The use of marijuana in adolescents is a public health problem of national importance because the number of smokers has been on the rise since the 1990s (1). The National Youth Risk Behavior Survey (YRBS), which is conducted every two years providing data from 9th through 12th grade students, showed that some drug trends have begun to increase. The survey showed that more students have used marijuana one or more times, have used marijuana on school property one or more times, and have been offered, sold or been given drugs on school property between 2009 and 2011. (2) The rising use of marijuana amongst peers can be linked to adolescents decrease in perceived risk of using the drug. (3) It is imperative that there is a public health focus on marijuana use in adolescents since their age group is more susceptible to addiction. (4)
In response to the increased drug use by adolescents in the United States, the National Youth Anti-Drug Media Campaign was funded. (5) From 1998 to 2004 the United States Congress spent over one billion dollars towards the campaign. (6) The main focus of the campaign was to decrease drug use by educating, decreasing initiation, and convincing users to stop. (7) The current campaign is called Above the Influence, which targets adolescents with national messaging through television, print, and the internet. Much of the campaign focuses on commercials against the use of marijuana. One of the most frequently aired Above the Influence commercials is a thirty second commercial in which an adolescent who is high on marijuana is greeted in their kitchen by their dog. The dog tells the adolescent how they wish they didn’t smoke pot and that they are not the same when they are high.
While the National Youth Anti Drug Media Campaign was able achieve high levels of media coverage the intended message did not reach the targeted youths. Instead, many of the youths created parodies of the commercial which can been seen all over the internet. Not only did the message have the intended effect, the amount of coverage caused the opposite to occur. The exposure decreased the youth’s intentions to stay away from marijuana and decreased the antidrug social norms affiliated with marijuana (6). Had the campaign focused on the social and behavior effects the commercial would evoke, the overall goals of the campaign would have been more successful. In the subsequent paragraphs the main problems with the commercial used during this campaign will be discussed.
Critique: Ineffective use of the Health Belief Model
The health belief model is a psychological model developed to predict health behaviors in individuals. The model first came about when a doctor wanted to better understand why many people were not taking advantage of free tuberculosis testing that was available to them. The Health Belief Model is used as a predictive tool for behaviors such as life style behaviors, life style behaviors in relation to health, and compliance with medication. An assumption that this model makes is that individuals will engage in specific health behaviors if the outcome is favorable to them. (8)
There are six components of the health belief model, which were not effectively used to create behavioral change in the targeted youth of the Above the Influence campaign. The first component of the model is perceived susceptibility, which demonstrates an individual’s perception of their risk of developing the health issue. (8) In the commercial, the use of marijuana is not displayed as a health risk. Not displaying the health risks results in the targeted youths believing that marijuana is not a major cause of health problems. The second component is perceived severity, which demonstrates an individuals belief of the level of harm the health issue would cause if the individual were to develop it. (8) Many youths do not perceive marijuana use as harmful (3) and the commercial does not demonstrate the health risks involved with smoking marijuana to achieve the behavioral change. The next component is the perceived benefits. This component focuses on how changing an individuals habits would have a health benefit to them. (8) While the goal of the campaign is to show the benefits of not using or stopping the use of marijuana, the campaign falls short because the commercial demonstrates that if a person gets high they will have the benefit of talking to their dog. The forth component is the perceived barriers, here the model focuses on the obstacles an individual would face to maintain the beneficial health outcome. The commercial does not display the negative outcome of using marijuana only the positive outcome of communicating with their dog. The fifth component of the theory are the cues to action. This component is based on continual stimulation to increase the likelihood that the healthier choice would be made. Continual exposure to the commercial makes marijuana seem like the common social norm cuing the viewer into action to partake in drug use. The last component focuses on self-efficacy, an individual’s confidence in their ability to demonstrate the change. While a youth has the self-efficacy to decide to take action, not taking drugs may not be the action that they are willing to take. (9)
The three main goals of the campaign are to decrease drug use by educating, decreasing initiation of those who have never smoked, and convincing youths who do smoke marijuana to stop (7). Instead of reaching these goals to deliver a healthy drug free message the commercial sends the message that if a person gets high they will be able to have communications with their pet dog. It can be expected that many youths with pets would want the opportunity to speak with their dog. The commercial could have been more successful in translating their message into a behavior if they had examined the effects of social and behavioral models.
Critique: The Psychological Reactance Theory
The psychological reactance theory is a psychological theory developed to explain the reaction that occurs when an individuals freedom of behavior is threatened or eliminated. The theory describes that an individual has a set of behaviors that they can display at any moment within the realm of possibilities. In preparation of choosing their next behavior, an individual takes in their internal and external surroundings. After taking in their surroundings, the individual weighs which behavior would bring them the most satisfaction in that moment. When one of their behaviors is threatened or eliminated the individual feels the loss of their freedom. The perceived loss of freedom causes reactance in the individual. Reactance is the reaction that occurs due to this loss causing the individual to attempt to reestablish their freedom of choice. (10) The Above the Influence commercial created by the National Youth Anti-Drug Campaign causes reactance in the targeted youth because the commercial threatens a behavior. The message of the Above the Influence commercial is to not smoke marijuana and to those who do smoke, to stop smoking marijuana. The message is thus eliminating this behavior choice.
One of the main goals of the campaign is to focus on the youth that are already participating in smoking marijuana and convincing them to stop. Those that are already actively smoking marijuana or have previously smoked will feel the most reactance towards the message of commercial. The magnitude of reactance that is felt by an individual depends on the worth of the behavior to the individual. The greater the behavior is to the individual the greater the magnitude of reactance. The youths that are actively participating in smoking marijuana will have the greatest reactance towards the Above the Influence commercial. A smaller magnitude of reactance will occur in those who have not smoked marijuana or have only smoked a small number of times. The youth may not feel the reactance right away but when they feel their freedom of choice challenged they will have an even stronger will to reestablish their freedom. The reestablishing of their freedom occurs when they partake in the behavior that was threatened or partaking in a similar behavior such as smoking cigarettes. (10) The youths will be pushed towards the behavior that was threatened. This means that youths who have never smoked may start and those who do smoke will smoke more. The campaign is creating the opposite effect then the desired behavioral change.
Another aspect that plays a role in the magnitude of reactance is similarity. When there is similarity between the individual and what the individual is observing, studies have shown a decrease in the negative force of reactance and an increase in the positive force of compliance. (11) In the commercial, a dog delivers the main message of the National Youth Anti-Drug Campaign. A dog and adolescent are not similar. Having a dog deliver the main message only increases the negative force of reactance in the youth. In this aspect the commercial pushes the targeted population further away from compliance with the main message of the campaign.
The psychological reactance theory creates a motivational state (10), where the youth may not have thought about wanting to try marijuana but the ad brings the behavior into their mind. This behavior is then threatened or eliminated from, in turn motivating them to take action against the commercial. The commercial makes the targeted youth believe that their peers are using marijuana, which increases the increases the likelihood that they should also smoke marijuana (6) Here a youth who may have never considered smoking marijuana may now have the intent to do so. The more times the youth is exposed to the commercial the more reactance they will feel. The psychological reactance theory may be able to explain why the intent to stay away from marijuana decreased during the time after the Above the Influence commercial campaign. (12)
Critique: The Social Cognitive Theory
The social cognitive theory is a psychological theory that was developed to explain how environmental factors, personal factors, and human behavior interact. The theory is used to describe how an individual gains knowledge through direct observation. The media plays an important outlet where individuals can observe and learn different behaviors. Through the media, individuals can observe both an action and the consequences while maintaining the sequence of events that led to behavior and outcome. Observations can motivate an individual to act despite whether there is a positive or negative reaction following the behavior. Through the Above the Influence commercial, the targeted youth observe someone their age who is high from smoking marijuana. The youth gains knowledge of the behavior and learns the outcome, which in the commercial is hearing their dog talk to them. Observing the commercial motivates the targeted youth to perform the behavior instead of avoiding the behavior. (8)
There are three core determinants of the social cognitive theory that can effect an individuals behavior. The first determinant is based on an individuals understanding of the expected outcome. The individual develops an expected outcome through gaining knowledge of the risk related to the behavior. This knowledge can then create the condition for change. (8) In the Above the Influence commercial, the behavior that changed was not the goal of the campaign since a study found that youths were less likely to stay away from marijuana following the message. (12) The youth watching the commercial observes someone around their age, who is high and listening to their dog talk to them. The youth then understands that if they act the behavior of smoking marijuana their expected outcome is to talk to their dog. The second determinant is perceived self- efficacy and the third determinant is goals. This describes that an individual must have the skills necessary for change and believe they can make the change. Roles models can be factor that effects these determinants. Applying these two determinants to the commercial, the youth see someone their age, high and realize that they have the ability to get high and obtain the same outcome. (8)
There are key concepts to the social cognitive theory that can effect the main factors responsible for change. The first concept is expectations; the anticipated outcome of the behavior. In the commercial the only focus is on the outcome of smoking marijuana instead of focusing on the benefits of not smoking. Another concept is behavioral capability; having the skills to perform a behavior. With the widespread reach of the Above the Influence campaign, many youths observe others their age getting high. The observation creates the illusion that if their peers can get smoke marijuana then they also have the ability to smoke marijuana. Another concept of this theory is reinforcement, which is demonstrated by the wide spread media campaign. The commercial creates the idea that smoking marijuana is more common among youth and their peers increasing the likelihood of the behavior (12). Two other concepts of this theory is modeling and observational learning. In the Above the Influence commercial the targeted youth observes someone their age getting high. The youth gains knowledge of what it looks like to be high as well as gaining of knowledge from someone within their age group. Many of the concepts that effect behavior, as described through the social cognitive theory, caused an opposite effect of the main goals of the Above the Influence campaign. (8)
Changing the Above the Influence campaign to include social and behavioral theory will increase compliance of the National Youth Anti-Drug Campaigns message. The main media source for the message would remain on television since this outlet creates observation learning with high sensation-value contexts. Studies show that messages geared towards older teenagers and young adults are most persuasive through television. (1) A commercial that shows a group of youths lead by a celebrity refusing to smoke marijuana, the commercial then shows the group off having fun playing soccer while the individual who offered the drugs is alone with anxiety. The use of a celebrity is critical because the use of someone famous has been shown to increase compliance with the health message. (14) The use of a similarly aged group as the targeted youth is used since adolescents are more likely to demonstrate behaviors similar to their peers (15). Instead of just stating the smoking marijuana is bad, the commercial shows the risks creating a larger impact (12) and demonstrating the benefits of saying no.
Solution: Health Belief model
The first critique of the Above the Influence commercial addressed social and behavioral problems explained through the health belief model. This theory describes that if there is a serious enough threat to someone’s health, that person will avoid the action. (8) In the Above the Influence commercial there is no threat to the youths health even though the main message is to not smoke marijuana. A better direction to take the commercial is to develop media that shows the health risk and severity that can be relatable to the youths. (16) A successful campaign that targeted youths to stop smoking cigarettes was the “truth” campaign. This campaign showed that the risks described to youths to cause change had to be relatable to their everyday lives such as pregnancy and divorce. The campaign demonstrated that everyday risk factors had a larger impact then long term risk factors. They found that youths had no reaction toward the risk of death because to them the scary facts were not seen as a big deal. The “truth” campaign also realized that they needed to use a message other then “don’t”. (17) The “truth” campaign shows that more can be achieved through showing why not to do something instead of saying “don’t” do something. The message of the serious risks of smoking marijuana, such as losing friends or anxiety (13), should be delivered by someone relatable to the youth instead of using a dog.
At the beginning of the paper, the different components of the health belief model were discussed in relation to the negative effects caused by the Above the Influence commercial. Here, the components will be discussed in relation to delivering the National Youth Anti-Drug message to achieve behavioral change in the targeted youths. To achieve perceived susceptibility, marijuana should be reintroduced as harmful to strengthen the social norm that drugs are not good. To achieve perceived severity, the commercial should focus on the commonality of the risk factors associated with smoking marijuana. To achieve perceived benefits, the focus should not be on avoiding health risks but on a positive outcome. A benefit must be something relatable, unlike talking to a dog. This could be spending time outside with friends, playing rigorous sports, or participating in other group activities. (11) To show that there are no barriers, the commercial should focus on groups of students staying away from drugs. Self-efficacy can be achieved through reaching youths through the campaign, verbal reinforcement and showing peers working together in the commercial to stay away from marijuana. The goal of the campaign can be met through a commercial, if the commercial uses the health benefit model to its advantage by studying the social and behavioral components associated with the model.
Solution: The Psychological Reactance Theory
The second critique that was made about the Above the Influence commercial focuses on the psychological reactance theory. This theory is used to describe the reaction of an individual if their freedom of behavior is threatened or eliminated. In the commercial, the goal of the dog is to relay the message of not smoking marijuana. The campaign would have been more successful at delivering this message if the message did not threaten the freedom of behavior. This problem can be solved without changing the main message of the National Youth Anti-Drug Campaign. In changing the commercial, the goal is to deflect reactance and increase compliance. When a message threatens freedom of choice, there is a positive force to comply and a negative force to react. In many cases of reactance, the negative force is the more powerful force causing the reaction. The goal of the commercial should be to reduce the negative force so that it is equal or less then the positive force. Achieving this will increase compliance. (11)
The reduction of the negative force of smoking marijuana can be achieved through using similarity. Delivering the message by someone who the targeted youths relate too will increase the positive force to comply and decrease the negative force to react. In the current commercial, a dog delivers the message, which is not similar to the targeted youth. This difference increases the negative force to react and decreases the positive force to comply. (11) The commercial instead should have an adolescent who is similar to the targeted youth deliver the message because adolescents are influenced by their peers (15). This similarity would increase the positive force to comply while decreasing the negative force to react. (11) To create even more compliance, a person that many adolescents look up to such as a celebrity should be used. A celebrity that is around the age of the targeted youth from a band, movie or television show would further increase the positive force and decrease the negative force of reactance. (14) Using a celebrity would increase the positive force and decrease the negative force by influencing the perception of the magnitude of the threat to freedom. Making a few changes to the Above the Influence commercial, following the psychological reactance theory would create a higher rate of compliance among the targeted youth.
Solution: The Social Cognitive Theory
The third critique that was made about the Above the Influence commercial focuses on the social cognitive theory. This theory describes how different factors can cause behavioral change in an individual. The three core determinants of this theory were discussed above and will now be applied to make constructive changes to the campaign commercial. The first determinant is outcome expectancies (8). In the current commercial the outcome described is using marijuana to talk to a dog. Instead, the commercial should be changed to highlight the real effects of smoking marijuana. For example, the commercial could show that marijuana causes anxiety and loss of friends (13) creating the condition for change. The second and third determinant is perceived self-efficacy and goals. This part of the commercial should highlight the mechanism by which the goal of not smoking is achieved. The goal of not smoking marijuana should be delivered by a group of people that the targeted youth can relate to as to demonstrate that the youth can do it too. Using these determinants properly through a commercial can have a large effect on implementing change in an individual’s health practice (8).
Changing the commercial to include some of the key concepts of the social cognitive theory can have a large impact on behavioral change. The first concept is expectations. Instead of the expectation of getting high and talking with their dog, the youth should understand the negative expectations associated with smoking marijuana. Another concept is behavioral capability. In the commercial the targeted youth observes someone who is similar to them being high. This demonstrates that they have the ability to get high too. Instead, the commercial should focus on someone who is similar to the youth not getting high. The commercial could demonstrate other activities with the person refusing to get high. The message of not smoking would be able to reach the youth because they would know they have the ability to refuse to smoke marijuana. Having the same widespread media impact as the Above the Influence campaign already has would create reinforcements of the positive message. The two other concepts of this theory are modeling and observational learning. Using someone his or her age to model refusing to smoke marijuana is more relatable then using a dog to deliver the campaigns message. This also gives the opportunity for the targeted youth to learn through observation. Making small changes based on the concepts and core determinants of the social cognitive theory would have a large impact on the compliance of the targeted youth. (8)
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