social marketing and drug and alcohol prevention: evidence and examples martine stead deputy...

Social marketing and drug and alcohol prevention: evidence and examples Martine Stead Deputy Director Institute for Social Marketing University of Stirling and The Open University

1.Evidence for the effectiveness of social marketing as an approach 2.How social marketing has been applied to substance use prevention: some examples

How effective is social marketing as a strategy for drug and alcohol prevention? The first place to look for evidence of effectiveness is systematic reviews Some reviews do not include social marketing as a category of intervention Some reviews equate social marketing with media approaches A lack of understanding of social marketing among reviewers

Review conducted by ISM into effectiveness of social marketing interventions for diet, physical activity, alcohol, tobacco and drugs Health Education Vol. 107 No. 2, 2007 pp. 126-191

How we defined social marketing Not by the label used in the article or report about the study By the extent to which an intervention met Andreasens 6 social marketing criteria: BEHAVIOUR CHANGE CONSUMER INSIGHT SEGMENTATION & TARGETING EXCHANGE COMPETITION MARKETING MIX

1.Searched for good quality systematic reviews (SR) of all substance misuse interventions 2.Identified 310 individual studies from these SRs which potentially met the social marketing criteria 3.Assessed these 310 studies against Andreasens 6 benchmarks 4.35 studies met all 6 criteria Search Strategy (drugs, alcohol and tobacco): 35 SRs 310 individual studies 35 studies of social marketing interventions

Results The interventions 15 measured impact on alcohol-related behaviour, 13 on drug-related behaviour

Study Intervention Ary 1990Project PATH, school prevention programme including peer leaders Biglan 2000Comparison of a school programme with community advocacy to reduce under-age access to tobacco (also measured impact on alcohol use) Botvin 1997Life Skills Training for minority adolescents, theory-based school programme Botvin 2001Life Skills Training for minority adolescents, theory-based school programme Cuijpers 2002Netherlands school-based drug prevention including parent/home elements Ellickson & Bell 1990Project ALERT, school social influences programme including teen leaders Ellickson et al 2003Revised Project ALERT Hansen et al 1988Project SMART, school theory-based social influences programme Hecht et al 1993School drama-based drug prevention programme McBride et al 2000Project SHAHRP, Australian school programme for alcohol harm minimisation Pentz et al 1989Project STAR, multi-component school, community and media drug prevention Perry et al 1996Project Northland, multi-component programme incl. community taskforces & alcohol policy Spoth et al 2001Strengthening Families, theory-based drug and alcohol intervention for families Sussman et al 1998Project TND (towards no drug abuse), theory-based school programme Sussman et al 2002Project TND (towards no drug abuse), theory-based school programme Wagenaar et al 2000Community and policy intervention to reduce youth access to alcohol and drink-driving

Study 12 m: alcohol24+ m: alcohol12 m: drugs24+ m: drugs Ary 1990 No- - Biglan 2000 YYWeak Botvin 1997 Y-Y- Botvin 2001 YWeak Cuijpers 2002 YYYNo Ellickson & Bell 1990 Mixed, weakNYNo Ellickson et al 2003 Mixed, weak-Y- Hansen et al 1988 YYYNo Hecht et al 1993 --Y- McBride et al 2000 Y--- Pentz et al 1989 YNYY Perry et al 1996 -Y-N Spoth et al 2001 YY-- Sussman et al 1998 Mixed, weak-Mixed 1998- Sussman et al 2002 Mixed, weakNoYY Wagenaar et al 2000 -Weak--

Alcohol prevention/harm minimisation (15 studies) 8 reported positive effects on alcohol-related behaviour at 12 months, 5 at longer-term follow-up 2 also reported changes in retail practices and local laws Illicit drug use prevention (13 studies) 8 reported positive effects at 12 months, 2 at longer-term follow-up

Overall, reasonable evidence that social marketing approaches to alcohol and drug prevention can have positive effects on behaviour in the short term, although effects wear off over time, and not all programmes are effective Since the review, two major studies (Slater et al 2006, Slater et al 2011) of social marketing drug prevention interventions have reported significant reductions in marijuana use associated with exposure to a mass media campaign and participation in an in-school media campaign

1.Evidence for the effectiveness of social marketing as an approach 2.How social marketing has been applied to substance use prevention: some examples

Above the Influence and Be Under Your Own Influence, USA media campaigns One national mass media campaign, one in-school media campaign, 1999 to 2009 Target groups: Teenage youth (general population, school) Behaviour change: Reduce marijuana use Consumer insight: Research before each campaign showed that young people are already familiar with the risks and are turned off by negative messages. They take drugs partly because it makes them feel mature and independent (competition) Exchange: Alternative and attractive ways of feeling independent and mature.

Above the Influence and Be Under Your Own Influence, USA media campaigns Marketing mix: Media campaign around core message: drug use is inconsistent with your identity as an independent person. Culturally appropriate materials for different segments (gender, ethnicity, lifestyles) within the population. Materials included posters, t-shirts, water bottles. Posters developed in conjunction with schools and colleges, featuring photos of local children. Interactive elements (Facebook etc). Evaluation: significant reductions in marijuana use, suggesting that media campaigns based on consumer-research can work independently of school-based programmes (Slater et al 2006 HER, Slater et al 2011 Prev Sci)

Getting messed up is just another way of leaving yourself behind.

Make your night last, media campaign, north west England Target: 18-24 year old drinkers Behaviour change: to reduce drunkenness by encouraging young drinkers to have water between alcoholic drinks. Consumer insight: Young adult drinkers like having a laugh and a good night out. They arent interested in health messages, but dont like the hassle sometimes associated with drinking to excess (fights, trouble, hospital). Exchange: you can still have a good night out with less hassle Marketing mix: Tone of the campaign reflected the drinking cultures and humour of the target group. It made ironic references to some of the consequences of drinking to excess.

Free water bottles printed with same messages distributed in bars

truth Anti-tobacco industry campaign, Florida Target: Florida teens, age12-17 Behaviour change: Reduce youth smoking prevalence, access to tobacco products and exposure to secondhand smoke Consumer insight: Young people didnt see tobacco as a big deal. They didnt want to be told what to do. They knew tobacco killed, but this didnt put them off it made smoking more attractive. They smoked as a way of asserting that they were in control smoking was a tool of rebellion (competition). Exchange: If we were to turn the tables on tobacco, we surmised that we could not take away their tool of rebellion without giving them an alternative. Attacking the duplicity and manipulation of the tobacco industry became truths rebellion (Hicks 2001 Tobacco Control)

truth Anti-tobacco industry campaign, Florida Marketing mix: Youth-led mass media, online and advocacy campaign which harnessed youth rebelliousness against the tobacco industry itself by exposing its manipulative practices. Rather than targeting youth, the campaign positions itself as on their side (including smokers) against the exploitative adult world. Tone reflects the humour and irreverence of young people. truth sought to become as compelling and engaging a brand as other successful youth products Roadshows, action groups and new media encourage interaction Evaluation: Young people exposed to the campaign were significantly more likely to remain non-smokers over 2 year period; dose-response effect (Sly et al 2001, Am J Pub H; Sly et al 2002, Prev Med)

Florida's truth anti-smoking advertising campaign exposes the duplicity and manipulation of the tobacco industry with edgy humour. Hicks J J Tob Control 2001;10:3-5 2001 by BMJ Publishing Group Ltd

the truth National campaign the truth built on Florida model

Can the truth approach work without millions of dollars of funding? We are currently working with a youth group in the west of Scotland who want to use a similar approach, but locally and on a much smaller budget

Road Crew programme, mid-west USA Target: 21-34 year old men who drank heavily and caused a large proportion of drink-driving crashes Behaviour change: Reduce alcohol-related car crashes Consumer insight: Young men knew they shouldnt drink and drive, but did so. Heavy drinking was a strong part of local culture. If men drove to the pub in their cars, they were very tempted to drive home when their judgement was impaired (competition). The idea of going to the pub and not drinking was unrealistic. The best way to stop them driving home drunk was to get them to the pub without their cars.

Exchange: A fun and easy means of getting to and from the pub without using their own car. Marketing mix: A limousine service to collect groups of young men from their homes and to drive them around all evening. The limousines were attractive (older luxury vehicles). Men paid 10- 15$ each per evening. Each local community adapts the programme to its own needs and context. Evaluation: results to date suggest that drinking behaviour has not increased, while drink-driving has reduced (estimated 17% reduction in crashes in first year, Rothschild et al 2006). Road Crew programme, mid-west USA

NE Choices, school-based drug education programme, North-East England 1995-1999 Target: 13-16 year old school pupils in 10 schools Behaviour change: Reduce drug use prevalence AND to reduce the harmfulness of drug taking among young people Consumer insight: Young people wanted drug education, but it had to be credible and interesting. They related to real life stories and people like them. They didnt believe that drug takers were bad. Drug offers were most likely to come from friends not strangers. Simply saying no was unrealistic young people needed strategies for coping with situations in which drugs were offered Parents needed constructive advice on how to talk about drugs

NE Choices, school-based drug education programme, North-East England 1995-1999 Competition: one of the main forms of competition was the perception that drug education was boring and negative Exchange: A highly engaging, enjoyable, locally-relevant drug education experience which offers credible ways of dealing with drug offer situations An attractive, high quality, well-resourced drug education programme for schools Segmentation: Both universal and selective approaches. For whole school year groups in the 1 st and 2 nd years of the programme; self-selecting peer projects and an outdoor esteem- building programme for high risk youth in the 3 rd year.

NE Choices, school-based drug education programme, North-East England 1995-1999 Marketing mix: Interactive drama based approaches (theatre workshop in 1 st year, out-of-school all-day drama experience in 2 nd year) designed to explore attitudes towards drugs and help young people rehearse how they would cope with drug offer situations Peer-led projects Outdoor activity programme Parent materials and activities; incentives for participation Teacher training Tone and branding were crucial fun, engaging, non- judgemental, personally relevant (NE), a real event

PaulMamKirsty Emma Rachels Room Secrets & Lies Computer work-stations for small group work Stage Darren Character Rooms Video screen In groups, young people investigated the disappearance of a fictional 17- year old girl, Rachel (who appeared only on a video clip) by visiting 7 different rooms. 5 rooms contained a character who had some connection to Rachel and represented a different view of drugs. The characters performed a piece of drama then answered questions put by the groups of pupils. The Secrets and Lies room contained multi-media materials designed to explore facts and opinions regarding drugs. Groups also used interactive software to find out more about the characters, and took part in tasks (eg.producing a newspaper article about Rachels disappearance.) Rooms were decorated to match character (eg. Mam had a sitting room, Darren an old shed) NE Choices: drama experience, 2 nd year

NE Choices: Evaluation High levels of engagement, ownership, credibility, trust Effective in making young people relate to the characters in the dramas and think about their own drug use and attitudes No differences in drug prevalence or harm reduction measures. Evidence of modest de-escalation of drug use (eg. switching from harder to softer drugs) Why? Intervention possibly not intensive enough, targeted at too old an age group, weaknesses in evaluation and analysis. OR: perhaps the intervention WAS effective in encouraging young people to make more informed choices about drugs but they didnt make the choice the programme developers wanted?

To sum up: Social marketing and drug and alcohol prevention Because they are based on consumer insight and offer benefits which consumers want, social marketing programmes score highly on acceptability, feasibility, engagement, credibility, enjoyment and personal relevance And there is evidence that they can produce positive behavioural outcomes Effectiveness can be enhanced by combining social marketing framework with evidence-based approaches (eg. appropriate theory) Engagement etc may not be sufficient in itself to change behaviour but it is an absolutely essential first step

social marketing and drug and alcohol prevention: evidence and examples martine stead deputy...

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