Module 11- Education and persuasion strategies Part One- Alcohol Policy and Public Health Preventing people from binge drinking and alcohol-related problems is a broadly shared goal among policy makers. When focused on young people, prevention programmes enjoy broad popular support as well. This module summarizes research on programmes designed to delay or to prevent entirely the use and misuse of beverage alcohol. Strategies and interventions are examined in several contexts and settings, including schools, colleges, and communities and the general population. Module 11- Education and persuasion strategies Pan American Health Organization

Learning Objectives Upon completion of this module you will be able to: Describe policies aimed at educating and persuading consumers to change their habits and their effectiveness Upon completion of this module you will be able to describe policies aimed at educating and persuading consumers to change their habits and the effectiveness of such policies. Pan American Health Organization

Education Strategies School-based alcohol education programs among the most popular types of prevention programs for policymakers Approaches include mass media campaigns, alcohol warning labels, school-based alcohol education, comprehensive school programs School-based alcohol education programs are among the most popular types of prevention programs for policymakers. Approaches include mass media campaigns, alcohol warning labels, school-based alcohol education and comprehensive school programs. Pan American Health Organization

Assumptions Underlying Education and Persuasion Policy Options Provide information to adults and young people especially through mass media and school-based alcohol education programs Health information increases knowledge, changes attitudes and prevents drinking problems The main assumption underlying education and persuasion prevention options is that health information increases knowledge, changes attitudes and prevents drinking problems. Pan American Health Organization

Education and Persuasion Strategies: Public Service Announcements (PSAs) Messages prepared by nongovernmental organizations, health agencies, and media organizations that deal with responsible drinking, the hazards of drinking-driving and related topics Despite their good intentions, PSAs are an ineffective antidote to the high-quality pro-drinking messages that appear much more frequently as paid advertisements in the mass media In response to the extensive promotion of alcoholic beverages in many countries, governments and private organizations have sponsored information campaigns. This has taken several forms, including social advertising, also called public service announcements (PSAs) and placement of warning messages on actual advertisements. These social advertising messages are prepared by governments, nongovernmental organizations, health agencies, and media organizations for the purpose of providing important information for the benefit of a particular audience. In some cases PSAs depend upon donated time or space for distribution to the public. When applied to alcohol, PSAs often deal with responsible drinking, the hazards of drink-driving, and related topics. Despite their good intentions, PSAs are an ineffective antidote to the high-quality pro-drinking messages that appear much more frequently as paid advertisements in the mass media. In most countries, the number of PSAs concerning alcohol is at best a small fraction of the total volume of alcohol advertisements and PSAs are rarely seen on television. Moreover, the content of information campaigns cannot easily challenge the other persuasive influences supportive of drinking. Pan American Health Organization

Recent PSAs http://youtu.be/VHGMcQJxgRA http://youtu.be/2Y1QxF0hs_0 While PSAs on their own have no effects on rates of consumption, they can still act contribute to other educational and intervention strategies. Click on the links on this slide to see examples of PSAs that have been produced recently. http://youtu.be/2Y1QxF0hs_0 Pan American Health Organization

Warning Labels Emphasize the potential for birth defects when alcohol is consumed during pregnancy and the danger of alcohol impairment when driving Some evidence that warning labels impact knowledge, awareness, intentions and perceptions No convincing evidence of an effect on alcohol consumption and driving after drinking A fairly extensive amount of research has been conducted on US-mandated alcoholic beverage container warning labels. Emphasis has been placed on the potential for birth defects when alcohol is consumed during pregnancy, the danger of alcohol impairment when driving or operating machinery, and general health risks. Some states require posted warnings of alcohol risks in establishments that serve or sell alcohol. There is evidence that warning labels impact knowledge, awareness, intentions and perceptions, but evidence on drinking behaviour is at best equivocal. A review by MacKinnon and Nohre (2006) concludes that there is no convincing evidence of an effect of general alcohol warning labels on behaviour, such as alcohol consumption and driving after drinking, and across studies little evidence that alcohol use has decreased as a result of warning labels. In summary, the warning label research does not demonstrate that exposure produces a change in drinking behaviour per se. There is little evidence that alcohol warning labels have measurable effects on drinking behaviours.   Pan American Health Organization

School-based Alcohol Education Programs Can increase knowledge and change attitudes toward alcohol Do not change drinking behavior Modest changes in drinking have been associated with programs that include both resistance skills training and normative education School-based alcohol education programs have been the method of choice in preventing alcohol-related problems among young adults. School-based alcohol education programs have been found to increase knowledge and change attitudes toward alcohol, but they are not an effective means to change drinking behavior. Beyond the provision of information about alcohol's negative effects, programs that address "values clarification," self-esteem, general social skills, and activities intended to replace alcohol use (e.g., sports) are equally ineffective. Modest changes in drinking have been associated with programs that include both resistance skills training and normative education (which attempts to correct adolescents’ tendency to overestimate the number of their peers who drink) but the effects wane after the program is concluded. Comprehensive programs that include both education and community-level interventions may be equally inadequate to delay the initiation of drinking, or to sustain a reduction in drinking beyond the operation of the program. Pan American Health Organization

Education and Persuasion Strategy or Intervention Effectiveness Supporting Research Cross-National Testing Classroom education +++ ++ Mass media campaigns, including drink-driving campaigns Warning labels and signs + Social marketing College student normative education and multicomponent programs Brief interventions with high-risk students Education and persuasion programs have been evaluated extensively relative to other alcohol policy areas. Despite extensive research on classroom education mass media campaigns, and social marketing approaches, the evidence indicates a lack of effectiveness for all of these approaches if behavior change is considered the main criterion for success. Many school-based programs include both resistance skills training and normative education, which attempts to correct adolescents’ tendency to overestimate the number of their peers who drink or approve of drinking. Scientific evaluations of these programs have produced mixed results, with generally modest effects that are short-lived, unless accompanied by booster sessions. Some programs include both individual-level education and family- or community-level interventions. Evaluations suggest that even these comprehensive programs may not be sufficient to delay the initiation of drinking, or to sustain a small reduction in drinking beyond the operation of the program. The strongest effects have been found in programs directed at high-risk groups, an approach akin to assessment and brief intervention. Media campaigns prepared by government agencies and nongovernmental organizations that address responsible drinking, the hazards of drink-driving and related topics have not proven effective in countering the pro-drinking messages prevalent in most societies. Pan American Health Organization

Summary: Information – Education – Communication Education strategies in the absence of changes in the environment have shown little or no effect, regardless of the approach taken or the level of investment. Providing information about alcohol in a health curriculum/ lifestyle education increases knowledge but won’t change behavior. Selective education (including a treatment component) shows some evidence of success. Based on the reviews, it would appear that many programs without demonstrated effectiveness continue to be implemented, apparently based on the assumption that providing information will somehow change behavior and help maintain the change. On the other hand, programs with multiple interactive components and dimensions and those that reach beyond the classroom seem to have some potential. Education is not necessarily the best description of the adolescent-focused or school-based programs that have some potential for positive impact. These dimensions may be part of such programs, but their ‘selective’ or ‘indicated’ foci combined with components that resemble family therapy or screening and brief intervention may be the most potent components. The reviews typically show that information is not sufficient on its own to delay initiation of alcohol use or to prevent alcohol-related problems. In general, prevention programs seem more successful when they maintain intervention activities over several years and incorporate more than one strategy. Pan American Health Organization

Summary: Education Strategies The impact of education and persuasion programs tends to be small at best, and positive effects rarely last long-term. Even comprehensive programs may not be sufficient to delay initiation of drinking or sustain small reductions after program. Programs with multiple interactive components that resemble family therapy and brief intervention seem to have some potential. The impact of education and persuasion programs tends to be small at best. When positive effects are found, they do not persist. Among the hundreds of studies, only a few show lasting effects (after 3 years) (Foxcroft et al. 2003). Even comprehensive programs may not be sufficient to delay initiation of drinking or sustain small reductions after program. Programs with multiple interactive components that resemble family therapy and brief intervention seem to have some potential. Many programs shown to be ineffective continue to be used. Pan American Health Organization

REFLECTION Select and describe an education program you know in your country. Discuss positive and negative points of the program and whether it could make a difference at a population level. Pan American Health Organization