The Power of Positive Peer Pressure Social Norm Marketing: Jan L. Gascoigne, Ph.D., CHES Linda Hancock, FNP, Ph.D. Ruth McGinley, RN, BSN

How We See the Problem is How We Define the Solution What Will We Promote?

What Do We Want To Normalize? Illness or Health “Anyone can be an alcoholic” Vs. “Anyone can be healthy”

Health Promotion If we want health we must promote health

Make Smoking History Advertisement Campaign 3000 Kids Start Smoking Everyday 1st Bike5 years old 1st Hamster8 years old 1st Cigarette11 years old

Traditional Health Education Strategies “If only you knew...” n “I’m okay...You, not so much...” n “Health Terrorism”

“If only you knew...” n Information n Motorcycle Helmets Save Lives n Seat Belts Save Lives: “Buckle Up for Safety” n Alcohol is a Drug n Smoking Causes Cancer

“I’m okay...You, not so much...” n Preaching n Smoking Doesn’t Make You Look Cool n I Don’t Drink, You Shouldn’t Either

Health Terrorism: Scaring the Health into Students n There are bad things out there n Everyone is at risk

Traditional Health Education Strategies “Health Terrorism” n Sex = AIDS & Death or Pregnancy n “Drink, Drive, and Die”

Traditional Health Education Strategies Information n Raises awareness, but does not necessarily translate to behavior n Skill Building n Often does not reach the target population n May conflict with cultural and environmental values n Scare Tactics n Negative marketing n No credibility n Sets a norm that the behavior is common

Social Marketing  Is a health promotion strategy  Utilizes commercial marketing techniques to promote health behaviors and social justice issues  Creates advertising and promotional materials for organizations or concepts  Addresses the needs of the target population  Takes time and persistence to create change

Social Marketing  Has a focused message  Take on one issue at a time  Requires saturation of the target community

Social Norms Marketing Social Marketing Plus Social Norms Theory

Marketing Commercial Marketing GOAL: Sell products or services Based on research. Consumer focused! Social Marketing GOAL: Behavior change Social Norms Marketing (SNM) Goal: Promote healthy social norms

Social Norm Theory Pro-Active Prevention Most students are making HEALTHY CHOICES and have Healthy Attitudes about pertinent Life issues

Most Students do not know they are Most Students

Silent Majority The “Perceived Norm” of irresponsible behavior becomes acceptable-- Healthy students become the “Silent Majority”

Misperceptions of Peer Attitudes and Perceived Campus Norms for Alcohol Use Among Students. (Perkins & Berkowitz, 1986)  “Drinking is never a good thing to do.”  “Drinking is all right, but a student should never get ‘smashed’.”  “An occasional ‘drunk’ is okay as long as it doesn’t interfere with grades and responsibilities.”  “An occasional ‘drunk’ is okay even if it does occasionally interfere with grades or responsibilities.”  “A frequent ‘drunk’ is okay if that’s what the individual wants to do.”

Percentage Distribution of Personal Attitudes and Perceived Campus Norms for Alcohol Use Among Students ( Perkins & Berkowitz, 1986)

Misperceptions and Social Norms Theory “This theory holds that if students perceive something to be the norm, they tend to alter their behavior to fit that norm, even if it isn’t reality. So if students think heavy drinking is normal, they’ll drink more. If they think responsible drinking is normal, they’ll drink more responsibility.” - Michael Haines, NIU

Where Do Misperceptions Come From? Extreme Behavior Stands Out n The Media n Perceptions of College Life n Carriers of Misperception n “Bystander” Syndrome

Why It Works? n It is cost effective n It is local- it is about me n Marketing is a powerful n It is tradition-forming n It is campus or community-wide

Downsides? Telling the truth is dangerous n People will want to add their own stuff n Harm reduction focus n It takes time and patience to get saturation n You will get bored, your students/staff will n get bored--keep the faith n The “most” can isolate the “some” n Very hard to get buy-in/consistent messages n People may feel attacked--”that can’t work”

Montana Model: Systemic Coordination Montana Model Linkenbach & D’Atri 1998

Social Norm Marketing Steps & Components Montana Model Linkenbach & D’Atri, 1998

BACCHUS & CDC Social Norms Tobacco Project Focus Area: Reduce Tobacco Use Among College Students Participants: Oswego State University University of Maryland University of Hawaii-Manoa Univ. of Texas Pan American Gustavus Adolphus College Bowie State University Training: Administration, Students Project Timeline: 5 Years Survey: BACCHUS Tobacco Survey Budget: Training Survey Marketing Materials Advertising

Social Norms Demonstration Sites that Focus on Priority Populations Bowie State - Historically Black College/ University - 88% African American University of Texas Pan-American - 85% Hispanic population (Mexican American and Puerto Rican) University of Hawaii at Manoa - 75% AsianAmerican/ Pacific Islander population

Demonstration Site Campaign Materials Staff Training Bi-Annual Report Documentation Book Advertising Money Technical Assistance Promotional Items

Data Collection Process Survey students in the Spring semester –Dillman mailing method –Random sample of undergraduate full-time students –Return rates range from 30% - 55% Use data to develop four messages

Preliminary Data 24% began smoking during college years 59% say it is unlikely that they will be smoking one year from now 72% say it is unlikely that they will be smoking after graduating from college 51% of smokers say they have made one or more serious attempts to quit

Message Objective- Prevent Initiation of Tobacco Use Most students choose not to smoke. Distributed in August/September Promotions items (highlighters with logo and statistic) are distributed at Orientation/ Academic Advising 500 Posters 500 Highlighters Print Ads for campus publications

Percentage of students who had not smoked in the last 30 days InstitutionPercent of Change Bowie State University5% Univ. of U. of Texas-Pan American11% University of Maryland 4% Gustavus Adolphus College 8% Oswego State University 5%

Message Objective - Eliminate Secondhand Smoke Most students prefer to socialize in a smoke-free environment Distributed in November to support task force and policy change initiatives on campus Promotional items: Frisbees with the logo and statistic

Percentage of students who prefer to socialize in a smoke-free environment InstitutionPercent of Change Bowie State University4% Univ. of U. of Texas-Pan American6% University of Maryland 6% Gustavus Adolphus College 5% Oswego State University-4%

Message Objective - Promote Cessation All things being equal, most students would rather date a non-smoker. Distributed in January/February Often in conjunction with Valentine’s Day Promotional items: candy mints with logo and statistic

Percentage of students who would rather date a non-smoker, all things being equal InstitutionPercent of Change Bowie State Universityno change Univ. of U. of Texas-Pan American6% University of Maryland 2% Gustavus Adolphus College no change Oswego State University no change

Message Objective - Promote Cessation Most students would support a friend who wants to quit smoking. Distributed in March to encourage cessation at the end of the year or for graduation.

Students who said they would support a friend who wants to quit smoking InstitutionPercent of Change Bowie State University31% Univ. of U. of Texas-Pan American10% University of Maryland 21% Gustavus Adolphus College 18% Oswego State University 4%

Lessons learned while working with campuses Little opposition to tobacco issues Be prepared for cessation opportunities Educate faculty and other allies about project Get students involved; message, distribution Document what is happening on campus Work with local community organizations; ACS, ALA

A Comprehensive Plan for Tobacco Reduction University of Wisconsin Oshkosh

Grant Support Wisconsin Tobacco Control Board American Cancer Society Center for Tobacco Research and Intervention (CTRI)

UW Oshkosh Comprehensive Tobacco Use Reduction Plan Goal –Reduce tobacco use by 4% in one year Objectives –Policy initiatives –Social norms campaign –Education –Cessation –Community Partnerships

Survey instrument Used CDC definition of a smoker Developed UW Oshkosh College Tobacco Survey –Knowledge –Behavior –Attitudes –Demographics

Social norms marketing campaign Developed/administered survey Chose most powerful norm statistic Utilized brainstorming, focus groups and individual feedback Used theme consistently/repeatedly

Survey data 0% 20% 40% 60% 80% 100% PerceptionReality 57% 96% 39% What we need to address Smokers who want to quit before graduation

Website nttowww.uwosh.edu/programs/youknowyouwa ntto –Reinforces Campaign Theme –Provides information Upcoming events Cessation resources Quit kit resources Links

Marketing survey results Poster88% Art car75% Jane51% Info tables63% Campus paper46%

Change in perception Pre-perceptionPost- perception 2 nd post- perception Reality Percent who want to quit 57%71%74.8%96%

Smoking rate Pre-testPost-test2 nd post-test Smokers33.9%23.8%22.6%

A Paired Comparison Study on SNM and Tobacco Use Reduction “ They’re just stupid posters, but they seem to work.” Linda Hancock, FNP, PhD Virginia Commonwealth University

Guidelines for Creating SNM Campaigns Collect baseline data Develop the message Educate those in authority Deliver the message to target population Support message retention Evaluate impact (get free booklet)

Study Design: What was done. Pre-test,post-test comparison group design. Two large urban campuses selected for convenience. Pre-test was given by residence hall advisors to freshmen at both sites the week before classes began. A non-smoking campus wide SNM media campaign was conducted at the intervention campus for the first semester. A post-test was given at both campuses about 10 weeks after the semester started and assessed the impact on residence hall freshmen.

Description of the SNM Intervention: Getting the norms known… “7 of 10 college students don’t smoke.” Poster Campaigns Table Tents Newspaper Advertisements Spokesperson- Darth Vapor Promotional Items: Key chains, Mousepads, T-shirts

Market Saturation Survey 94% of participants could recall at least one component Media Channel % Recalling Item Posters in RH77.1 Table Tents48.6 Posters in Class rooms45.7 Darth Vapor27.1 Newspaper Ads25.7 T-shirts15.7 Mousepads5.7 N=70 Males= 37%, Females = 63% 71.4% had not smoked in past 30 days

Results of Comparison Group Study Resident Hall Freshmen 10 weeks pre-post study paired t-tests, chi square (n=534) Perceptions Behavior Non-smokers cognitive commitment More Accurate Remained the same at VCU 3ppd at Control Campus at VCU at Control Campus

Findings in the PREDICTED DIRECTION = INDICATOR Change WITHIN Respondents Intervention Comparison Difference in Change BETWEEN Perception Much more accurate p<.0005 Slightly more Inaccurate p=.204 t=7.16 p<.0005 Behavior (cigs/mos.) Stable use p=.723 Increased use p=.006 t=2.42 p=.008 Non-smokers Cognitive Predisposition More Committed p=.077 Less Committed p=.424 X 2 = 2.78 p=.047

Set the non-smoking norm at the same time that you advertise cessation services. Cessation & Prevention

Curriculum Infusion Fashion Merchandising Assignment: Make smoking unfashionable The double benefit of sharing facts and norms… and it spreads the word about cessation services on campus.

Lessons Learned: BACCHUS & GAMMA Create a stakeholder group. Value peers in the process. Train the carriers of the misperceptions. Consider norms messages that are attitudes. Be prepared to answer questions. Vary the message medium. Less is more. Carefully construct messages.

Lessons Learned: VCU Choose media development team carefully. Keep the focus on norms. Choose the type of evaluation research you can best afford that eliminates confounding variables. Not all non-smokers are the same. Conduct market saturation surveys. Be prepared for those who want to quit.

Lessons Learned: Oshkosh Build a diverse core team. Understand your target market. Repeat the message with sophistication. Assess with multiple measures. SNM catalyzes policy change.

Next Steps… Improve data collection of college students’ tobacco use and attitudes (and in specific priority populations). Work with national, state and local tobacco control organizations to involve college students on advisory committees and boards. Promote Social Norm Model to counter-market industry targeting.

FREE sources of info on how to build a SNM campaign Free booklets by Haines and Zimmerman available at Higher Education Center for Alcohol and other drugs THE REPORT ON SOCIAL NORMS, Social Norms Resource Center