Alcohol and Public Policy Beyond the Shadow of Prohibition (1981) / Chapter Skim
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Reducing Alcohol Abuse: A Critical Review of Educational Strategies
Reducing Alcohol Abuse: A Critical Review of Educational Strategies
Pages 286-335
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From page 286... ...
To induce people to moderate their drinking behavior, it was thought John L Hochheimer is a graduate student at the Institute for Communication Research.
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From page 287... ...
Why should we bother with attitudes at all, since what we are really after is behavior change? Have there not been 30 years of attempts to modify drinking behaviors through the mass media with no demonstrable effect (Blanc 1976, Blane and Hewitt 1977, Goodstadt 1978~?
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From page 288... ...
When viable objectives for an effective alcohol campaign are compared with other, successful health education experiences (for example, SHDPP and certain behavior modification programs for smoking and weight reduction) the resemblances encourage investment in alcohol education.
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concluded that the mass media changed attitudes minimally and functioned primarily to reinforce previously held views. As recently as 1976, in evaluations of the "Feeling Good" television series (Swinehart 1976)
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"With rare exceptions," says Mendelsohn, "mass communications researchers have been documenting and redocumenting the by now obvious fact that when communicators fail to take into account fundamental principles derived from mass communications research, their efforts will be generally unsuccessful.... In short, very little of our mass communications research has really tested the effectiveness of the application of empirically grounded mass communications principles simply because most communications practitioners do not consciously utilize these principles" (p.
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From page 291... ...
, for example, reviewed studies on the development and evaluation of mass mediated campaigns aimed at drinking and driving (among other safety campaigns)
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3 Only under certain conditions is strong fear arousal the most effective use of fear appeals (Chu 1966~.
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of drinking behavior was necessary for effective pretesting of messages. Real-world driving behavior differed significantly from behavior manifested under experimental conditions; hence, any means of measuring the effects of the campaign other than direct observation of real-world behavior would be invalid.
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found that few evaluations of public education campaigns related to alcohol abuse have been methodologically sound. Typically, a simple before-and-after design is used to assess changes in attitudes, knowledge levels, and behavior of a target audience.
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Given the lack of both formative research and sufficient evaluation it is no wonder that previous public education campaigns aimed at reducing the incidence of alcohol abuse have had such inconclusive results. Proper use of the mass media for effective dissemination of messages is a multifaceted process that requires a great deal of planning, evaluation, and willingness to replan during the campaign if necessary.
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From page 296... ...
The Stanford Heart Disease Prevention Program 3-Community Study, described in detail below, is an example of a successful community-based health education program. The theoretical model for the 3-Community Study was based on the work of Cartwright (1949~.
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From page 297... ...
Cartwright believed that the mass media are usually most effective in initiating change in cognitive and affective structures; they are not often successful, however, in initiating change in action structures. Although the existence of these three components of a "hierarchy of effects" of any persuasive message is well established, it is of critical importance to determine which particular ordering of the three components will yield the best results.
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From page 298... ...
Without appropriate persuasive communication, mandated behavior change can do more harm than good. For example, the campaigns
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THE STANFORD HEART DISEASE PREVENTION PROGRAM: AN INTEGRATED MODEL OF BEHAVIOR CHANGE Description The Stanford Heart Disease Prevention Program 3-Community Study, as predicted by the work of Cartwright, achieved success by supplementing mass media programs with intensive interpersonal instruction. In addition, the study shows that certain reduced-risk behaviors (such as simple dietary changes and exercise)
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From page 300... ...
An approach that combines methods found to be effective in antismoking campaigns with methods used in successful strategies for dietary change may prove valuable in affecting alcohol abuse. One of the difficulties with any strategy for behavior change (such as moderating alcohol consumption)
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It is important to understand the theoretical basis of attitude change in designing strategies of intervention. The next section discusses what attitudes are, how they are formed and can be changed, and what their relationship is to behavior.
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Only after people are taught or persuaded about an evaluative relationship, e.g., between high-density lipoprotein and heart disease, that an attitude about frequent consumption of sizable amounts of alcohol enters their logical structure. Many attitudes are based on a similar combination of evaluative and nonevaluative beliefs, although the linkage is not quite so obvious.
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From page 303... ...
If Figure 2 were a true depiction of a person's attitude structure about drinking, it would be possible to convince him or her that Baptist preachers are good people who may not drink for other reasons; such persuasion, however, would not change the overall attitude, since this person still wants the respect of his or her Deer proud and a decree. in tencinn _ ~ 1 ~~ T — ~ [ _ __ O_ ~ _.
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One focus of a public education campaign aimed at reducing alcohol abuse could be the dissemination of messages showing that the excessive drinker is not, for example, a "he-man" or that teenage peers do not consider excessive drinking to be normal or "cool" behavior. INTERPERSONAL STRATEGIES FOR BEHAVIOR CHANGE SOCIAL LEARNING APPROACH In some instances, the knowledge that a problem exists is insufficient impetus to change certain health behaviors.
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in a new manner. An interpersonal strategy for teaching behavior change has been shown to be effective in several areas: smoking (Bernstein and McAlister 1976, Thoreson and Mahoney 1974, McAlister 1978, McAlister et al.
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During early adolescence, peers take over from adults as the primary source of influence (Utech and Hoving 1969~. Teaching by peers can efficiently provide traditional health education to large numbers of elementary school children (McRae and Nelson 1971~.
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The social learning approach is not concerned with information per se, but rather with the particular behaviors to be changed. Initially, goals are established for the person and systems are initiated for modeling new behaviors, practicing them, and rewarding their successful practice.
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Mass media messages, however, are not received equally by each person. Rather there exists a multistep flow, wherein some people get their information directly from the media, others through an opinion leader who has gotten the information from the media and/or other opinion leaders, etc.
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As mentioned earlier, training people to change their behavior related to alcohol is similar to training them in dietary change, in that it seeks, not necessarily to eliminate the behavior entirely, but to teach people to control and modify their behvior in such a way that the degree of risk is reduced. Examples of successful interventions using small-group interaction processes can be found in the summary report of Lewin (19584.
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As goals were attained, self-efficacy grew, which increased motivation to reach higher goals, which led to further weight loss. Since this progress took place within small groups, each person's success served to suggest to the others in the program that "If she can do it, I can do it, too." In the Stanford Heart Disease Prevention Program 3-Community Study, programs of professionally led behavior modification to reduce the rate of smoking among high-risk individuals were implemented with a certain degree of success (a net decrease of 35 percent in number of cigarettes smoked daily after 2 years [Farquhar et al.
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From page 311... ...
What was lacking was the specific information that could guide people in how to implement the behaviors advocated in the campaign. The Stanford Heart Disease Prevention Program utilized the mass media in a way that is not typical: namely, to teach specific behavioral skills (Stern et al.
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A number of studies have shown that differences in perceived expertise are correlated with how much opinion change a source achieves (cited in Roberts 1975~. Thus, we must determine who the target population of a campaign believes to be competent and trustworthy in the area of alcohol abuse education.
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Following what could be termed the "swine flu fiasco" of a few years ago, it would seem that the public is extremely wary of certain government information programs that might attempt to influence their health behaviors (Medical Progress and the Public, n.d.~. We should not assume that government affiliation with an alcohol education program will be highly credible to the public.
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To conclude, the sponsoring agency of an alcohol education strategy must pretest the proposed target audience to discern both the agency's credibility to the audience and the credibility, attractiveness, and power of those sources within the messages themselves. MESSAGE There are many aspects of message composition, including what information is included or left out, whether the message contains opposing arguments, whether the message aims at values or beliefs, whether the conclusion is explicit or left to the receivers, and how extreme a behavior change is advocated.
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in a program to induce people to get chest X-rays, and the San Antonio, Texas Alcohol Safety Action Program "Fear of Arrest" campaign (Hawkins and Cooper 1976~. There are implications of this approach for an alcohol abuse education campaign.
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It should be something that can be done easily and immediately; the person should be able to feel a sense of efficacy in performing the suggested act and feel fairly certain that it will be successfut in preventing the threatened damage. In the Stanford Heart Disease Prevention Program study, a specific suggestion, such as "cut down to 2 to 3 eggs a week," produced greater responses in the heart disease program than vague, long-term suggestions (Farquhar et al.
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For example, in the Stanford Heart Disease Prevention Program's 3-Community Study, radio was employed heavily for Spanish-speaking people because it was ascertained (through formative evaluation) that Hispanics in the target communities spent a great deal of time listening to Spanishlanguage radio.
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Thus, in the- Stanford Heart Disease Prevention Program, television and radio spots got people to heed longer messages and to learn from those longer messages, e.g., advice about food purchases, cooking, etc. Although most public education campaigns cannot mount huge, multimillion dollar campaigns due to budgetary restrictions, wise use of the various available media may make the difference between no positive outcomes and the initiation of some degree of change.
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The Stanford Heart Disease Prevention Program found that it could not simply translate English-language spots into Spanish to reach California's large Chicano population. Rather,
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From page 320... ...
Research is needed on the audiences available to particular channels, as is continuous monitoring of the existing knowledge, beliefs, attitudes, risk-related behavior, and media use of those audiences. We should account for the differing level of need and the differences in ethnic group, socioeconomic status, sex (public education messages about alcohol use tend to have a distinctly masculine orientation, according to Blane and Hewitt t1977~)
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notes that children in junior high school are at an age at which they appear to be most easily persuaded by information contained in a drug (or alcohol) education program.
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careful consideration is given to delineating specific targets in terms of their demographic and psychological attributes, their life-styles, value and belief systems, and mass media habits. This kind of approach to message design based on principles derived from research was the strategy in the Stanford Heart Disease Prevention Program's 3-Community Study.
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CASPAR ALCOHOL EDUCATION PROGRAM The premise of this program is that specially trained teachers can teach their students about alcohol-related issues rather than alcoholism, modify their attitudes about drinking, and help them develop strong decisionmaking skills about drinking. It is anticipated that these factors will lead to a reduction of alcohol abuse by teenagers.
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(3) The use of alcohol by students can be influenced by using a combination of mass media to promote awareness (setting the agenda)
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Those who wish to mount campaigns with the ultimate goal of changing behavior must be willing to invest more than 6 months before deciding the success or failure of their efforts and to stay cognizant of the quasi-experimental nature of their efforts—and hence the need for use of quasi-experimental design features as development of controls. As the Stanford Heart Disease Prevention Program's 3-Community Study showed, unlearning old behaviors (which may have taken years to develop)
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Each is different and involves somewhat different populations, patterns of mass media use, messages, sources, etc. Each target behavior has a distinct impact on the costs of the project.
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In these larger cities, however, media and other costs are high. The Stanford Heart Disease Prevention Program 3-Community Study was conducted in towns with populations of less than 15,000 (Tracy, Gilroy, and Watsonville, California)
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This prefield test is a good way to find out how effective, convincing, and credible the proposed messages and sources are. For example, in the Stanford Heart Disease Prevention Program, the "Heart Health Test" was tried out in a shopping center.
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, and adequate concurrent, as well as post hoc, evaluation procedures. The Stanford Heart Disease Prevention Program was shown to to be effective on a limited basis.
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(1977) Mass Media, Public Education and Alcohol: A State-of-the-Art Review.
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(1976) The effects of mass media and education program on problems of drinking driving.
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II. Experimental data, mass media research, and methodological considerations.
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L (1972) The agenda-setting function of mass media.
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Stanford, Calif.: Stanford Heart Disease Prevention Program.
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From page 335... ...
Journal of Social Psychology 78:267-274. Wallack, L
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