Showing posts with label Alcohol. Show all posts
Showing posts with label Alcohol. Show all posts

Monday, May 20, 2013

Critique of Above the Influence Campaign - by Julie Yaroni


Introduction

Over the past few centuries media has grown to serve as an extremely influencing source of information.  Individuals are influenced through movies, television, music, and magazines. From a very early age individuals are taught from alcohol advertisements that partying and drinking leads to popularity and a happy life. This ideal lifestyle has played a major role in causing the percent of youth’s who use substances to increase.  In order to reduce the amount of youth’s partaking in alcohol and substance use many campaigns have been created.  One of the major campaigns, the National Youth Anti-Drug media campaign, fought to educate individuals about drug use, prevent youths from beginning using drugs, and to encouraging individuals who already use drugs to stop. The National Youth Anti-Drug Media Campaign grew and created another branch known as the Above the Influence campaign.
Above the Influence campaign, ATI, was founded in 1998 and focuses on reducing the percent of teenagers who participate in drug and alcohol use. Above the Influence is said to influence teenagers to, “live above the influence of drugs and alcohol and reject the use of any substance that gets in the way of their goals in life” (8). The campaign works at both the national and local level, attempting to teach youths across the nation. ATI uses a variety of sources to gain awareness such as social media networks, television commercials, magazine ads, and working together with youth groups such as the Boys and Girls Club. Through their various advertisements Above the Influence campaign exemplifies to teenagers what it is like to be under the influence and the extreme consequences that can occur. Unfortunately although the campaign has a positive goal, there are many flaws within the structure of the campaign that harms the strength of its effectiveness.
Poor Framing
How an argument is formed and supported will directly affect the level of support it receives.  The values and images that are associated with the message will either cause someone to support it or not. Above the Influence has framed their core position to not use alcohol or drugs around the value of health. Compared to values though such as freedom and autonomy, which America was built upon, most individuals recognize health as a weak core value. In efforts to support this value they use many visual advertisements that represent the health risks associated. Above the Influence made a mistake using this value because health is not considered a strong value outside of the public health world.   In the Above the Influence campaign, teenagers would prefer to risk their health in order to save their freedom.

 Poor use of models: Health Belief Model and The Theory of Planned Behavior

 Although group level models often show more success than individual based models, Above the Influence campaign is based around two individual level theories, The Health Belief Model and the Theory of Planned Behavior. The Health Belief Model, HBM, one of the oldest individual health behavior theories, takes into account four factors; perceived susceptibility, perceived severity, perceived benefits of an action, and perceived barriers to taking that action. (6). The Theory of Planned Behavior, a revised version of the Theory of Reasoned Action, also looks at why a person performs certain behaviors. Both The Health Belief Model and the Theory of Planned Behavior assume that people act rationally; that if they know the risks of a behavior they would choose to perform healthier actions. Unfortunately, people do not act rationally, and following these theories weakens the Above the Influence Campaign.
 Above the Influence campaign believes that if teenagers are aware of the risks of drug and alcohol use, they would not want to experience the consequences, and will therefore not participate in drug and alcohol activities. There are many flaws with this idea. First, the majority of teenagers are already aware of the risks of alcohol and drug use before they try it; therefore the Above the Influence commercials are not exposing them to anything they are not already aware of.  Secondly, Above the Influence assumes that if people are knowledgeable about the risk they will feel susceptible to them, but that is false as well. According to an article by Neil D. Weinstein, “among negative events, the more undesirable the event, the stronger the tendency to believe that one’s own chances are less than average” (11). A third flaw of using these models is that Above the Influence campaign is acting at an individual level: “The HBM primarily focuses on individual decisions and does not address social and environmental factors” (6). This is a major problem, especially when the target population is teenagers because social norms are considered extremely important.  People want to fit in and feel that they belong, and socially it has been taught that drinking and smoking is the way to fulfill that. Finally, the Health Belief Model and the Theory of Planned Behavior also assumes that people act rationally, when that is not true. Teenagers do not stand at a party and weigh the pros and cons of having a beer or smoking from a bong, but rather they act spontaneously and hope that their actions followed the social norm and allowed them to fit it with their peers.
In order to truly reduce the percent of teenagers that use alcohol and drugs social norms must change. The media must stop portraying movies and commercials where all the popular students are drinking and partying. Constantly being surrounded by those images only reinforce the idea that drinking is cool, and “living above the influence”  means a lack of popularity and being an outcast in social circles.
 Triggers psychological Reactance  

No individual likes feeling that their freedom is being taken away, and when it is they must react in order to save their freedom. While the Above the Influence Campaign’s purpose is to reduce drug and alcohol use in teenagers, there are many factors to the campaign that actually trigger psychological reactance, and cause a boomerang affect.  One factor is in the campaign’s advertisements. How a campaign advertises its purpose is crucial, and many factors determine its effectiveness.  For instance, who delivers information is essential in determining how responsive the population receiving the message will be. Research has shown that individuals respond better when they can relate to the person delivering the message.
Above the Influence does not follow this concept and delivers very important information through extremely un-relatable sources. For example many of their ads and commercials have animals telling people not to drink or smoke. In one commercial a girl’s pet dog comes into the kitchen and tells her not to smoke because she isn’t the same when she does, the girl does not respond and the dog goes to play outside.   In no way can teenagers watching the commercial relate to a talking dog. Delivering information through a source that people cannot relate to is one way psychological reactance will be triggered. When similarity is not there, the perceived risk to losing freedom is higher.  This boomerang affect can also be due to an overexposure of alcohol and drug use. According to research, ““ a sample of anti-marijuana public statement announcements used in national anti-drug campaign in the U.S produced immediate effects opposite to intended by creators of this campaign on the youth’s attitudes to marijuana” (2) .

 Poor use of social marketing
With media having a growing effect on society, social marketing has become a major factor in how public health interventions spread their message.  Social marketing often uses three strategies to encourage individuals to change a behavior; shame, fear, and guilt. By using these negative appeals, “the instigators hope that by creating discomfort people will be motivated to act (or not) to decrease the feeling of discomfort” ( 1 ). Above the Influence commercials are designed to express these negative appeals.  For example the “Human Puppet” commercial shows a girl who is passed out from drinking and people from the party are writing on her face and treating her like a puppet.  People in the background are speaking negatively about the girl and how it was wrong of her to get that drunk. Although this commercial is meant to make people feel embarrassed about getting into situations similar to that, which does not always occur. This will not work because “individuals do not feel ashamed unless they care what others think about them” (1).  Teenagers care more about what their peers think rather than their parents, so although their parents may think they should be ashamed of their actions, their peers approve of it. Above the Influence commercials also focus on instilling fear in teenagers. By showing the worst case scenarios in many commercials the campaign hopes to scare people away from alcohol and drugs.  This does not work with the teenager population though, because teenagers believe they are invincible and although other people may experience negative consequences, it will not happen to them.
In a study performed on 226 college freshmen to test the effect of anti-marijuana ads, it was proven that the opposite effect of what was intended actually occurred. The study also showed that after watching the commercials, they felt that message delivered was weak.  “Past anti-drugs media campaigns in the U.S have been criticized for exaggerated use of fear-based arguments and some factual inaccuracies, practices that some researches warned might backfire by enforcing attitudes opposite to intended by the campaign creators” ( 2 ).  Above the Influence is one of the many media campaigns that overuse the concept of instilling fear of severe risks. For instance one commercial has a grandmother with a tube in her throat because smoking caused her to have cancer. Although this is meant to trigger negative emotions research has found that, “Many felt that even when they take notice of marketing campaigns, they would switch offfrom the message because of the negativity depicted within the message and any subsequent call to action” (1).  Rather than focuses on these negative emotions, Above the Influence would have benefited from other forms of advertisements.

Comparison to other current campaigns

Although Above the Influence has good intentions, its overall layout and execution of the campaign have proved to make it not as strong as a campaign as it hoped. Other campaigns, such as Florida’s “truth” campaign, were able to be successful without triggering psychological reactance and causing a boomerang affect. The “truth” campaign which focuses on decreases tobacco use in youths, avoids advertising a negative stigma associated with drug use.  Through their advertisements they allow individuals to relate to their message in order to reduce the level of threat to their freedom.   While ATI has proven to have a boomerang effect, “early evaluation results indicate that the truth has been successful in changing tobacco-related beliefs, attitudes, and intentions to smoke among teens nationwide” (4).  If future anti-drug campaigns wish to be successful, they should follow in the footsteps of the “truth” campaign rather than of the Above the Influence campaign.

New campaign overview
I would like to propose a new intervention called the “YES” campaign. This intervention has the same underlining purpose as Above the Influence and seeks to decrease the amount of teenagers who drink and use drugs. This new program is called the Yes campaign in order to promote a positive outlook on sobriety: say yes to your future, yes to playing sports, yes to happiness. This campaign would target children ages 10-15, in order to promote the idea and benefits of being sober before the pressure of drinking is even mentioned.  It is easier to stop individuals from starting a behavior rather than make people change their behavior.   The “Yes” campaign will follow in the footsteps of Florida’s “truth” campaign, in the aspect of how it relates to the target population. The “Yes” campaign will focus on decreasing psychological reactance, giving the target population a sense of identity, and supporting values they find important.

Decrease Psychological Reactance
The structure of the campaign’s commercials and advertisements are designed to decrease psychological reactance. In order to do this, the target population should be able to relate to the campaign. According to an article by Paul J. Silvia, “similarity should decrease the negative force toward resistance by influencing perceptions of the degree of threat. Similarity and liking profoundly affect social perception- people interpret the actions of liked others in positive, flattering ways” (10). In order to make the target population relate to the campaign, promoters of the “Yes” campaign will be peers so people do not feel threatened as well as older students and role models in order to increase attractiveness and appeal of the “Yes” campaign.  For example, in most schools the football players are considered the most popular kids in school. In movies they are advertised as having the most girls and the most friends, and everybody admires them. By having a football player and other athletes stand up for the “Yes” campaign and express all the natural hard work they did and the benefits they have seen, people will admire them  and want to follow in their footsteps. Sharing personal stories will allow these young teens to realize that their dreams and goals are reachable. According to an article by Neil D. Weintstein, “previous personal experience with an event increases the likelihood that people will believe their own chances are greater than average” (11). Knowing that their neighbors, friends, teammates, etc., achieved their goals will allow other individuals to see that their own goal is reachable as well.
To further reduce the level of psychological reactance, spokesmen of the “Yes” campaign will never say do not do drugs, but rather will promote the positive outcomes they have reached without partaking in those activities. The “Yes” campaign will better implement the social marketing theory by not triggering negative emotions such as shame, guilt, and fear.  By not showing disapproving opinions on specific behaviors and looking down upon the target population, individual freedom will not threatened, and teenagers are less likely to rebel.
By having peers share their experiences both at schools and through the media, other individuals will practice the habits they observe.  It is natural for people respond based on whether or not a result proved beneficial. According to the social learning theory, “it attempts to explain how individuals observe other people’s actions and how they come to adopt those patterns of action as personal modes of response to problems, conditions, or events in their own lives” (3).  If young teens see that by not using drugs and alcohol people were rewarded, they will want to perform similarly in order to be rewarded as well.  
Branding
Everybody, especially during the teen years wants to feel a sense of belonging and identity. The “Yes” campaign will become part of their identity. In this aspect, it will follow in the steps of Florida’s “truth” campaign. The “truth” campaign has proven to be an extremely successful intervention, and a large part is due to making “truth” a brand.  They believed, “if we wanted youth to really embrace our anti-tobacco effort, it made sense that we should deliver it just like other successful US youth products, such as Adidas, Fubu or Abercrombie-in a branded form they understood” (5).  Branding the “Yes” campaign will help spread awareness of the campaign, and allows the youths who take part in its effort to feel a sense of belonging and identity.  Like these other successful brands slogans, values, and a sense of community must be formed. The “Yes” campaign will incorporate all of these.
In order to build a group that the youths will feel a part of, “Yes” conventions will be held. These will be events where students from several schools who support the campaign can gather, share stories, participate in activities, and expand their social network with individuals of similar values. People will promote the slogan, “I said YES” while sharing their experiences. This community will also be found on social networks. The webpage Isaidyes.org will be a place where individuals can share their stories, find support, and relate to one another. 

Framing
How a campaign is framed largely effects how its message is received. “A frame is a way of packaging and positioning an issue so that it conveys a certain meaning” (7). How a message is framed can alter peoples’ opinion and change how they view something. “Framing not only defines the issue, but it also suggests the solution: ‘if we alter the definition of problems, then the response also changes’” (7). Framing will not only affect people’s opinions, but their behaviors and actions as well, which is why it is essential for the “Yes” campaign to have a strong frame.  Beyond the outlining argument, a frame contains symbols, metaphors, catch phrases, and core values. Often times public health campaigns support their arguments with the core value of health; unfortunately health is not considered a strong core value.
 Rather than following this public health trend, the “Yes” campaign is going to find out what value are important to the target population, and frame  its arguments around those values. Youths are looking for a way to be independent, freedom from their parents, autonomy, etc. These values are considered dominant frames, and they are the frames the “Yes” campaign will incorporate; by “saying yes” the youth population has the freedom to create their own future, they have the right to happiness, and the freedom to choose. Also, unlike the Above the Influence campaign which uses visual images of depression and injuries, and other consequences of alcohol and drug use, the “Yes” campaign will focus on positive symbols such as athleticism, success, dreams, happiness, popularity, etc. These core values and symbols will also be another way to decrease psychological reactance by making the target population feel in control.
Conclusion
Although above the Influence and the “Yes” campaign have different ways to execute an intervention, the end goals are the same:  have teenagers make healthier life decision by reducing the amount of teens that partake in alcohol and drug related activities.  Although people are not always aware of is, society plays a major role in influencing everyday decisions and behaviors. People act a certain way because they feel that is the way society wants them to behave; society expects teenagers to be rebellious, having your friend drink is a passage into adulthood, etc.  It is no surprise that the rate of teenagers who use drugs and alcohol have risen over the years because these actions are constantly advertised through movies, television, music, and other aspects of everyday life. In order to truly reduce the amount of teenagers engaging in these activities, society as a whole must change their views and expectations. Parents and other sources should not scare their children out of drinking, but rather be honest with them.  People of all ages get a thrill out of doing something that they believe is a little dangerous, removing that thrill immediately takes away some of the joy and reduces the amount of people participating in that activity. If teenagers do not feel that their freedom is taken away, they would not have the thrill to partake in drinking and drug related activities.

References

1.    Brennan Linda, Binney Wayne. Fear, Guilt, and shame appeals in social markets. Jounrnal of Business Research. 2010; 63:140-146.
2.   Czyegska Maria, Ginsburg Harvey J. Explicit and implicit effects of anti-marijuana and tobacco tv advertisments. Addictive Behaviors 2007: 3: 114-127.
3.   DeFleur ML, Ball-Rokeach SJ. Theories of Mass Communication (5th edition). Chapter 8 (Socialization and Theories of Indirect Influences), pp. 202-227. White Plains, NY: Longman Inc., 1989
4.   Herey James C., Niederdeppe Jeff., Evan W. Douglas., Nonnemaker James, Holden Debra, Blahut Steven, Messeri Peter, and Habiland M. Lyndon. The theory of “truth”: how counterindustry media campaigns affect smoking behavior among teens. Health Psychology 2005; 24” 22-31.
5.    Hicks J.J. The strategy behind Florida’s “truth” campaign. Tobacco Control  2001; 10: 3-5.
6.   Individual health behavior theories (chapter 4). IN: Edberg M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers, 2007, pp. 35-49.
7.   Menashe C.L., Siegel M. The power of a frame: an analysis of newspaper coverage of tobacco issues- United States, 1985-1996. Journal of Health Communication 1998; 3(4): 307-325
8.   Office of national drug control policy. Campaign effectiveness: http://www.whitehouse.gov/ondcp/Campaign-Effectiveness-and-Rigor
9.   Rosenstock Irwin M., Strecher Victor J., and Becker Marshall H. Social learning theory and the health belief model. Health Education Behavior 1988: 15:175. 
10.                  Silvia P.J. Deflecting reactance: The role of similarity in increasing compliance and reducing resistance. Basic and Applied Social Psychology 2005; 27; 277-284.
11.Weinstein N.D. Unrealistic optimism about future life events. Journal of Personality and Social Psychology 1980; 39: 806-820.










Talk. They Hear You. Or Do They?: Analyzing the Public Health Approach To Underage Drinking –Kelly Mitchell


Background

            Alcohol consumption among adolescents is a major public health problem in the United States. Despite the fact that alcohol consumption under the age of 21 is illegal, people age 12 to 20 years drink 11% of all alcohol consumed and account for 189,000 emergency room visits for conditions related to alcohol each year. (1) While the underage drinking rates have been steadily declining, the statistics still remain at an alarming level and continue to cause senseless injuries and even death among adolescents. Despite many efforts to reduce this behavior, the question of why adolescents choose to drink alcohol remains at the forefront of public health debates across the nation.
            In an effort to decrease the prevalence of underage drinking, the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention (CSAP) recently launched its Underage Drinking Prevention National Media campaign entitled “Talk. They Hear You.” (2) This intervention aims to reduce underage drinking among youth by providing parents and caregivers with resources they need to understand the risk factors involved with alcohol and then address the issue with their children at an early age. Through increasing parents’ awareness of the prevalence and risks of underage drinking; equipping parents with the knowledge, skills, and confidence to prevent underage drinking; and increasing parents’ actions to prevent underage drinking, (2) the campaign aims to decrease the prevalence of alcohol use among adolescents. The foundation of this intervention is to educate parents about alcohol abuse among teenagers who will then use this knowledge to influence their children’s decisions about alcohol consumption in the future. (3)
Overview of the Critique
           
            The strength of the “Talk. They Hear You.” intervention is inadequate based on the social and behavioral theories and principles that contradict the components of the campaign. SAMHSA’s approach is flawed in several aspects and will likely be unsuccessful in reducing alcohol use among adolescents. First, the campaign does not take into account the fact that social and environmental factors highly influence the behavior of adolescents according to the Social Cognitive Theory. Since teenagers spend the majority of their time in school with their peers, social influence will play a higher role than parents when it comes to decision-making. Additionally, the effects of psychological reactance will cause adolescents to feel robbed of their autonomy and will therefore counteract the intervention. They will feel the urge to rebel against their parents by doing the exact opposite of what is asked of them. The final flaw is that the intervention incorrectly utilizes the traditional Health Belief Model by assuming that adolescents will rationally weigh the cost and benefits of alcohol consumption even if fully explained by their parents. Furthermore, the campaign falsely assumes that the parents themselves will think rationally about the issue and fully understand the risks of alcohol consumption. 
Flaw #1: The Impact of Social Learning and Modeling on Adolescents

            The main focus of the “Talk. They Hear You.” campaign is to target parents and caregivers by offering the necessary educational tools and resources to enable parents to confidently talk to their children about alcohol. Parents will then present this knowledge by speaking to their children about the risks of alcohol use. One of the main goals of the intervention is “to reinforce the importance of talking with children about the dangers of alcohol use.” (4) This value of the intervention does not take into consideration the fact that their children’s environment, social scene, and media exposure significantly influence their ability to make reasonable decisions. Children and adolescents are swayed by these factors for various reasons; in fact, most studies have shown that many teenagers report using alcohol because all of the “cool” kids drink. (5) This perception of “cool” is not something that parents can change since it is rooted in the social and environmental components of an adolescents’ life. The intervention overlooks the vital impact of social models on the fragile adolescent lifestyle—which does not always include parents and guardians in the mind of an adolescent.
            This parental approach to teaching children about the dangers of alcohol use aims at the individual for a change in behavior. According to the Social Learning Theory, individual behavior is part of a triangle—an interaction between an individual, their behaviors, and the environment. (6) The social and environmental factors that influence teenager’s behavior are so strong that parental intervention is often unsuccessful in overruling this notion. In fact, studies have hypothesized that alcohol use behaviors are largely the result of cognitive processes through which people anticipate the consequences associated with their actions and act accordingly, consistent with the social learning approach. (7) In other words, one’s personal beliefs about drinking are at the forefront of their decisions, and those values stem from examples of others’ behavior. It only makes sense that these examples must include people that teenagers respect and admire.
The concept of “observational learning” or “modeling” complements this idea as it refers to the “process whereby people learn through the experiences of credible others, rather than through their own experience.” (8) This supports the notion that adolescents learn a specific behavior by following a model. The “Talk. They Listen.” campaign uses parents as models, which might work in some cases. However, since most adolescents look to their peers as models for behavior, this campaign lacks credibility. Therefore, when creating a campaign targeting adolescent behavior, it is imperative to take into account the impact of social models and ensure that the models themselves are chosen wisely.
Flaw #2: The Effects of Psychological Reactance

While the idea to talk to children about alcohol before they reach their teenage years is well intentioned and may have some benefits, by the time children become adolescents they reach a point in which their independence and autonomy are of the highest importance to them. Adolescents do not want to be told how to live their life; they want to have experiences and learn from those experiences on their own merit. Parental influence on their teenager’s decision to drink alcohol will likely threaten their individual freedom and trigger psychological reactance. The psychological reactance theory poses that if a person’s behavioral freedom is reduced, he or she will become motivationally aroused to counterforce this loss of freedom. (9)
An applicable example of this theory is an experiment involving 2-year-olds who are placed in a room with several toys. Beside the toys set up for the children to play with, there are additional toys behind a barrier that the children cannot reach. As the theory implies, the children are inclined to play with the unattainable toys—theoretically, because it is out of their control. This experiment exemplifies the concept that it is natural for people want to be in control of their own choices and behavior. As a result, people will often purposely choose to oppose a particular force, rule, or intervention in an attempt to restore their limited freedom.
Another one of the goals of the “Talk. They Hear You” campaign states “to inform parents to start the conversation early—before they are teenagers.” (4) The problem with this method is that when a child enters their teenage years, the effects of psychological reactance will inevitably come into play and directly threaten the teenager’s freedom. In essence, a boomerang effect will occur when teenagers are told not to drink by their parents, and the information they were given as children will become irrelevant when the forces of psychological reactance come into effect. Whether they were told as children how to make decisions, adolescents thrive on testing their parents and bending the rules by maintaining their own sense of self and making their own choices. This inevitable attitude among adolescents will not bode well with this intervention because they will want to make decisions on their own when it comes to alcohol.
Flaw #3: Challenging the Health Belief Model
            The Health Belief Model has been the traditional foundation for public health interventions since the 1950’s and one of the first theories of health behavior. Social psychologists, Godfrey Hochbaum, Irwin Rosenstock, and Stephel Kegels based the mechanism on the understanding that people weigh the scale of perceived benefits of practicing a behavior versus the opposing costs. (10) According to the model, there are six main constructs that influence people’s decisions about whether to take action: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cue to action, and self-efficacy. (9) While these elements can often be useful in exploring individual behavior, the assumption that individuals rationally evaluate the costs and benefits of a situation is a major flaw of the Health Belief Model as it directing ignores elements of external and social influence. (10) Additionally, the model fails to recognize that there are major disparities in knowledge among individuals. Individuals hold varying levels of understanding which makes it difficult to fully perceive the susceptibility and severity of a threat, recognize the benefits of avoiding that threat, and then make a rational decision to act. This model fails to consider that many individuals are unable to see reality clearly and understand these factors because they do not always have the capacity.   
            With regard to the “Talk. They Hear You.” Campaign, the flaw of the Health Belief Model is two-fold. First, the intervention makes the false assumption that children and adolescents will rationally decide to take their parents’ advice and abide by their rules. The underlying truth is that adolescents have a skewed perception of right and wrong because of social and environmental factors that influence their decision-making skills. They may remember conversations with their parents when they were children regarding alcohol, but they may not take this information into consideration as an adolescent when faced with a decision. Secondly, it is naïve to assume that the parents and caregivers themselves will receive the message of the campaign, have the full capacity to understand the resources, and convey that message to their children. Another weakness in the campaign is that it essentially takes an extra step in reaching the adolescent by connecting the parent directly and the adolescent indirectly. Further, this information might not even resonate with some folks who do not think rationally about alcohol consumption among teenagers. 
The idea of optimistic bias is another major flaw of the campaign among both parents and their children. Optimistic bias stems from the idea that people tend to assume that their susceptibility to an outcome is lower than others, and generally expect positive events to occur in their futures. Alternatively, while individuals underestimate the risk and probability of negative outcomes in their own lives, they often believe that the general population is at a higher risk than themselves. Unfortunately for the “Talk. They Hear You.” campaign, optimistic bias opposes the main function of the intervention. If parents do not believe that their child will develop a drinking habit, then they will not utilize the resources within the intervention or even pay attention to the message conveyed. Parents might presume that the campaign is a great idea for the general population, but if every parent thinks that their child does not need an intervention, then the campaign will not be successful.  
Proposed Alternative Intervention

            An alternative intervention can be implemented in order to decrease the prevalence of underage drinking on a national level that promotes independence and freedom rather than parental influence. With that in mind, the new intervention plan will involve a nation-wide initiative that establishes a “peer mentor committee” at every public high school. The committee will be called “#DrugFreeStandUp” and each high school will have its own subcommittee title. For example, the committee at Brighton High School will be called “#BHSStandUp” and a private school like Christian Brothers Academy that might decide to join could be called “#CBAStandUp”. This committee will consist of three boys and three girls in each grade level at the high school, totaling 24 students. These students will commit to a drug and alcohol free lifestyle and will serve as peer mentors to the rest of the student body. The peer mentors will be elected by their classmates each year, so they will be well-respected and have a strong influence on the behavior of their peers.
            To add to the credibility of this intervention among high school students, the nation-wide committee will be endorsed by two popular young celebrities—a male and a female—who will also commit to living a healthy lifestyle and serve as the faces of the committee. This group will not only surround students with healthy choices within their social network, it will give them the illusion of control over their lives and lead to safe choices with regard to alcohol.
Intervention #1: Recognition of the Group as a Whole Versus the Individual

            The “Talk. They Hear You.” campaign failed to utilize the Social Learning Theory because parents were assigned as the main models for teen behavior. #DrugFreeStandUp will properly apply the Social Network Theory—the idea that networks of close family and friends highly influence values and behavior—by assigning peers as models. Social network analysis, which is a set of theories, methods, and techniques used to understand social relationships and how these relationships might influence individual and group behavior (11), has proven that individual substance use and misuse is strongly associated with, and perhaps influenced by, use within one’s social network. (11)
            Based on this theory, the new intervention will have a significant impact on the behavior of students. The nationwide attention that #DrugFreeStandUp will receive whether through the celebrities that endorse it or through word of mouth will encourage adolescents to want to mimic the lifestyles of their peer leaders who will lead by example. This group will represent the new “popular” thing to do, and members will take pride in being elected to a group that is competitive and prestigious in nature. Adolescents crave a sense of belonging in a time that can be physically, emotionally, mentally, and psychologically confusing. It is important that they feel this sense of comfort in their every day lifestyle which begins at school. By promoting their own alcohol-free standpoint, the peer mentors will eliminate any fear of not fitting in among students who choose not to drink.
An intervention that simply encourages parents to speak to their children about alcohol is just not enough. #DrugFreeStandUp will move beyond the traditional Social Learning Theory and aim toward a group level approach. When “mob mentality” occurs, the behavior of a large group cannot be justified by individual decision-making. In other words, an intervention must target the group as a whole in order to make a difference rather than on an individual level. (12) The new intervention will ensure that masses of adolescents are reached at every high school in the nation. This is particularly more effective than focusing on the individual through a parent. The “Talk. They Hear You.” campaign misses a significant factor in the influence of the adolescent lifestyle—social norms and networks. #DrugFreeStandUp will be sure to address these crucial factors.
Intervention #2: Emphasis on the Illusion of Control

            Incorporating the illusion of control to this new intervention will give adolescents the sense of freedom that they are making decisions on their own. According to the illusion of control theory, people overestimate their ability to control events. Through #DrugFreeStandUp, students will be socially drawn to a group that happens to make good decisions with regard to alcohol consumption. In the students’ minds, they are choosing to do the right thing on their own. This is an illusion because in fact, the peer mentor committee is inadvertently influencing the behavior of the students that respect and admire the group.
            The illusion of control aspect of the new intervention is a direct improvement upon the effects of psychological reactance in the “Talk. They Hear You.” campaign. Rather than imposing rules upon adolescents, the new intervention gives them the perception that they invented the rule. This illusion of control avoids the rebellion that often occurs as a result of psychological reactance and translates to voluntary healthy behavior and choices.
Intervention #3: A Focus on the “Big Picture”

            The “Talk. They Hear You.” campaign provides valuable material to parents that include the most up to date studies and statistics on underage drinking. As explored earlier, the Health Belief Model falsely assumes that parents will rationally absorb these statistics and educate their children based on facts. #DrugFreeStandUp will be more effective because it takes into account the fact that presenting statistics is not always effective. The law of small numbers and optimistic bias are well-known theories that work to design effective interventions in addressing human irrationality. The law of small numbers states that humans struggle with probability and have a distorted perspective on statistics. Since there is a misconception with regard to risk, it is difficult for people to relate to numbers and therefore are not influenced by statistics. Essentially, “Talk. They Hear You” will not be effective because parents will often be misled by the statistics provided to them and will therefore not convey the “big picture” to their children.
People are more inclined to behave a certain way through single examples and personal stories rather than raw numbers sway their decision. The new intervention will certainly provide opportunities to share real stories about fun ways to avoid situations with alcohol which will be much more effective than reciting data. Through monthly retreats, alcohol-free social events, and community service activities, students will have the opportunity to share personal stories of obstacles they have faced with regard to alcohol and other issues in order to experience first hand the alternative ways to have fun with their peers.
Conclusion:

            The “Talk. They Hear You.” campaign fails to meet the social and behavioral theories and concepts that consistently drive the way people think about issues and act on them. While it is certainly important for parents to talk to their children about alcohol and create an open environment at home, the intervention will not solve the serious alcohol issue among adolescents as a whole. Since each flaw in the old intervention has been addressed by theories of social and behavioral science, there is room for success in the near future for adolescents through #DrugFreeStandUp. The new intervention focuses on viewing adolescents as a group rather than as individuals, provides an illusion of control, and allows for the adolescent to see the big picture—concepts that are vital to changing behavior. The core value of freedom is now prevalent as the individual will make their own decisions based on personal stories from their peers and support from leaders in their community.
REFERENCES:

1) Centers for Disease Control and Prevention. Fact Sheets – Underage Drinking. Atlanta, GA: Centers for Disease Control and Prevention. http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm.
2) Greenburg, M., Spoth, R., and Turrisi, R. Preventive Interventions Addressing Underage Drinking: State of the Evidence and Steps Toward Public Health Impact. Journal of the American Academy of Pediatrics. 2008; 121:311-336. http://www.pediatricsdigest.mobi/content/121/Supplement_4/S311.short
3) Nash, S.G., McQueen, A., and Bray, J.H. Pathways to Adolescent Alcohol Use: Family Environment, Peer Influence, and Parental Expectations. Journal of Adolescent Health. 2005; 37(1): 19–28. http://www.ncbi.nlm.nih.gov/pubmed/15963903
4) Substance Abuse and Mental Health Services Administration. Sample “Talk. They Hear You.” Materials. Rockville, MD: Substance Abuse and Mental Health Services Administration.  http://www.samhsa.gov/underagedrinking/
5) Klein, J., Schoen, C., and Simantov, E. Health-Compromising Behaviors: Why Do Adolescents Smoke or Drink? JAMA Pediatrics. 2000; 154(10):1025-1033. http://archpedi.jamanetwork.com/article.aspx?articleid=351569
6) Siegel, Michael. “Traditional Health Behavior Models.” SB721. Boston University, Boston. 21 Feb. 2013. Lecture.
7) Grube, J., Paschall, M., and Lipperman-Kreda, S. Community Norms, Enforcement Of Minimum Legal Drinking Age Laws, Personal Beliefs And Underage Drinking: An Explanatory Model. NIH Public Access. 2010: 35(3): 249–257. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2863071/
8) National Cancer Institute. Theory at a Glance: A Guide for Health Promotion Practice. National Cancer Institute. Part 2. 2005; 13-21.
9) Allen, D., Sprenkle, D., and Vitale, P. Reactance Theory and Alcohol Consumption Laws: Further Confirmation Among Collegiate Alcohol Consumers. Journal of Studies On Alcohol. 1994; 55: 34-40. http://www.jsad.com/jsad/downloadarticle/Reactance_Theory_and_Alcohol_Consumption_Laws_Further_Confirmation_among_C/2147.pdf
10) Edberg, M. Individual Health Behavior Theories. (pp. 35-49). Essential of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett, 2007.
11) Gallagher, P., Mouttapa, M., and Valente, T. Using Social Networks to Understand and Prevent Substance Use: A Transdisciplinary Perspective. Substance Use & Misuse. 2004; 39 (10-12): 1685-1712. http://www-hsc.usc.edu/~tvalente/Publications/valente%20et%20al%20SUM.pdf
12) Siegel, Michael. “Alternative Models.” SB721. Boston University, Boston. 7 Feb 2013. Lecture.






Friday, May 10, 2013


A Critique of Drive Sober or Get Pulled Over – Catherine Tobin

The Problem: Drinking and Driving

Driving after consuming alcohol is a large problem in the United States, despite the risk being common knowledge. This problem is by no means a new development, as it has seen serious consequences for decades and continues to take lives every day. Drinking alcohol raises a person’s blood alcohol content (BAC,) which, at the illegal level of .08%, causes poor muscle coordination including balance, vision, and reaction time, makes it harder to detect danger, and impairs judgment, self control, and reasoning. (1) These effects often have detrimental consequences when one attempts to drive, causing countless crashes resulting in fatalities and critical injuries. Sadly, a large problem with drinking and driving is its prevalence in the Unites States. According to the CDC, adults reported drinking and driving about 112 million times in 2010. (2) That same year, 10,228 people were killed in alcohol-impaired driving crashes, accounting for nearly one-third (31%) of all traffic-related deaths in the United States. (3)
Driving with a BAC at or above .08% is illegal and many people do get pulled over and face charges, but more often than not drinking and driving goes unnoticed until a tragedy occurs; law enforcement just couldn’t possible catch all drunk drivers. Because of the frequency and horrific aftermath of this problem, many organizations have launched public health campaigns in efforts to reduce the lives lost in drunk driving accidents. One of these campaigns is Drive Sober or Get Pulled Over, launched by the National Highway Traffic Safety Administration (NHTSA), an organization whose mission is to “save lives, prevent injuries and reduce economic costs due to road traffic crashes, through education, research, safety standards and enforcement activity.”(4)

Drive Sober or Get Pulled Over

The Drive Sober or Get Pulled Over campaign was created to reduce the prevalence of drunk driving. The campaign actively tries to convince the public not to drive after consuming alcohol. The main idea that is presented in the commercials and posters of the campaign is that when you drive drunk, law enforcement will catch you and you will be arrested. Several of the campaign videos follow a similar story of people – a group of friends, a couple, etc. – who are clearly intoxicated stumbling towards their parked car with unseen cops lurking in the background. The people get into their car or onto their motorcycle and begin to drive away, and then get caught by the police who had been invisible until they were pulling them over. Each video concludes with the same slogan: “They'll see you, before you see them. Cops are cracking down on drinking and driving. Drive sober or get pulled over.” (5-7)
 This idea of the ‘invisible’ cop is a large aspect of the campaign. The website even has an entire section dedicated to the making of the invisible cops, complete with behind the scenes videos. The page says, “Using ‘invisible’ cops to make the point that they’ll see you before you see them seems like a cool idea.” The website also has interactive quizzes where visitors can test their knowledge about drunk driving rates and death rates. This program is comprehensive and had a lot of thought put into it. However, while the NHTSA undoubtedly has the public’s best interest in mind and has an important and relevant mission, this campaign has some major weaknesses that prevent it from being as effective as possible. (8)

Ineffective Framing

The first weakness of the Drive Sober or Get Pulled Over campaign is the way the issue is framed. A frame is an approach to relaying a message in the way you want people to receive it. Siegel and Menashe define it as a way of packaging and positioning an issue so that it conveys a certain meaning. (9) When used effectively, framing can be a valuable tool in public health campaigns and advertising in general: “Framing not only defines the issue, but it also suggests the solution.” (9) The makers of the Drive Sober or Get Pulled Over campaign framed the problem of drunk driving both as a crime problem and separately as a safety problem. Unfortunately, neither of these frames makes for a very convincing argument.
The crime frame is used on the website of this campaign and largely in the commercials and posters. The campaign was intentionally shaped in a way that communicated drunk driving as an action that merits punishment.  It is a threatening approach that essentially just reminds viewers that drunk driving is illegal and, unintentionally, tells them to make sure they don’t get caught when they do it. It uses core values of abiding by the law and evading authoritative law enforcement. Symbols and images in this frame consist of angry police officers, breathalyzers, and handcuffs. Although ideally this should be effective, the truth is that people do not place a lot of value on following the law. (10) This is especially true for preventive laws that do not have an immediate, tangible effect, such as drinking and driving. This frame is ineffective because it incorrectly assumes that people will place importance on following the law and respond to the threat of punishment.
Independently, the safety frame used on the website relays the message that drunk driving is a safety problem: it kills and harms many people. The core values of this frame are the health and safety of the public, which realistically do not really resonate with people. Rationally, people should care a great deal about their health and the health of their friends and family. However, those values do not invoke strong reactions because of how disconnected people feel from the reality of harm or death. Health and safety are ideas that seem complex and out of our own control, and therefore do not receive much weight when threatened. Therefore, framing drunk driving as a safety problem is not going to invoke much reaction from viewers.

Provoking Psychological Reactance

Psychological reactance theory has been defined as “an aversive affective reaction in response to regulations or impositions that impinge on freedom and autonomy.” (11) Essentially, when one is told in a threatening way not to do something, they feel that their freedom is threatened and their response is to claim their freedom by carrying out the banned action. This is a strong reaction because of the extent to which people value their personal freedom. Jack W. Brehm explains, “If a person’s behavioral freedom is reduced or threatened with reduction, the person will become motivationally aroused…this would presumably be directed against any further loss of freedom, and…toward the reestablishment of whatever freedom had already been lost or threatened.” (12) People are more likely to have psychological reactance the more dominant and controlling the message is, the more threatening the messenger is, and the less justification is provided with the message (13)
This campaign effectively did everything possible to provoke psychological reactance. The entire focus of the advertisements is to threaten and scare viewers out of drinking and driving. The message is very dominant and authoritative; complete with angry police officers positioned as the adversary, accompanied by dramatic, eerie music that further suggests an enemy is lurking nearby. Even the title of the campaign is an aggressive warning. (5-8) Furthermore, the justification offered is limited to the illegality of drinking and driving. The commercials don’t even attempt to connect drunk driving to the possible harm that can happen; they are entirely focused on telling the viewer that it is illegal and that they will get caught if they do it. (5-8) Additionally, psychological reactance is reduced when the messenger is relatable and likeable. (14) However, in this campaign reactance is only heightened by the messengers: law enforcement who are commanding and purposely framed as the enemy. Drive Sober or Get Pulled Over has a major weakness in that it inadvertently drives viewers to do the opposite of what it intends to promote because it is so prone to psychological reactance.

Overestimating Risk Perception

While part of this campaign does attempt to advertise the effects on people that drunk driving so often has, the campaign uses this information in a very ineffective way. On the Drive Sober or Get Pulled Over website, numerous statistics about drunk driving and death rates are front and center on the home page. They are visible on each page of the website, and upon clicking, one will find themselves engaged in an interactive quiz with a series of questions testing their knowledge about even more statistics. (8) Although these figures are truthful and quite staggering, the large numbers meant to daunt people do not have much of an effect. The makers of this campaign greatly overestimated risk perception in the people they intended to reach.
Humans are irrational when it comes to perceiving risk and understanding statistics. We often fall victim to the Optimistic Bias and the Law of Small Numbers. Optimistic bias is defined as “the mistaken belief that one's chances of experiencing a negative event are lower (or a positive event higher) than that of one's peers.” (15) This is the theory behind the cliché ‘I never thought it would happen to me’ mindset.  Neil D. Weinstein’s findings conclude, “An optimistic bias is often introduced when people extrapolate from their past experience to estimate their future vulnerability.” (16) People believe, quite irrationally, that because they have been okay so far, nothing bad will happen to them. Hence, they attribute the large statistics to the rest of the population.
Furthermore, the Law of Small Numbers can cause people to perceive statistics in a very skewed manner. Daxhammer, Hanneke, and Nisch said, “According to the law of large numbers, large random samples closely represent the population from which they are drawn. In contrast, the law of small numbers is the effect that people think that small random samples are highly representative for their underlying population.” (17) The Law of Small Numbers causes people to have an illogical understanding of large statistics. Tversky and Kahneman propose that “people tend to believe in the law of small numbers, but not in the law of large numbers.” (18) This means, for example, that someone would believe they were much less likely to get in a drunk driving accident if all of their friends drunk drive and have not gotten into accidents. This is clearly not the case, but when campaigns use statistics, it becomes much more challenging for people to understand their realistic risks.
Relatedly, the Illusion of Control is activated when it comes to drunk driving. The Illusion of Control can be defined as “an expectancy of a personal success probability inappropriately higher than the objective probability would warrant.” (19) Typically, people give higher value to things that they have control over, such as the safety of driving while intoxicated. Humans trust our own control much more than is rational. Because of the Optimistic Bias, the Law of Small Numbers, and the Illusion of Control, Drive Sober or Get Pulled Over is ineffective in relaying the risks of drunk driving to their viewers.

Campaign Improvements Are Possible

Although this campaign has some major flaws, an effective anti-drunk driving campaign is possible! While Drive Sober or Get Pulled Over uses framing inefficiently, provokes psychological reactance, and overestimates risk perception in it’s target population, with some changes this campaign could be drastically more effective. I have a few suggestions that I believe would improve this campaign and more successfully reach the viewers and reduce the prevalence of drunk driving, ultimately saving lives.

Combine Frames

To address the issue of weak frames, I would combine the frames currently in use, and center them on a strong central frame of freedom. I would make the argument that drunk driving is a crime because it threatens the freedom of innocent people that are often harmed in subsequent accidents, as well as the drivers themselves. I would argue that people have the right to be healthy and happy, and drunk driving takes that right away from everyone involved when accidents happen. The original crime frame was sending the message that people would be fine as long as they are not caught drunk driving, instead of telling them that it is dangerous for others and can have severe consequences. Framing the issue as a freedom problem while incorporating criminality of drunk driving and safety of those affected into the message would be effective in invoking reactions in people. It would put the viewer primarily in the shoes of those harmed by drunk driving rather than solely in the shoes of the person committing crime and being arrested. The core values of this revised frame are freedom and rights, which are universally strong values that trump safety and health. (12) Because of the United States’ history of fighting for rights and independence to live freely, many people in this country especially identify strongly with those values and will become defensive when they feel their freedom being threatened. (20) By re-framing the issue of drunk driving in this way, the campaign would become much more emotive for viewers and consequently would more successfully achieve the goal of reducing drunk driving.

Get on the Viewer’s Side

This campaign is very prone to psychological reactance because of the threatening approach used. To diminish this phenomenon but maintain the goals of the campaign, I would create a situation where viewers come to the realization of the message on their own. (13) Instead of using intimidating threats and dominant law enforcement presence, I would show the effects that the campaign is ultimately trying to reduce. Replacing the direct warnings with an emotional message that drunk driving is harmful will ultimately make viewers realize that they should not drink and drive. This angle also offers ample justification for the message of anti-drunk driving by showing the dreadful consequences, which makes it even less likely for the viewer to experience psychological reactance. (13)
People can more easily picture themselves in the position of a victim rather than a criminal, so making the messenger a person harmed by drunk driving would make them more relatable and thus send a much stronger message, whether the person was the driver or someone else. (14) Therefore, commercials consisting of the detrimental consequences of drunk driving on people, families, and communities would be much more likely to get through to viewers, and would actually position drunk driving as the enemy, communicating the fundamental message of the campaign. By changing the campaign to eliminate opposition to the viewer, we eliminate psychological reactance and consequently strengthen the message to reduce drunk driving.

Ditch the Statistics

Drive Sober or Get Pulled Over is very reliant on statistics and rates to inform their audience of the harms of drunk driving. Since statistics and large numbers are not very effective in making people understand their own risk, a different, more personal approach would be much more successful. Instead of using large numbers and population estimates of the harm done by drunk drivers, I would share detailed personal stories of those tragically affected by drunk driving accidents. Individual cases would be much more comprehendible to viewers, and would invoke an emotional reaction that statistics could not. A personal story has the ability to somewhat dissolve people’s optimistic biases and illusions of control by showing a real individual similar to the viewer themselves that experienced an unexpected tragedy. By making the viewer stop and think about the life of the person in front of them, the campaign would be much more effective in reaching viewers on a personal level and making them understand the extent of the risk of drunk driving. Ultimately, this approach would reduce drunk driving much more so than a cluster of statistics that people feel disconnected from. (21)

Conclusion
Drive Sober or Get Pulled Over has several flaws that hinder it from attaining its goals of reducing drunk driving. By reconstructing Drive Sober or Get Pulled Over into a new campaign, which we can call Think Twice to Save a Life, we could introduce changes that would make for a more successful public health campaign. The ineffective framing of drunk driving as a crime problem and a safety problem can be combined and enhanced, the psychological reactance that is so largely induced can be eliminated, and the harmful effects of drunk driving can be communicated without useless statistics.
The Think Twice to Save a Life program would use personal stories of individuals negatively affected by drunk driving to communicate the realistic risk of life altering accidents. The campaign would frame drunk driving as having taken away the freedom of these individuals to live healthily and happily, which would invoke a strong reaction in viewers. Ultimately, people watching the commercials or visiting the website would identify with the harmed individuals telling their stories, and would understand the risk that drunk driving has on both innocent people and the drivers themselves.
REFERENCES

1.    Centers for Disease Control and Prevention. Effects of Blood Alcohol Concentration (BAC). Atlanta, GA: Centers for Disease Control and Prevention. http://www.cdc.gov/Motorvehiclesafety/Impaired_Driving/bac.html
2.   Centers for Disease Control and Prevention. Drinking and Driving. Atlanta, GA: Centers for Disease Control and Prevention. http://www.cdc.gov/vitalsigns/drinkinganddriving/
3.   Centers for Disease Control and Prevention. Impaired Driving: Get the Facts. Atlanta, GA: Centers for Disease Control and Prevention. http://www.cdc.gov/motorvehiclesafety/impaired_driving/impaired-drv_factsheet.html
4.   National Highway Traffic Safety Administration. NHTSA's Core Values. Washington, D.C.: National Highway Traffic Safety Administration. http://www.nhtsa.gov/About+NHTSA/NHTSA's+Core+Values
5.    “Drive Sober or Get Pulled Over,” YouTube video, 0:34, posted by "NYS DMV," January 8, 2013, http://www.youtube.com/watch?v=YRu0IlOxJP0
6.   “Drive Sober or Get Pulled Over Motorcycle,” YouTube video, 0:30, posted by “MyFDOT,” August 31, 2011, http://www.youtube.com/watch?v=7ILRoguA7wM
7.   “Drive Sober or Get Pulled Over Couple,” YouTube video, 0:30, posted by “MyFDOT,” August 31, 2011, http://www.youtube.com/watch?v=-2NkztWW6IE
8.   National Highway Traffic Safety Administration. Drive Sober or Get Pulled Over. Washington, D.C.: National Highway Traffic Safety Administration. http://www.nhtsa.gov/drivesober/
9.   Menashe C. L., Siegel M. The power of a frame: an analysis of newspaper coverage of tobacco issues – United States, 1985-1996. Journal of Health Communication 1998; 3(4):307-325.
10.                  Vito, G. F., Maahs, J. R., Holmes, R. M. Criminology: Theory, Research, and Policy. Sudbury, MA: Jones and Bartlett, 2007.
11.Moss, S. Psychological Reactance Theory. Psychlopedia 2008.
12.                  Brehm, J. W. A theory of psychological reactance (pp. 377-392). In: Brehm, J. W. Organization Change: A Comprehensive Reader. San Francisco, CA: Jossey-Bass, 2009.
13.                  Dillard, J. P, Shen, L. On the Nature of Reactance and its Role in Persuasive Health Communication. Web of Science, 2007.
14.                  Silvia, P. J. Deflecting reactance: The role of similarity in increasing compliance and reducing resistance. Basic and Applied Social Psychology 2005; 27: 277-284.
15.Klein, W. M. P. Optimistic bias. National Cancer Institute 2011.
16.                  Weinstein, N. D. Unrealistic optimism about susceptibility to health problems: Conclusions from a community-wide sample. Journal of Behavioral Medicine 1987; 10(5): 481-500.
17.                  Daxhammer, R. J., Hanneke, B., Markus, N. Beyond risk and return modeling-How humans perceive risk. Hochschule Reutlingen 2012.
18.                  Tversky, A. & Kahneman, D. Judgment under uncertainty: Heuristics and biases. Science 1974; 185, 1124-1131.
19.                  Langer, E. J. The illusion of control. Journal of Personality and Social Psychology 1975; 32:311-328
20.                 Bullard, B. Polls show more Americans value freedom over safety. Personal Liberty Digest 2013.
21.                  Paulos, J. A. Stories vs. statistics. New York Times 2010.