The Effectiveness of Mass

Media Campaigns: Youth

Substance Abuse

Bill Bukoski, Ph.D., NIDA

Robert Orwin, Ph.D., Westat
June 7, 2006
OVERVIEW
 1. Youth’s Exposure to Mass Media.
 2. Possible Risks of Mass Media.
 3. Possible Benefits of Mass Media.
 4. 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,  30% multi-task:
magazines, movies, phone+IM+music+
video games, cell, +TV+surf the web.
internet, e-mail, IM,  53% - families have
cds, dvds, MP3, etc. no rules - TV.
 Youth (8-18) – 6.5  51% - use web daily.
hrs per day or 44.5  32% - use IM daily
hrs per week – all
forms of media.
 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 on-line from “no-
prescription” web sites by anyone with access
to a credit card to include youth.
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).
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 (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.
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 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
 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 Media Feature (N with, N without)

Exposed to Media Intervention (48, 18)*

Effects on Source
Radio (24, 24)*
Video (12, 34)*

Substance Television (32, 15)*

Print (36, 12)*

Using Message Target

Parents and Significant Adults (18, 24)*
Retailers and Others (27, 21)*

Behaviors
Youth (31, 9)*

Message Characteristics
Influencing Others (13, 14)*
Alternatives to Use (11, 12)*
Positive Attitudes to Non-Use (24, 6)*
Knowledge of Consequences (All)*
Negative Attitudes to Use (41, 3)*
Perceived Normative Use (29, 2)*
Resistance Skills (15, 9)*

Substance Addressed
Alcohol (36, 11)*
Illcit Drugs (37, 11)*
Marijuana (39, 6)
Tobacco (12, 35)*
Any (40, 6)*

Intervention Characteristics
Series or Sequenced Messages (4, 36)*
One Time Message Only (1, 46)
Supplementation (21, 25)*
Repetition (33, 7)
General Broadcast (33, 15)*
Multiple, Different Messages (44, 4)*
Arranged Audience (19, 28)*

Recipient Characteristics
Subjects At-Risk (10, 33) Gain with characteristic
Under 50% Male (15, 28)* Gain without characteristic
Under 22 Years (22, 24)*

*p<.05
-0.10 -0.05 0.00 0.05 0.10 0.15 0.20

Mean Pre-Post Standardized Gain Effect Sizes

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

■ HSS ● LSS Marijuana

Initiative
25 Campaign Period

20

15

10

0
A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M
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
 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