PERSPECTIVES ON DRUGS Mass Media Campaigns For The .

UPDATED 28. 5. 2013European Monitoring Centrefor Drugs and Drug AddictionPERSPECTIVES ON DRUGSMass media campaignsfor the prevention of druguse in young peopleThe use of mass media campaigns as adrug prevention intervention is relativelycommon, but it is not without controversy.Both policymakers and practitionershave debated the effectiveness of suchcampaigns in reducing drug use amongyoung people, and there is a possibilitythat they may be counter-productive. InEurope, more than one-third of the 30countries affiliated to the EMCDDA reportthat mass media campaigns on illicitdrugs are either not carried out or havebeen cut back, in some cases because ofconcerns about their safety. This analysiscontributes to the debate by reviewing theavailable evidence on the efficacy of massmedia campaigns for drug use prevention.Full edition of this article with interactivefeatures available online sThe use of mass media campaigns to reduce health problemsin society gained momentum in the 1970s, with an initialfocus on improving cardiovascular health. The positiveresults obtained by the first campaigns led to their furtheruse in areas as diverse as heart disease, cancer, HIV/AIDSprevention, family planning and domestic violence. From the1970s on, media campaigns were increasingly used in theprevention of tobacco, alcohol and illicit drug use.Mass media campaigns in public health disseminateinformation about health, or threats to it, in order topersuade people to adopt behavioural changes. They areusually implemented via television and radio, newspaper ormagazine advertisements, billboards and road posters. Theycan also use the Internet, text messaging and e-mail. Publichealth media campaigns are generally undertaken by publicbodies and may be standalone interventions or they may beintegrated into complex social marketing programmes, andmay encompass several rounds of delivery.The potential of mass media campaigns lies in their abilityto propagate simple and focused messages to largeaudiences repeatedly, over time, at a low cost per capita.It is also assumed that they are able to reach a large andheterogeneous proportion of the population (Wakefield etal., 2010). However, a major ethical dilemma associated withsuch campaigns lies in the fact that the target population hasgenerally not requested this kind of social intervention, andfurthermore they might have negative effects (see below).

PERSPECTIVES ON DRUGS I Mass media campaigns for the prevention of drug use in young peopleI Where do public health media campaigns work?Media campaigns have been successfully applied to thereduction of tobacco use and the promotion of road safety,and have shown moderately positive results in a number ofareas including: the promotion of healthier nutrition, physicalactivity, participation in screening for breast and cervicalcancer, organ donation and pre-hospital response times forpotential heart attack symptoms (Wakefield et al., 2010).Media campaigns have been widely used for the preventionof illicit drug use in young people. They often addressspecific substances with the aim of reducing use and raisingawareness about the associated problems. These types ofcampaign typically target young people because evidenceshows that drug use often starts during adolescence, a timein life when young people may experiment with cigarettes,alcohol and illicit drugs. Relatively few drug prevention mediacampaigns have been formally evaluated, however, and mostof the evaluations have solely focused on assessing whetherpeople understood and retained the main messages, and ifthey liked them. Where stronger evidence is available, it israrely conclusive.IRandomised studies on mass media campaigns versus otherinterventions to reduce intention to use drugs meta-analysis of evaluation studies on drugAprevention media campaignsA meta-analysis was carried out of studies that evaluate theeffectiveness of mass media campaigns to influence druguse, intention to use, or the attitude towards illicit drugs ofyoung people under the age of 26. A search of the scientificliterature found 23 studies, which involved around 200 000young people and were conducted in Australia, Canadaand the United States between 1991 and 2011. Only 14 ofthese met the criteria for inclusion in the meta-analysis. Theresults of the analysis of the nine randomised controlledstudies are presented below. Of the remaining studies, fourshowed a non-statistically significant reduction of use in theexperimental groups or no effect, and one study found anunwanted effect (Hornik, 2006; Hornik et al., 2008).IExplanation: The four randomised controlled studies analysedcompared an experimental media campaign with nointervention (Lee et al., 2010; Newton et al., 2010; Schwinnet al., 2010; Slater et al., 2008). In the above graph, the blackdiamond summarises graphically the results of the metaanalysis. It overlaps with the vertical line ‘0’, also known as the‘no effect line’. Statistically speaking, the diamond includesthe ‘null hypothesis’ – that there is no difference betweenthose exposed to media campaigns and those not exposed.Furthermore, in one study (Newton et al. 2010), drug use islower in the group not exposed to media campaigns. A fifthstudy (Fang et al., 2010) that otherwise merited inclusion,however, was excluded from the meta-analysis because nomeasures of effect on reduction of drug use were available forthe experimental group.ResultsRandomised studies on mass media campaigns versus otherinterventions to reduce drug useExplanation: The pooled results of these four studies,comparing an experimental media campaign with nointervention (Fang et al., 2010; Yzer et al., 2003; Zhao et al.,2006), a lower level of exposure to the intervention, a nondrug related intervention (Yzer et al., 2003), three differentnon-drug related interventions (Polansky et al., 1999), or acombination of interventions (Yzer et al., 2003) are weakly infavour of media campaigns.In summary, this meta-analysis of randomised studies foundno effect on reduction of use and a weak effect on intentionto use illicit substances. It also identified reports of possibleunwanted effects in terms of young people declaring that theywould like to try drugs.IFew European evaluationsIn Europe, a systematic evaluation of whether mass mediacampaigns are leading to changes in drug use attitudes andbehaviours has yet to be carried out. A number of countriesreport having evaluated mass media campaigns in drugprevention (Bulgaria, Denmark, France, Netherlands, Sweden,United Kingdom), but most of the studies in question have

PERSPECTIVES ON DRUGS I Mass media campaigns for the prevention of drug use in young peopleWhat theories are behind media campaigns?Mass media campaigns, whether they are used as a drugprevention or health promotion tool, tend to be based(explicitly or implicitly) on a number of psychologicaltheories and models. These are summarised below.Media campaigns that aim to prevent drug use by providinginformation are based on the health belief model (Glanz etal., 2002). Under this model, awareness about the severityof a health condition along with knowledge of the benefitsof actions to avoid it is essential for healthy behaviour.Therefore, the provision of factual information about thenegative effects and dangers of drugs is supposed to deteruse.The theory of reasoned action or planned behaviour(Ajzen, 1991) proposes that an individual’s behaviouralintentions have three constituent parts: the individual’sattitude towards the behaviour, the social norms asperceived by the individual, and the perceived controlover one’s own behaviour. According to this model, druguse is a consequence of a rational decision (intention),which is based on the individual’s attitude to drug use, theperceived social norms towards drug use, and the beliefabout controlling one’s own behaviour. Social marketingcampaigns aimed at setting or clarifying social and legalnorms (as well as information campaigns) are based onthese theories.I Interactive element: map with videosSocial norms theory (Perkins and Berkowitz, 1986) atteststhat an individual’s behaviour is influenced by perceptions,often incorrect, of how other members of their social groupthink and act. Campaigns based on this theory, also referredto as ‘normative education’, challenge the misconceptionthat many adults and most adolescents use drugs andaccept (tolerate) substance use.Related to the social norms theory is the super-peer theory(Strasburger et al., 2008), which postulates that media (oradvertisement) portrayal of substance use (or casual sexor violence) gives adolescents the impression that this iscommon behaviour or even a behavioural model. Socialmarketing campaigns aimed at correcting false normativebeliefs are based on social norms or super-peer theories.Social learning theory (Bandura, 1977) postulates thatpersonality and behaviour are an interaction betweenenvironment, behaviours and the psychological processesof an individual. Also referred to as observational learning,social learning theory places emphasis on observingand modelling other people’s behaviours, attitudes andemotional reactions. Social marketing campaigns providingpositive role models or promoting realistic social norms arebased on this theory.merely assessed whether people had seen the campaign,had discussed the slogans with their friends, liked the ideaor the slogans, or increased their knowledge. Although, theScottish media campaign ‘Know the Score ’ was evaluated,the reports did not meet the inclusion criteria for our metaanalysis. Nevertheless, it is interesting to note that the reporton cocaine did not exclude the possibility of the campaignhaving an unintended harmful effect. In a similar vein, aDutch evaluation of a media campaign (Wammes et al.,2007) aiming to reduce cannabis use found that adolescentsexposed to the campaign were slightly more likely to think thatsmoking cannabis with friends would be enjoyable comparedwith adolescents not exposed to the campaign.IInteractive: examples of media campaigns in Europe available on the EMCDDAwebsite: emcdda.europa.eu/topics/pods/mass-media-campaigns ConclusionThe majority of the studies reviewed here assessed mediacampaigns conducted in the United States. Furthermore,the questionnaires that were used to ask young peopleabout their use or intention to use illicit drugs are diverse,and rarely comparable. These two factors taken together