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CHAPTER 18
The Siren’s Call
Mass Media and Drug Prevention
William D. Crano, Jason T. Siegel, and Eusebio M. Alvaro
The appeal of the mass media in drug prevention rests on the prospect that a single crusade, executed properly, will cheaply and effectively resolve the exasperating and seemingly intractable problems of illicit substance use. This magic bullet mentality is understandable and possibly even correct, though the evidence of the past century’s efforts offers faint encouragement that we will arrive at this enchanted outcome any time soon. Our purpose in writing this chapter is to review some of applications of the mass media in drug prevention, to identify possible reasons for their inconsistent effects, and to suggest means of arriving at more positive preventive outcomes. This plan involves reconsideration of a general theory of message effects whose consistent implementation may foster development of campaigns that deliver on their promise to attenuate the problem of drug misuse.
Analyzing and integrating the fit of past campaigns with recommendations of contemporary theory is complicated by research operations that often involved only a weak association with established theories and untested assumptions about the mindset and usage status of the intended audience. The sometimes tenuous theoretical underpinnings of the many early mass-mediated prevention campaigns, and the less than optimal evaluation techniques adopted, surely impeded progress (Crano, 2010; Fishbein et al., 2002; McGuire, 1991). Identifying these shortcomings may facilitate development of informed guidelines leading to more sure and rapid progress, for although the promise of the mass media in drug prevention has largely gone unrealized, the jury is still out regarding the possible efficacy of the general approach in the critical arena of drug prevention.
Common Problems Whose Solution May Lead to Progress
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Mis- or Nonapplication of Theory and Level of Analysis
For those steeped in the hypothetico-deductive approach of modern social science, it may come as a surprise that many past mass-mediated antidrug interventions were based on little more than horse sense and uninformed assumptions of campaign targets’ general susceptibility to common messages. Even campaigns that adopted empirically established models of attitude formation or change often neglected to make use of a consistent theory of message effects in their message-development strategy. In the present context, a theory of message effects is a model of the factors involved in attitude change, and the features of the communication that must be present in addressing these factors. It stands to reason that if some degree of resistance to a counterattitudinal message is expected, it may prove useful to understand something about the resistance processes that are brought on line when a persuasive message is encoded. Messages should be designed in full cognizance of this expected resistance or counterargumentation. Following the theory of reasoned action (TRA; Fishbein & Ajzen, 2010), for example, one might have a clear idea that changing attitudes or subjective norms may affect intentions and subsequent behaviors.
However, the theory does not reveal how one designs persuasive messages to accomplish these changes in attitude or perceived subjective norms. It was not designed to do so. These message factors thus remain speculative, dependent more on preference than established theory and research. This is not a shortcoming of the TRA; rather, it is the result of a lack of an empirically established theory of message construction, and it may be the heart of past failures. The issue is one of level of analysis (Doise, 1986). The typical theory of attitude formation and change is explicit about the factors that must be affected if a communication is to bring about change, but with few exceptions, these theories adopt a strict receiver orientation. That is, the explanatory mechanism for change is almost always located in the intended receiver, rather than among the variables the campaign organizer can actually control (but see Palmgreen, Stephenson, Everett, Baseheart, & Francies, 2002; Stephenson & Palmgreen, 2001).
The common theories of change operate at a metalevel, but the mircolevel advice often is lacking. This is not a fault of the common theories; rather, this lack of message specificity suggests the need to develop more precise models of the persuasion process, and the message features required to interface with these processes to effect change. Not many such models exist, but there are some, and they should be used and refined in light of current knowledge.
There are, of course, positive examples of theory-guided, empirical, mass media research that amply illustrate the potential of strategies that meld a theory of attitude formation and change with a theory of message construction (see Atkin, 2002; Atkin & Wallack, 1990; Donohew, 2006; Palmgreen & Donohew, 2010; Salmon & Atkin, 2003), but in general, campaigns that satisfy both of these requirements are the exception rather than the rule. If a mass media anti-drug persuasion campaign is to succeed, it should be built on a reasonable and empirically established theory of attitude formation or change, which is paired with a reasonable and empirically established theory of message construction. Of course, recognizing receiver characteristics that might affect message reception, especially usage status in the case of illicit substance prevention, also must be a central feature of the antidrug media campaign (Crano, Siegel, Alvaro, Lac, & Hemovich, 2008b; Crano, Siegel, Alvaro, & Patel, 2007). Ignoring either can spell disaster for any mass mediated persuasion attempt.
Consider, for example, the recent National Youth Anti-drug Mass Media Campaign (henceforth, the Campaign). The budget of the Campaign exceeded a billion dollars (http://www.whitehouse.gov/
ondcp/anti-drug-media-cam paign), but its results were
not nearly as positive as hoped. The Campaign was theory based and focused on a specific audience of adolescents at risk of initiating drug use (marijuana was most frequently targeted, though inhalants and amphetamines also were featured). It attained an exceptionally high frequency of message exposure. Almost all known media were used in its unprecedented ad blitz, which carried over four years, nationwide. The goal of the Campaign was to reduce adolescent drug initiation and misuse, an ambition that had remained unfulfilled over the years. Most of the elements were in place, but structural features of the Campaign imperiled its outcome.
Those familiar with the ads produced in this program would find it difficult to discern a through-line in the messages used in this heroic, four-year, ultimately unsuccessful effort (Hornick, Jacobsohn, Orwin, Piesse, & Kalton, 2008). Although the guiding theoretical rationale was in place from the start, the Campaign’s ads did not appear to be based on a clear theory of messaging, and this resulted in a damaging lack of commonality of persuasive approach and a series of persuasive ads that did not seem particularly persuasive. Both outcomes were perhaps inevitable, given the nature of the process by which the ads were created and deployed. Although developed by well-regarded marketing firms, the communications did not speak with a common voice, nor were they based on a clear idea of the factors that might be involved adolescents’ accepting or rejecting an antidrug message.
This resulted in a series of one-off communications whose only commonality was their frequency of exposure. Absence of a consistent theme did not permit program developers to connect the many ads that were created, which might have reduced resistance and added to their impact. This shortcoming was not a signal feature of the Campaign. Any mass media persuasion campaign that is not framed by a strong theoretical view of how and why particular ads will operate is inevitably prone to failure, because even if some effective communications are developed, their effects will not cumulate owing to their haphazard appearance and ultimate dilution in a sea of failed messages. Intuition is not a substitute for empirical research when persuasion via well-developed messages is a sought-for outcome. Because a message attracts attention, is salient, funny, artistic, colorful, memorable, or charming does not necessarily imply that it will be persuasive. None of these features can substitute for strong theory and empirical research when deciding on the likely outcome of a message—or a full-blown media campaign.
Iatrogenesis
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An unfortunate, if not inevitable sequel of a failed persuasion campaign is an outcome that is diametrically opposite to that intended (Cho & Salmon, 2007). Iatrogenic effects in response to mass mediated prevention ads are not new. Researchers in communication and psychology have been aware of boomerang or contrast effects in response to persuasive messages for many years. Sherif and Hovland (1961), for example, developed an interesting model based on earlier psychophysical research to explain unwanted and often unanticipated changes in response to persuasive messages, and they were not the first. Commenting on mass persuasion and education efforts more than 80 years ago, Payne (1931, pp. 219–220) found that “The proposed introduction of narcotic education into the public schools, like sex education, raises some questions. One of the most serious of these is the reputed danger of stimulating the curiosity and adventure interest of the child through emphasizing either negatively or positively the unusual effects of drugs upon both mind and body.”
Forty years later, a Canadian report noted the “Speed Kills” campaign that aired in North America in the late 1960s may have had more “attractive than deterrent power” (Commission of Inquiry, 1970). In 1973, the National Commission on Marijuana and Drug Abuse made many recommendations to President Richard Nixon based on a two-year study of the problem, noting that drug prevention efforts might “merely stimulate youthful interest in drugs” (Feingold & Knapp, 1977). In the mid-1980s, a pre-launch article in the British Medical Journal noted that a forthcoming U.K. campaign might be “more than a waste of money;” rather, it was feared that it would stimulate curiosity in drugs and thereby increase their use (Hanson, 1985; Home Office, 1984).
Reactance
Over the years and across diverse literatures, various explanations have been offered for the iatrogenic effects of antidrug campaigns. Brehm’s (1966) psychological reactance theory provides a plausible explanation for these outcomes (Brehm & Brehm, 1981; Burgoon, Alvaro, Grandpre, & Voloudakis, 2003), especially on respondent samples concerned with independence threats. Persuasive communication may be viewed in PRT terms as representing an inherent threat to freedom. When a perceived freedom is threatened by a message proscribing an attitude or behavior, people may experience motivating pressures to reestablish that freedom (Heilman & Toffler, 1976). PRT-based research has found that reactance arousing messages have a negative effect on persuasion (Burgoon et al., 2003; Dillard & Shen, 2005; Grandpre et al., 2003; Miller, Burgoon, Grandpre, & Alvaro, 2006; Quick & Stephenson, 2007). While not explicitly based on PRT, Comello and Slater (2011) presented encouraging findings on the potential of messages that enhance feelings of autonomy to facilitate drug resistance. In their study, students exposed to autonomy-supportive print ads from the Campaign evidenced greater accessibility of the belief that marijuana use was inconsistent with autonomy, and were less willing to use the substance.
Awareness of Persuasive Intent
We have known for some time that participants aware of an influencing agent’s intent to persuade will prove more resistant to persuasion (Allyn & Festinger, 1961; Wood & Quinn, 2003). Walster and Festinger (1962), for example, showed that an “overheard” persuasive communication concerned with an issue on which the individual was highly vested was significantly more persuasive than directly focused or irrelevant messages, a result later replicated and expanded by Brock and Becker (1965). These studies indicate that the more explicit the intent to persuade, the less persuasive is the appeal, if the target is concerned about the issue, and the message is not perceived as unduly propagandistic. All bets are off if these conditions are not met. It stands to reason, then, that the less explicit the intent to persuade, the more receptive is the target.
Crano and associates (2007) built on this possibility in creating a minimal “overhead communication” manipulation to influence subjects’ responses to anti-inhalant messages in a mass mediated experiment. Embedded in an antibullying video, a maneuver designed to minimize suspicion and experimental demand effects, middle school participants saw a video message that began with either, “Are you in the sixth, seventh, or eighth grade?” or “Parents, do you have a young teen at home?” The message target was reiterated four times throughout the video with statements such as either “Your child …” or “Parents” or “Students.” For resolutely abstinent nonusers, the indirectly targeted message (analogous to an overheard communication) was not expected to impart any greater influence than the direct message, as either would be of minor relevance to them. However, an inhalant-relevant communication was expected to be highly relevant for inhalant users, and for non-users at high risk for initiation. Both hypotheses were supported: the direct or indirect feature of the message had no effect on resolute non-users; however, it significantly affected the attitudes of those for whom the message was relevant. The “indirect” manipulation, less than a dozen words, caused increased positivity of ad evaluations of adolescent inhalant users and those at high initiation risk; positive message evaluation, in turn, predicted significantly lower intentions to use inhalants.
Curiosity
Curiosity is perhaps the oldest, yet least-researched explanation for the iatrogenic effects of antidrug campaigns. As Sheppard, Goodstadt, and Willet (1987, p. 197) put it: “education raises levels of awareness, leading to curiosity which in turn leads to experimentation.” Although there is little research directly examining the extent to which iatrogenic antidrug campaign effects are predicated on increased curiosity about drugs, a study by Lancaster (2004) studied the impact of general messages about drugs on cu
riosity. Drawing on the model of product curiosity, Lancaster found that exposure to mediated messages about drugs increased awareness of drugs, interest in drugs, and uncertainty about drug use. She argued this process may lead to a higher intent to use drugs, especially among those at risk for use.
Resistance Enhancement
A relatively unexplored, but nonetheless serious outcome of successful resistance, if not an iatrogenic reaction to antidrug media, is suggested in recent research by Tormala in his resistance appraisals model (RAM: Tormala, 2008; Tormala & Petty, 2002, 2004). The RAM holds that people’s attitude certainty increases as a result of their successfully resisting strong persuasive messages. The stronger the resisted message, the greater the augmentation of certainty and subsequent resistance. Thus, attitudes strengthened as a result of successfully resisting messages perceived as strong are likely to persist, to prove resistant to change, and to show a stronger link with behavior (Petty & Krosnick, 1995).
Arguably, ads would be perceived as strong if presented as part of a nationwide mass media saturation campaign and attributed to a well-known agency of drug prevention. However, if the ads were not compelling, and hence were resisted, enhanced (pro-drug) attitude certainty would be expected among at-risk nonusers and users. According to the RAM, then, in addition to the iatrogenic effects reported in the evaluation of this campaign by Hornik and colleagues (2008; see also Orwin et al., 2006), the Campaign’s failed persuasion attempts created greater resistance to future drug prevention appeals than was evident before their ads aired. It is possible in drug prevention that nothing sometimes is better than something.
Normative Considerations
Social norming is a yet another common explanation for iatrogenic effects. A test of the social norming hypothesis was afforded by examining the Campaign’s evaluation data. Jacobsohn (2005) assessed the extent to which estimates of perceived marijuana use were associated with campaign exposure and found the exposure/marijuana use relationship was mediated by increased-use perceptions. In line with social norms theory (Berkowitz, 1997; Perkins & Berkowitz, 1986), she proposed that the meta-message that marijuana use is prevalent had a greater impact on use than the explicit anti-marijuana message. The social norming explanation has drawn considerable interest from prevention scientists. If targets of large-scale persuasive prevention interventions assume that the problem under attack is widespread, or normative, and if complying with normative demands is considered desirable, then reversing the perception that a targeted behavior is widespread may prove a useful avenue of prevention.
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