Explicit and implicit effects of anti-marijuana and anti-tobacco TV advertisements

Effects of anti-tobacco and anti-marijuana TV advertisements on explicit (i.e., semantic differential ratings) and implicit (i.e. Implicit Association Test, IAT) attitudes toward tobacco and marijuana were compared. Two hundred twenty nine, 18- to 19-year-old U.S. college students were randomly assigned to anti-tobacco or anti-marijuana PSA viewing conditions. Participants completed a short survey on attitudes to tobacco and marijuana. Afterwards they watched 15 PSAs embedded in a 15-min science program. At the end, all participants completed IAT for marijuana, IAT for tobacco and the assessment of explicit attitudes. Results of ANCOVA revealed a significant interaction between type of TV PSAs watched and implicit attitudes, F(1,223)=7.12, p<0.01 when controlling for preexisting attitudes to both substances; the implicit attitudes were more negative toward the substance that corresponded to the content of advertisements watched (i.e., anti-tobacco or anti-marijuana). However, analogical analysis on explicit measures showed that attitudes to marijuana became less negative among students that watched anti-marijuana ads than the group with anti-tobacco ads, F(1,222)=5.79, p<0.02. The discussion focused on the practical and theoretical implications of the observed dissociation between implicit and explicit attitudes to marijuana after the exposure to anti-marijuana PSAs.

Changing smoking attitudes by strengthening weak antismoking beliefs - Taiwan as an example

I first explored the strength of Taiwanese high school students' beliefs regarding five antismoking messages. Findings of a nationwide survey showed that the students held these beliefs in the following order of decreasing strength: second-hand smoke damages health, smoking has long-term health consequences, smoking has short-term health consequences, cigarette marketers are manipulative, and smokers are perceived negatively. Experiment one further showed that antismoking ads featuring weakly held beliefs are more effective than those featuring strongly held beliefs. Experiment two demonstrated that antismoking campaigns need to be framed carefully; in general, it is more effective to positively frame messages about strongly held antismoking beliefs but negatively frame messages about weakly held antismoking beliefs.

Industry sponsored anti-smoking ads and adolescent reactance: test of a boomerang effect

OBJECTIVE

To examine whether adolescents' exposure to youth smoking prevention ads sponsored by tobacco companies promotes intentions to smoke, curiosity about smoking, and positive attitudes toward the tobacco industry.

DESIGN

A randomised controlled experiment compared adolescents' responses to five smoking prevention ads sponsored by a tobacco company (Philip Morris or Lorillard), or to five smoking prevention ads sponsored by a non-profit organisation (the American Legacy Foundation), or to five ads about preventing drunk driving.

SETTING

A large public high school in California's central valley.

SUBJECTS

A convenience sample of 9th and 10th graders (n = 832) ages 14-17 years.

MAIN OUTCOME MEASURES

Perceptions of ad effectiveness, intention to smoke, and attitudes toward tobacco companies measured immediately after exposure.

RESULTS

As predicted, adolescents rated Philip Morris and Lorillard ads less favourably than the other youth smoking prevention ads. Adolescents' intention to smoke did not differ as a function of ad exposure. However, exposure to Philip Morris and Lorillard ads engendered more favourable attitudes toward tobacco companies.

CONCLUSIONS

This study demonstrates that industry sponsored anti-smoking ads do more to promote corporate image than to prevent youth smoking. By cultivating public opinion that is more sympathetic toward tobacco companies, the effect of such advertising is likely to be more harmful than helpful to youth.

National Youth Anti-Drug Media Campaign and school-based drug prevention: Evidence for a synergistic effect in ALERT Plus

This analysis examined the possible synergistic effect of exposure to the National Youth Anti-Drug Media Campaign and a classroom-based drug prevention curriculum among 9th grade students participating in a randomized trial of ALERT Plus. A total of 45 South Dakota high schools and their middle-school feeder(s) were randomly assigned to an ALERT condition (basic prevention curriculum delivered in 7th and 8th grades), an ALERT Plus condition (basic curriculum with booster lessons added for 9th and 10th grades), or a control condition. Marijuana use in the past month was significantly less likely among ALERT Plus students reporting at least weekly exposure to anti-drug media messages. The National Youth Anti-Drug Media Campaign may have led to reductions in marijuana use among youth who simultaneously received school-based drug prevention.

Interventions for prevention of drug use by young people delivered in non-school settings

BACKGROUND

Interventions intended to prevent or reduce use of drugs by young people may be delivered in schools or in other settings. This review aims to summarise the current literature about the effectiveness of interventions delivered in non schools settings.

OBJECTIVES

(1) - To summarise the current evidence about the effectiveness of interventions delivered in non-school settings intended to prevent or reduce drug use by young people under 25;(2) - To investigate whether interventions' effects are modified by the type and setting of the intervention, and the age of young people targeted;(3) - To identify areas where more research is needed.

SEARCH STRATEGY

We searched Cochrane Central Register of Controlled Trials (CENTRAL - The Cochrane Library Issue 4, 2004), MEDLINE (1966-2004), EMBASE (1980-2004), PsycInfo (1972-2004), SIGLE (1980-2004), CINAHL (1982-2004) and ASSIA (1987-2004). We searched also reference lists of review articles and retrieved studies.

SELECTION CRITERIA

Randomised trials that evaluated an intervention targeting drug use by young people under 25 years of age, delivered in a non-school setting, compared with no intervention or another intervention, that reported substantive outcomes relevant to the review.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trial quality and extracted data. Results were tabulated, as studies were considered too dissimilar to combine using meta-analysis.

MAIN RESULTS

Seventeen studies, 9 cluster randomised studies, with 253 clusters, 8 individually randomised studies with 1230 participants, evaluating four types of intervention: motivational interviewing or brief intervention, education or skills training, family interventions and multi-component community interventions. Many studies had methodological drawbacks, especially high levels of loss to follow-up. There were too few studies for firm conclusions. One study of motivational interviewing suggested that this intervention was beneficial on cannabis use. Three family interventions (Focus on Families, Iowa Strengthening Families Program and Preparing for the Drug-Free Years), each evaluated in only one study, suggested that they may be beneficial in preventing cannabis use. The studies of multi component community interventions did not find any strong effects on drug use outcomes, and the two studies of education and skills training did not find any differences between the intervention and control groups.

AUTHORS' CONCLUSIONS

There is a lack of evidence of effectiveness of the included interventions. Motivational interviewing and some family interventions may have some benefit. Cost-effectiveness has not yet been addressed in any studies, and further research is needed to determine whether any of these interventions can be recommended.

Differential effects of exposure to social norms campaigns: a cause for concern

College students' processing of alcohol social norms messages, related effects on normative judgments, attitudes toward their own behaviors, and perception of undergraduate attitudes were examined using expectancy violation theories and social norms marketing. Data were collected from 2 universities (N = 393). Following message exposure, the majority moved their normative judgments toward the statistic provided in the message. Slight attitude change occurred but not always in the desired direction. Those most likely to develop unhealthier attitudes drank more than those who developed healthier attitudes, consistent with psychological reactance to the messages. Therefore, the effects of social norms campaigns on those at greatest risk for primary and secondary alcohol effects due to their increased alcohol consumption could lead to increased risk for those participants, indicating that the widespread use of social norms campaigns needs to be scrutinized.

Stepping back from social norms campaigns: comparing normative influences to other predictors of health behaviors

Recent health campaigns on college campuses have used a social norms approach, which suggests that one's perceptions of others' attitudes and behaviors are the key components in attitude and behavior change. However, the efficacy of social norms campaigns has been mixed. This study was conducted to assess the relationships among sociodemographics, normative perceptions, and individual attitudes on 3 health behaviors. Students at 2 universities (N = 393) completed questionnaires assessing how these variables related to their consumption of alcohol, tobacco use, and exercise behaviors. Regressions indicated that each of these variables was associated with behavior, but varied independent variables emerged as the salient predictors among behaviors. In several conditions the effect of normative perceptions on behaviors was not significant, a finding in direct opposition to social norms marketing. In all 3 behavioral conditions, the variable accounting for the greatest variance was whether or not the individual liked participating in that particular behavior. Thus, although some social norms marketing may be meeting with success, it may be the case that predicted attitudinal and behavioral changes will not be found when applied across diverse health topics.

The application of youth substance use media campaigns to problem gambling: a critical evaluation

Despite the negative impact that problem gambling poses on individuals and society there have been few gambling prevention campaigns specifically targeting youth. The authors review the literature on past and current drug, alcohol, and tobacco use prevention media campaigns, examining the similarities across 25 health communication programs with the aim of viewing their applicability for the prevention of youth problem gambling. Critical features of effective campaigns are identified and assessed in terms of their applicability for youth problem gambling. Recommendations for the design, implementation, and evaluation of a youth gambling media campaign are discussed.

The science of public messages for suicide prevention: a workshop summary

There is minimal guidance for efforts to create effective public messages that increase awareness that suicide is preventable. To address this need, several agencies in the U.S. Department of Health and Human Services and the Annenberg Foundation convened a workshop consisting of suicide prevention advocates and persons with expertise in public health evaluation, suicide contagion, decision-making, and marketing. "Logic models" were used to define intended messages and audiences, assumed mechanisms of change, and outcomes. This summary describes some of the challenges and opportunities identified by workshop participants in evaluating public awareness campaigns in suicide prevention, technical assistance needs, and a proposed research agenda.

Lessons learned from public health mass media campaigns: marketing health in a crowded media world

Every year, new public health mass media campaigns are launched attempting to change health behavior and improve health outcomes. These campaigns enter a crowded media environment filled with messages from competing sources. Public health practitioners have to capture not only the attention of the public amid such competition, but also motivate them to change health behaviors that are often entrenched or to initiate habits that may be new or difficult. In what ways are public health mass media campaigns now attempting to succeed in a world crowded with media messages from a myriad of sources? What are the conditions that are necessary for a media campaign to successfully alter health behaviors and alter outcomes in the long term? To what extent can the successes and failures of previous campaigns be useful in teaching important lessons to those planning campaigns in the future? In this chapter we attempt to answer these questions, drawing from recent literature on public health mass media campaigns.

The effectiveness of gateway communications in anti-marijuana campaigns

Successful anti-marijuana messages can be hypothesized to have two types of effects, namely persuasion effects, that is, a change in people's beliefs about using marijuana, and priming effects, that is, a strengthened correlation between beliefs and associated variables such as attitude and intention. This study examined different sets of anti-drug advertisements for persuasion and priming effects. The ads targeted the belief that marijuana is a gateway to stronger drugs, a belief that is often endorsed by campaign planning officials and health educators. A sample of 418 middle and high school students was randomly assigned to a control video or one of three series of ads, two of which included the gateway message in either an explicit or implicit way. Results did not support the use of the gateway belief in anti-marijuana interventions. Whereas no clear persuasion or priming effects were found for any of the ad sequences, there is some possibility that an explicit gateway argument may actually boomerang. In comparison to the control condition, adolescents in the explicit gateway condition tended to agree less with the gateway message and displayed weaker correlations between anti-marijuana beliefs and their attitude toward marijuana use. The results suggest that the gateway message should not be used in anti-drug interventions.

Ecstasy: America's new "reefer madness"

MDMA (3,4-methylenedioxymethamphetamine) was first used as a legal adjunct to psychotherapy in the 1970s. By the early 1980s, "Ecstasy" had become a tiny part of the recreational American drug scene, and was ultimately criminalized in 1986. For a decade use continued, but remained quiet. By the end of the 1990s, increased supply, demand, seizures of pills, arrests of distributors associated with organized crime, adverse reactions, and government reports of problematic brain changes created an Ecstasy media frenzy. The government's reaction led to a public education campaign and proposals for exponential penalties for production, distribution and use of MDMA. This article looks at the history, epidemiology, and politics of Ecstasy, the media's response, and the ways in which media and government reaction will compromise harm reduction and safety.