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CORK Bibliography: Social Marketing

53 citations. January 2003 to present

Prepared: March 2012

Atkinson AM; Sumnall H; Measham F. Depictions of alcohol use in a UK Government partnered online social marketing campaign: Hollyoaks 'The morning after the night before'. Drugs: Education, Prevention and Policy 18(6, special issue): 454-467, 2011. (107 refs.)

Aims: This study analysed the depiction of alcohol in an online government partnered social marketing campaign: Hollyoaks 'The Morning After the Night Before'. This was a new initiative, providing Internet-delivered episodes of a popular terrestrial drama targeted at young people. Methods: All the 12 episodes were coded for visual representations of alcohol, drinking acts and alcohol effect references. The drinking setting, point in time, type of alcoholic beverage consumed, drinker's demographics, effects/consequences of drinking, and official and unofficial responses to alcohol consumption and related harms were also coded. Audience comments were then categorized according to their content in order to gain an insight into viewers' thoughts regarding the campaign. Findings: A wide variety of data is reported. Most representations of alcohol were positively framed, and were depicted without immediate consequence. No explicit sensible drinking messages were included in the episodes. Analysis of viewer feedback indicated a lack of awareness of the intentions of the campaign and little discussion of alcohol-related issues was generated. In contrast, viewers seemed to reject the depictions of alcohol portrayed, and identified with, or admired, the central characters. Further analysis indicated little coherence between alcohol framing in the online campaign and representations in the terrestrial TV series. Conclusions: This article uses the example of KYL/Hollyoaks to draw attention to the emergent use of the internet and other new media in health promotion. New media provides creative new opportunities to engage young people with health-promoting messages. However, although new ways of delivery are important they should be part of a co-ordinated and internally consistent campaign, present realistic depictions of alcohol use, and be based upon clear evidence-based principles.

Awofeso N. Implementing smoking cessation programmes in prison settings. Addiction Research & Theory 11(2): 119-131, 2003. (31 refs.)

This report examines the implementation of a smoking cessation programs in prisons in Australia. The discussion outlines the reasons for implementing smoking cessation programs. It also provides the details of a suggested schema for implementing smoking cessation programs in prison settings. Finally it considers the lessons from the application of social marketing to smoking cessation programs.

Bellis MA; Morleo M; Hughes K; Downing J; Wood S; Smallthwaite L et al. A cross-sectional survey of compliance with national guidance for alcohol consumption by children: Measuring risk factors, protective factors and social norms for excessive and unsupervised drinking. BMC Public Health 10: 547, 2010. (30 refs.)

Background: The Chief Medical Officer for England has developed the first guidance in England and some of the first internationally on alcohol consumption by children. Using the most recent iteration of a large biennial survey of schoolchildren we measure the extent to which young people's drinking fell within the guidelines just prior to their introduction and the characteristics of individuals whose drinking does not; how alcohol related harms relate to compliance; and risk factors associated with behaving outside of the guidance. Methods: A cross-sectional survey was conducted utilising a self-completed questionnaire with closed questions. A total of 11,879 schoolchildren, aged 15-16 years, from secondary schools in North West England participated in the study. Data were analysed using chi square and conditional logistic regression. Results: Alcohol consumption is an established norm by age 15 years (81.3%). Acute alcohol related violence, regretted sex and forgetfulness were experienced by significantly fewer children drinking within the guidance (than outside of it). Over half of drinkers (54.7%) reported routinely drinking more heavily than guidance suggests (here >= 5 drinks/session >= 1 month), or typically drinking unsupervised at home or at a friend's home when parents were absent (57.4%). Both behaviours were common across all deprivation strata. Children with greater expendable incomes were less likely to consume within guidance and reported higher measures for unsupervised, frequent and heavy drinking. Although drinking due to peer pressure was associated with some measures of unsupervised drinking, those reporting that they drank out of boredom were more likely to report risk-related drinking behaviours outside of the guidance. Conclusions: Successful implementation of guidance on alcohol consumption for children could result in substantial reductions in existing levels of alcohol related harms to young people. However, prolonged social marketing, educational and parental interventions will be required to challenge established social norms in heavy and unsupervised child drinking across all social strata. Policy measures to establish a minimum price for alcohol and provide children with entertaining alternatives to alcohol should also increase compliance with guidance.

Chen HL. Consumer risk perception and addictive consumption behavior. Social Behavior and Personality 37(6): 767-780, 2009. (28 refs.)

The aim was to establish a causal structural model to examine consumers' addictive consumption decisions about tobacco. It was found that a consumer forms his/her risk perception based on three information sources. Moreover, a consumer's risk perception can directly influence his/her attitude toward cigarette smoking and also indirectly influence his/her intention to start smoking. From this study, managerial implications for public health professionals and for tobacco manufacturers can be drawn. For the former, it was found that: (i) antismoking advertising should intensively focus on escalating consumer risk perception and should be targeted toward males, the elderly, or persons with less education; and (ii) antismoking advertising and campaigns should be directed towards encouraging less addicted smokers to cease smoking. For the latter, tobacco manufacturers should employ social marketing techniques encouraging people not to smoke in public areas and discouraging young people from smoking.

Clapp JD; Johnson M; Voas RB; Lange JE; Shillington A; Russell C. Reducing DUI among US college students: Results of an environmental prevention trial. Addiction 100(3): 327-334, 2005. (17 refs.)

Aims: Driving under the influence (DUI) of alcohol is among the most common and serious alcohol-related problems experienced by US college students. Community-based prevention trials using environmental approaches to DUI prevention have been effective in reducing DUI. Such interventions remain untested in college settings. This study is the first to test the efficacy of an environmental prevention campaign to reduce DUI among college students. Design: We used a quasi-experimental non-equivalent comparison group design to test the efficacy of the DUI prevention intervention. Students at the experimental university were exposed to a DUI prevention intervention that included a social marketing campaign, a media advocacy campaign and increased law enforcement (DUI checkpoints and roving DUI patrols). Setting: Students from two large public universities located along the US/Mexico border participated in the seven-semester study. Participants In total, 4832 college students took part. Measures: Using telephone interviews of randomly selected students, we took pre- and postintervention measures of self-reported DUI. Findings: Self-reported DUI (past year) decreased significantly from pre-test to post-test (odds ratio = 0.55) at the intervention school, whereas rates at the comparison campus remained stable. The campus-intervention interaction was statistically significant (P < 0.05), suggesting that the campaign led to the observed change in DUI. Conclusions: Environmental DUI campaigns similar to those validated in community prevention trials can be effective in college settings. Further research, however, is needed to determine the robustness of the changes associated with such campaigns.

Clapp JD; Lange JE; Russell C; Shillington A; Voas RB. A failed norms social marketing campaign. Journal of Studies on Alcohol 64(3): 409-414, 2003. (18 refs.)

Objective: In this article we test the efficacy of an intensive norms social marketing campaign to reduce heavy drinking among college students living in a residence hall. Method: We employed a pretest-posttest nonequivalent comparison group design. The study was conducted in two (experimental and comparison) comparable residence halls located in a large urban public university. We attempted a census at each hall, and pre- and postintervention data were collected in public areas of each residence hall. Relative sample sizes were approximately 60% in the experimental hall (both waves) and 38% in the comparison hall. Results: The campaign successfully corrected students' misperceptions of drinking norms but had no effects, or counterintuitive effects, on drinking behaviors. Conclusions: Despite the popularity of this approach, universities would be prudent to proceed with care before adopting this approach wholesale.

Cramer ME; Roberts S; Stevens E. Landlord attitudes and behaviors regarding smoke-free policies: Implications for voluntary policy change. Public Health Nursing 28(1): 3-12, 2011. (22 refs.)

Objective: The study purpose was to describe multiunit landlord attitudes and behaviors toward smoke-free policies. Design and Sample: This was a descriptive, cross-sectional survey of multiunit landlords in Douglas County (N=392). Measures: A 25-item survey was developed and pilot tested. It was administered by telephone (n=143) and mail (n=249) to multiunit landlords. Results: Combined response rate was 30.1% (81/143 telephone, 37/249 mail) representing 24,080 units on 974 properties with 34,399 tenants. Most respondents (73.7%) allowed smoking. Reasons for not implementing smoke-free policies were potential enforcement problems (57.0%), tenant objections (43.0%), loss of market share (39.5%). Respondents without smoke-free policies expected vacancy (53.6%) and turnover (50.0%) rates to increase, which was significantly different (p <.0001) than respondents with smoke-free policies where only 10.7% reported increased vacancy and only 3.7% reported increased turnover. Conclusions: Expected adverse impacts of smoke-free policies do not reflect real experiences of smoke-free policy implementation. Public health advocates can use these study findings to develop community-based education and social marketing messages directed at voluntary smoke-free policy changes. Respondents without smoke-free policies expressed interest at the end of the survey in learning how to implement smoke-free policies indicating a readiness for change.

DeJong W. Social norms approach to building campus support for policy change. IN: Perkins HW, ed. Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians. San Francisco: Jossey-Bass, 2003. pp. 154-169. (26 refs.)

This chapter describes how college presidents and other top administrators can best present the case for new policies and programs to stem student alcohol problems. This study reviews the environmental approach to prevention, which calls for new policies to change the campus and community environment in which students make decisions about alcohol consumption. Also addressed is how college presidents and other top administrators usually try to build a climate of support for new policies and the pitfalls of these traditional approaches. An alternative strategy is outlined which is grounded in the social norms approach. Advancing a policy agenda can go more smoothly if efforts are made to correct misperceptions of drinking norms, reinforce the positive values held by the majority of students, and demonstrate majority student support for certain reforms. This requires that administrators collect and report survey data that correct misperceptions of student drinking norms. Also, positive trends should be publicized to help reinforce further changes in behavioral norms. College administrators need to define the problem in a what that motivates behavior change. Coupled with a sincere effort to give students a meaningful role in reviewing, developing, and implementing campus policies, administrators should collect information on student opinion about various policy options. Whenever feasible, administrators should consider implementing a program of environmental change by starting with those policies that enjoy majority student support.

Diehr P; Hannon P; Pizacani B; Forehand M; Meischke H; Curry S et al. Social marketing, stages of change, and public health smoking interventions. Health Education & Behavior 38(2): 123-131, 2011. (22 refs.)

As a "thought experiment," the authors used a modified stages of change model for smoking to define homogeneous segments within various hypothetical populations. The authors then estimated the population effect of public health interventions that targeted the different segments. Under most assumptions, interventions that emphasized primary and secondary prevention, by targeting the Never Smoker, Maintenance, or Action segments, resulted in the highest nonsmoking life expectancy. This result is consistent with both social marketing and public health principles. Although the best thing for an individual smoker is to stop smoking, the greatest public health benefit is achieved by interventions that target nonsmokers.

Donovan R; Henley N. Social Marketing: Principles and Practice. Melbourne: IP Communications, 2003. (Chapter refs.)

This book provides a comprehensive review of the key components of social marketing, their application to health education and health promotion. This volume is not directed exclusively to substance abuse issues. However, many examples are drawn from the alcohol/drug field. The volume is organized into 15 chapters. Of note, efforts are made to avoid a narrow victim-blaming approach, and emphasis is placed on initiating a broad range of changes that promote health and well-being. The author deals with basic principles in marketing as well as the factors which promote change by individuals as well as the larger social spheres. Among the topics convered are theories of change, such as the Stages of Change model, the role of self-efficacy, media advocacy, as well as approaches to systematic planning for social marketing campaigns.

Eaton DK; Forthofer MS; Zapata LB; Brown KRM; Bryant CA; Reynolds ST et al. Factors related to alcohol use among 6th through 10th graders: The Sarasota County demonstration project. Journal of School Health 74(3): 95-104, 2004. (30 refs.)

Alcohol consumption by youth can produce negative health outcomes. This study identified correlates of lifetime alcohol use, recent alcohol use, and binge drinking among youth in sixth through 10th grade (n = 2,004) in Sarasota County, Fla. Results from a closed-ended, quantitative survey acknowledged a range of personal, social, and environmental influences. Breadth of these influences supports a need for multifaceted, community-based interventions for effective prevention of youth alcohol use. This study was unique because it represents population-specific research in which community partners are using the findings to develop community-specific social marketing interventions to prevent underage drinking and promote alternative behaviors.

Embry DD. Community-based prevention using simple, low-cost, evidence-based kernels and behavior vaccines. Journal of Community Psychology 32(5): 575-591, 2004. (61 refs.)

A paradox exists in community prevention of violence and drugs. Good research now exists on evidence-based programs, yet extensive expenditures on prevention have not produced community-level results. Various multiproblems are quite prevalent in the United States, such as violence, Attention Deficit Hyperactivity Disorder (ADHD), conduct problems, learning disabilities, depression, and other mood problems. Various studies have observed that, intuitively appealing community-based coalitions and best practice requirements have not produced prevention gains as hoped for by many. Calls for more money, fidelity, or dose seem unlikely to succeed. Other alternatives may be possible. Most of the best practices aimed at preventing these community problems are composed of evidence-based kernels, which act on core principles of prevention (risk and protective factors). What is not widely known is that the evidence-based kernels are powerful in their own right. Evidence-based kernels are irreducible units of behavior-change technology, and, they can be put together into behavioral vaccines (daily practices) with powerful longitudinal prevention results. Kernels and behavioral vaccines are simple, and they are not programs or curriculum in the conventional sense. This article presents examples of evidence-based kernels and behavioral vaccines that clan be promoted easily across whole communities or states using social marketing principles. Widespread propagation of evidence-based kernels and behavioral vaccines could have a significant impact on. communities and their prevention nouns, providing low-cost alternatives and practical models for community psychology, public health, and policy makers. Behavioral kernels and vaccines can, add needed precision to prevention science and community psychology.

Evans WD; Price S; Blahut S; Hersey J; Niederdeppe J; Ray S. Social imagery, tobacco independence, and the truth(SM) campaign. Journal of Health Communication 9(5): 425-441, 2004. (48 refs.)

Objectives: This study investigated relationships among exposure to the truth(sm) campaign, differences in social imagery about not smoking and related measures, and smoking behavior. We asked, "How does truth(sm) work? Through what psychological mechanisms does it affect smoking behavior?" We developed a framework to explain how receptivity to truth(sm) ads might influence youth cognitive states and subsequent effects on progression to established smoking. The main hypotheses were that social imagery about not smoking and related beliefs and attitudes about tobacco use mediate the relationship between truth(sm) exposure and smoking status. Methods: The study was based on data from the Legacy Media Tracking Survey (LMTS), waves I-III, which were conducted at three time points from 1999 through 2001. A nationally representative sample of 20,058 respondents aged 12-24 from the three time points was used in the analysis. We developed a structural equation model (SEM) based on constructs drawn from the LMTS. We investigated the model and tested our hypotheses about the psychological and behavioral effects of campaign exposure. Results: We tested our constructs and model using a two-stage structural equation modeling approach. We first conducted a confirmatory factor analysis (CFA) to test the measurement model. Our model achieved satisfactory fit, and we conducted the SEM to test our hypotheses. We found that social imagery and perceived tobacco independence mediate the relationship between truth(sm) exposure and smoking status. We found meaningful differences between paths for segmented samples based on age, gender, and race/ethnicity subgroups and over time. Conclusions: The truth(sm) campaign operates through individuals' sense of tobacco independence and social imagery about not smoking. This study indicates that the campaign's strategy has worked as predicted and represents an effective model for social marketing to change youth risk behaviors. Future studies should further investigate subgroup differences in campaign reactions and utilize contextual information about the truth(sm) campaign's evolution to explain changes in reactions over time.

Fabiano PM. Applying the social norms model to universal and indicated alcohol interventions at Western Washington University. IN: Perkins HW, ed. Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians. San Francisco: Jossey-Bass, 2003. pp. 83-99. (16 refs.)

This chapter describes three alcohol interventions at Western Washington University (WWU) that use the social norms model: (1) a large-scale universal prevention application for all WWU students before the onset of alcohol-related problems; (2) a smaller scale universal prevention application of social norms focused on nondrinking students living in substance-free residences; and, (3) an indicated prevention infusion of the model into WWU's risk reduction intervention for students who have already developed signs and symptoms of alcohol-related problems. The WWU Lifestyles Project Survey revealed that in 1997, 89% of students estimated that other students drank once a week or more; in 1998, only 49.6% held a similar view. The percentage of drinking students who reported consuming five drinks or more on a typical weekend occasion dropped from 34.15% in 1997 to 27/3% in 1998. The percentage of drinking students who reported at least one negative effect of alcohol use on the Rutgers Alcohol Problems Inventory decreased from 60.9% in 1997 to 51.3% in 1998. Results from the risk reduction intervention indicated that in 3 months there was a significant decrease in the typical number of drinks consumed from intake (3.83) to follow-up (3.45), a significant decrease in peak number of drinks consumed from intake (4.89) to follow-up (4.29), a significant decrease in drinking frequency per month (students reported a higher number of drinking per month at baseline [3.39]) than at follow-up (3.13), and a statistically nonsignificant 10% decrease in overall negative alcohol-related consequences.

Far JM; Miller JA. Small groups norms-challenging model: Social norms interventions with targeted high-risk groups. IN: Perkins HW, ed. Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians. San Francisco: Jossey-Bass, 2003. pp. 111-132. (22 refs.)

This chapter describes a prevention strategy based on social norms theory (SNT) developed by the Small Groups Norms-Challenging Model (SGNM) at Washington State University (WSU). As applied to alcohol abuse prevention on college campuses, SNT states that most students significantly overestimate the attitude and behavior norms of their peers with regard to alcohol use and abuse. They then adjust their behavior toward these inaccurate norms, and student drinking increases. The primary goal of SGNM interventions is to correct misperception of alcohol use norms among students in membership groups considered to be at high risk for alcohol abuse and related problems: fraternities and sororities; athletic teams; and small, intensive classes intended for first-year students. The survey instrument used was the Student Life and Health Behaviors questionnaire. Four case studies (two Greek fraternities/sororities, two varsity and one junior varsity athletic teams, and a curriculum infusion) are presented. In general, survey results indicated a significant reduction in misperception of student drinking frequency and quantity associated with implementation of the SGNM in the fraternity/sorority population. Actual drinking quantity among Greeks decreased by 2.2 drinks per occasion. A nearby university with a similar student population but without a SGNM program was used for comparison. One specific source of resistance to participation in this prevention strategy has been concern about confidentiality. This was overcome by use of a survey coding system.

Gordon R; McDermott L; Stead M; Angus K. The effectiveness of social marketing interventions for health improvement: What's the evidence? Public Health 120(12): 1133-1139, 2006. (34 refs.)

Objectives: To review the effectiveness of social marketing interventions designed to improve diet, increase physical activity, and tackle substance misuse. Study design and methods: This article describes three reviews of systematic reviews and primary studies that evaluate social marketing effectiveness. All three reviews used pre-defined search and inclusion criteria and defined social marketing interventions as those which adopted six key social marketing principles. Results: The reviews provide evidence that social marketing interventions can be effective in improving diet, increasing exercise, and tackling the misuse of substances like alcohol, tobacco, and illicit drugs. There is evidence that social marketing interventions can work with a range of target groups, in different settings, and can work upstream as well. as with individuals. Conclusions: Social marketing provides a very promising framework for improving health both at the individual level and at wider environmental and policy-levels. Problems with research design, lack of conceptual understanding or implementation are valid research concerns.

Haines MP; Barker GP. Northern Illinois University experiment: A longitudinal case study of the social norms approach. IN: Perkins HW, ed. Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians. San Francisco: Jossey-Bass, 2003. pp. 21-34. (26 refs.)

The purpose of the long-term study reported in this chapter was to assess a new method for reducing alcohol use and alcohol-related negative consequences: the social norms approach. Following the failure of traditional prevention approaches, in 1989-1990, Northern Illinois University initiated a social norms intervention to change student perceptions of peer drinking (reduce misperceptions of heavier episodic drinking as the norm), thereby reducing the actual level of drinks per occasion, and ultimately reducing alcohol-related student injuries. Two assumptions were fundamental to this mass intervention. First, though drinking in college is widespread and heavier drinking is not uncommon, there was no simple way to identify and reach heavier drinkers as a discrete target population. Second, like most adults in society, college students have multiple social affiliations and identities. The diversity of even ordinary social interaction means that there may be many social norms that could potentially influence a student's behavior. Social marketing was chosen as the least expensive, most effective, most credible, and most wide-reaching strategy to reach the large and diverse student population. All data were drawn from a self-report sampling of undergraduates. Analyses of data following this longitudinal program indicated that the social norms/social marketing approach significantly reduced the overestimation of heavier drinking perceived by students. These findings suggest a trend toward greater moderation in drinking among the students at Northern Illinois University. A broader analysis of national trends in college drinking behavior during the same 10-year period adds support for the social norms intervention approach to reduce undergraduate alcohol consumption.

Haines MP; Barker GP; Rice R. Using social norms to reduce alcohol and tobacco use in two Midwestern high schools. IN: Perkins HW, ed. Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians. San Francisco: Jossey-Bass, 2003. pp. 235-244. (15 refs.)

This chapter presents a social norms method of intervention with high school students, modeled after the social norm campaign conducted at Northern Illinois University. The four stages of project development were data collection (patterns of use, perceptions of use, protective behaviors, etc.), development of intervention strategies (marketing research, availability of media, targeting prevention population), implementation, and evaluation. The Communities CAN! School Youth Survey and a supplemental perceptions survey were used to gather demographic information, drug and alcohol use and related behavior patterns, family-related issues, student perceptions of peer alcohol use, and protective behaviors employed. A social norm campaign using various media to correct overestimations of student alcohol and cigarette use was developed. Parents were targeted with display ads and direct mailings. In 1999, 319 10th grade students participated; in the 2001 follow-up survey, 571 10th grade students participated. Data show that there was a decline in the mean perceived percentage of students who used alcohol in the last 30 days for parents from 49% in 1999 to 44% in 2001. A similar decline occurred in the mean perceived percentage of students who had five or more drinks in a row in the last two weeks. Results indicated that the media campaign led to reduction in parents', teachers', and students' overestimation of peer alcohol and cigarette use and, most importantly, to reduction in actual alcohol and cigarette use among students.

Hammett TM; Des Jarlais DC; Liu W; Ngu D; Tung MD; Hoang TV et al. Development and implementation of a cross-border HIV prevention intervention for injection drug users in Ning Ming County (Guangxi Province), China and Lang Son Province, Vietnam. International Journal of Drug Policy 14(5/6): 389-398, 2003. (25 refs.)

This paper describes the background and early implementation of a peer-based HIV prevention intervention involving social marketing of sterile needles and syringes for injection drug users (IDUs) in a border region of northern Vietnam and southern China. Peer educators collect and safely dispose of used needles and syringes and provide IDUs with a choice of new needles/syringes or vouchers redeemable in pharmacies and clinics for new needles/syringes. The project arose from a pattern of changing drug use and increasing HIV infection in the region but its development took 4 years and faced many challenges. Implementation of the intervention posed a new set of challenges for the participating health departments, police, peer educators, pharmacists, injection drug users, and the communities at large. Early implementation of the project has revealed successful multi-sectoral collaboration, and broad acceptance by IDUs of pharmacy vouchers and distribution of new needles/syringes. However, IDUs' persistent fear of the police, particularly in Vietnam, has required reliance on separate collection by peer educators of used needles/syringes and distribution of pharmacy vouchers and new needles. In China, new needles/syringes and vouchers are largely being provided through exchange. Understanding the development and implementation challenges and the strategies that were successful in overcoming them (including the importance of being flexible and adaptable to contextual factors) may be useful to those interested in launching similar, much-needed interventions in other parts of the world.

Hastings G; McLean N. Social marketing, smoking cessation and inequalities. (letter). Addiction 101(3): 303-304, 2006. (9 refs.)

Hoek J. Tobacco promotion restrictions: Ironies and unintended consequences. Journal of Business Research 57(11): 1250-1257, 2004. (34 refs.)

As the health consequences of tobacco smoking have become more apparent, governments have regulated the types of promotion available to cigarette manufacturers. Yet despite these efforts, the tobacco industry has continued to develop highly visible promotions that make greater use of youth role models and of new media known to have high penetration among youth. Attempts to reduce the impact of the tobacco industry's promotions seem unintentionally to have stimulated the development of more subtle initiatives that are harder to regulate and that reach and influence young people even more effectively. Alternative means of controlling the health-related consequences of smoking include further promotion restrictions and tighter controls on the sale and distribution of tobacco. Social marketing programmes based on techniques developed by the tobacco industry may yet provide the richest irony: use of the industry's own tactics to counter its messages.

Holtgrave DR; Wunderink KA; Vallone DM; Healton CG. Cost-utility analysis of the National Truth (R) Campaign to prevent youth smoking. American Journal of Preventive Medicine 36(5): 385-388, 2009. (17 refs.)

Background: In 2005, the American Journal of Public Health published an article that indicated that 22% of the overall decline in youth smoking that occurred between 1999 and 2002 was directly attributable to the Truth (R) social marketing campaign launched in 2000. A remaining key question about the truth campaign is whether the economic investment in the program can be justified by the public health outcomes; that question is examined here. Methods: Standard methods of cost and cost-utility analysis were employed in accordance with the U.S. Panel on Cost-Effectiveness in Health and Medicine; a societal perspective was employed. Results: During 2000-2002, expenditures totaled just over $324 million to develop, deliver, evaluate, and litigate the truth campaign. The base-case cost-utility analysis result indicates that the campaign was cost saving; it is estimated that the campaign recouped its costs and that just under $1.9 billion in medical costs was averted for society. Sensitivity analysis indicated that the basic determination of cost effectiveness for this campaign is robust to substantial variation in input parameters. Conclusions: This Study suggests that the truth campaign not only markedly improved the public's health but did so in an economically efficient manner.

Khowaja LA; Khuwaja AK; Nayani P; Jessani S; Khowaja MP; Khowaja S. Quit smoking for life: Social marketing strategy for youth. A case for Pakistan. Journal of Cancer Education 25(4): 637-642, 2010. (31 refs.)

Smoking is the single most avoidable risk factor for cancers. Majority of smokers know about this fact but it is difficult for them to give it up mainly in the face of widespread smoking advertisements by the tobacco industries. To reduce the prevalence of smoking and its associated cancers, immediate actions are required by public health authorities. Social marketing is an effective strategy to promote healthy attitudes and influence people to make real, sustained health behavior change by transiting through different stages which include precontemplation, contemplation, preparation, action, and maintenance. Social marketing can influence smokers to voluntarily accept, reject, modify, or abandon their smoking behavior. In Pakistan, the smoking prevalence has been increasing, necessitating effective measures. The trend of its usage has been going upwards and, according to the World Health Organization, in Pakistan, the usage of cigarette smoking is increased by 30% compared to 1998 figures. The Pakistan Pediatrics Association has estimated 1,000 to 1,200 school-going children between the ages of 6 and 16 years take up smoking every day. In Pakistan, ex-smokers in the low socioeconomic group reported spending 25% of the total household income on this habit. This paper focuses on the antismoking social marketing strategy in Pakistan with an aim to reduce smoking prevalence, especially among the youth.

Lavack A. Using social marketing to de-stigmatize addictions: A review. (review). Addiction Research & Theory 15(5): 479-492, 2007. (58 refs.)

Persons with addictions face a significant social stigma. Fear of being stigmatized often results in persons with addictions or substance abuse issues not seeking the help they require for fear of societal disapproval. This article examines how social marketing has been used, and can be used, to de-stigmatize addictions. Previous de-stigmatization campaigns are reviewed and discussed, and recommendations for future social marketing campaigns are provided.

Linkenbach JW; Perkins HW; DeJong W. Parents' perceptions of parenting norms: Using the social norms approach to reinforce effective parenting. IN: Perkins HW, ed. Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians. San Francisco: Jossey-Bass, 2003. pp. 247-258. (16 refs.)

This chapter reviews findings from the Montana Social Norms Project survey in the context of social norms theory and explores their implications for a statewide media campaign that encourages parental involvement and action. Future directions for research are discussed. Parents have fewer direct opportunities than youths themselves to observe youth substance use, but otherwise they rely on similar cultural information when trying to gauge adolescent norms and are subject to the same biasing factors as their teenage children. In turn, if parents share the misperception that youth substance use is more prevalent than it is, they are also more likely to underestimate the extent to which other parents are involved with their children or have taken a firm and consistent stand against alcohol, tobacco, and other drugs. The Montana Parent Norms Survey was completed by 787 parents with teenagers. Three-fourths of the parents reported that during the past three months they had discussed family rules about drinking or using other drugs with their teens. Forty-seven percent told their teenage child that they expect no underage drinking. Thirty-five percent had not talked about alcohol-related rules in the previous month. Parents said that they have a solid, trusting relationship with their teenage children and are informed about their activities. The Montana Parents Campaign was implemented statewide to assist parents of teenagers in establishing clear expectations, setting and maintaining firm rules, and monitoring their children. Survey results revealed that parents greatly underestimated how frequently other parents engage in a range of parenting behaviors.

Luna N. The media and prevention. IN: Hogan J; Gabrielsen K; Luna N; Grothaus, eds. Substance Abuse Prevention: The Intersection of Science and Practice. Needham Heights MA: Allyn & Bacon, 2003. pp. 170-209. (60 refs.)

An understanding of the media is central to prevention efforts in several prespects. It is frequently a tool in prevention programming. Simultaneously an understanding of the media is important in education, as media is a significant influence in the formation of attitudes towards substance use. The chapter considers media advoacy; media literacy; and social marketing.

Marko TL; Watt T. Employing a youth-led adult-guided framework "Why Drive High?" social marketing campaign. Family & Community Health 34(4): 319-330, 2011. (10 refs.)

The "Drugged Driving Kills project: Why Drive High?" social marketing campaign was developed and implemented by youth leaders and adult facilitators from public and community health to increase youth awareness of the adverse effects ofmarijuana on driving. The youth-led adult-guided project was founded on the Holden's youth empowerment conceptual model. This article reports on the results of the focus group evaluation, conducted to determine to what extent the tailored youth-led adult-guided framework for the " Why Drive High?" social marketing campaign provided an environment for youth leadership development.

Mattern JL; Neighbors C. Social norms campaigns: Examining the relationship between changes in perceived norms and changes in drinking levels. Journal of Studies on Alcohol 65(4): 489-493, 2004. (28 refs.)

Objective: This study examined changes in drinking as a function of changes in perceived drinking norms following a social norms marketing campaign to correct normative misperceptions of college student drinking among residence hall students. The researchers expected students to reduce their estimates of typical student drinking following the social marketing campaign and that reductions in perceived norms would be associated with reduced drinking. Method: Perceived norms and self-reported frequency and quantity of alcohol consumption were assessed before and after a social norms marketing campaign among 474 residence hall students. Results: Paired samples t tests revealed reduced perceptions of typical student drinking frequency and quantity. In addition, among nonabstainers, drinking quantity went down from pre- to postintervention. Further examination revealed that reductions in drinking were evident only among students whose perceived norms were reduced. Conclusions: Results suggest that social norms marketing in residence halls can effectively reduce overestimates of typical student drinking and that reduction of perceived drinking norms are associated with reduced drinking.

Messerlian C; Derevensky J. Evaluating the role of social marketing campaigns to prevent youth gambling problems - A qualitative study. Canadian Journal of Public Health 98(2): 101-104, 2007. (8 refs.)

Background: Gambling among adolescents is a growing public health concern. To date, social marketing as a strategy to address problem gambling among youth has not been widely used. Methods: A qualitative study through the use of focus groups was conducted to explore adolescents' exposure to existing prevention campaigns and their message content and communication strategy preferences for a youth gambling social marketing campaign. Findings:. Participants prefer that youth gambling ads depict real-life stories, use an emotional appeal and portray the negative consequences associated with gambling problems. They further recommend illustrating the basic facts of gambling using simple messages that raise awareness without making a judgement. Participants caution against the "don't do it" approach, suggesting it does not reflect the current youth gambling culture. Conclusion: This study should serve as a starting point for the development of a gambling prevention social marketing campaign. Targeting variables and campaign strategies highlighted should be considered in the early stages of development and tested along the way.

Messerlian C; Derevensky J. Social marketing campaigns for youth gambling prevention: Lessons learned from youth. International Journal of Mental Health and Addiction 4(4): 294-306, 2006. (28 refs.)

Youth gambling is an important, although often overlooked adolescent health issue. Media-based prevention programs have long been employed as tools to address high risk behaviours, namely drug, alcohol and tobacco use, as well as sexual health. However, social marketing has yet to be drawn upon as a strategy to address problem gambling among adolescents. This strategy would appear to be especially relevant given the recent rise in the portrayal of gambling in the mass media, often glamorizing and normalizing games and practices. The authors aimed to examine the use of social marketing as a strategy for gambling prevention among adolescent. A qualitative study using focus groups was conducted to explore adolescents' exposure to existing prevention campaigns and their message content and communication preferences for a youth gambling social marketing campaign. Social marketing advertisements, depicting real-life stories with an emotional appeal, that portrayed the negative consequences associated with a gambling problem were highly endorsed by participants. Participants further recommended illustrating the basic facts of gambling using simple messages that raise awareness in a non-judgmental manner. Adolescents are critical of the "don't do it" message as this approach does not reflect the current youth gambling culture. It is expected that this study serve as a source for the development of future social marketing campaigns on youth gambling. Targeting variable and campaign strategies recommended herein should be considered in the early stages and tested along the way.

Mogg D; Levy M. Moving beyond non-engagement on regulated needle-syringe exchange programs in Australian prisons. Harm Reduction Journal 6(7), 2009. (23 refs.)

Background: Australia is at a fork in the road with the possibility of a needle-syringe exchange program (NSP) to be introduced at the new prison in the ACT. However, the current situation is characterised by non-engagement from major stakeholders. We explore why informed discussion will not be enough to convince prison officers, policy makers and the wider community of the benefits of prison-based NSPs. Other methods of engagement and communication will be proposed - in that may provide avenues for "breakthrough". Methods: A review of the literature on needle-syringe exchanges and harm reduction strategies within the context of prisons and prisoner health was conducted. Literature on strategies to change attitudes and move beyond intractable situations was also consulted. In addition, one author, DM, conducted a two-hour interview with an ex-prison officer. Results: No studies were found which investigated the potential efficacy of interventions to modify attitudes or behaviours in the specific context of introducing an NSP into a prison. Nonetheless, several theories were identified which may explain the failure of informed discussion alone to create change in this situation and may therefore lead to suggestions for engagement and communication to move towards a resolution. Discussion: Cognitive-behavioural therapy highlights the importance of individual cognitions and how they shape behaviours in any change campaign. Social identity theory emphasizes changes to social processes that may open the prison officer workforce to change. Peace studies also suggests socialization strategies such as observing an established and effective prison-based needle-syringe exchange. Social marketing provides suggestions on how to sell an exchange to ensuring the benefits are framed to outweigh the costs. Conclusion: Psychology, peace studies and social marketing all agree people's views must be carefully collected and analysed if people are going to be convinced to consider and discuss the issue. By understanding the views and their underlying motivations of those who oppose NSPs, it will be far easier to influence these views. Furthermore, involving all stakeholders, especially prison authorities, will help create a sense of ownership of a solution and therefore increase the chances of that solution succeeding.

Moss HB; Kirby SD; Donodeo F. Characterizing and reaching high-risk drinkers using audience segmentation. Alcoholism: Clinical and Experimental Research 33(8): 1336-1345, 2009. (24 refs.)

Background: Market or audience segmentation is widely used in social marketing efforts to help planners identify segments of a population to target for tailored program interventions. Market-based segments are typically defined by behaviors, attitudes, knowledge, opinions, or lifestyles. They are more helpful to health communication and marketing planning than epidemiologically defined groups because market-based segments are similar in respect to how they behave or might react to marketing and communication efforts. However, market segmentation has rarely been used in alcohol research. As an illustration of its utility, we employed commercial data that describes the sociodemographic characteristics of high-risk drinkers as an audience segment, including where they tend to live, lifestyles, interests, consumer behaviors, alcohol consumption behaviors, other health-related behaviors, and cultural values. Such information can be extremely valuable in targeting and planning public health campaigns, targeted mailings, prevention interventions, and research efforts. Methods: We described the results of a segmentation analysis of those individuals who self-reported to consume 5 or more drinks per drinking episode at least twice in the last 30 days. The study used the proprietary PRIZM TM (Claritas, Inc., San Diego, CA) audience segmentation database merged with the Center for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS) database. The top 10 of the 66 PRIZM TM audience segments for this risky drinking pattern are described. For five of these segments we provided additional in-depth details about consumer behavior and the estimates of the market areas where these risky drinkers resided. Results: The top 10 audience segments (PRIZM clusters) most likely to engage in high-risk drinking are described. The cluster with the highest concentration of binge-drinking behavior is referred to as the "Cyber Millenials.'' This cluster is characterized as "the nation's tech-savvy singles and couples living in fashionable neighborhoods on the urban fringe.'' Almost 65% of Cyber Millenials households are found in the Pacific and Middle Atlantic regions of the United States. Additional consumer behaviors of the Cyber Millenials and other segments are also described. Conclusions: Audience segmentation can assist in identifying and describing target audience segments, as well as identifying places where segments congregate on-or offline. This information can be helpful for recruiting subjects for alcohol prevention research as well as planning health promotion campaigns. Through commercial data about high-risk drinkers as "consumers,'' planners can develop interventions that have heightened salience in terms of opportunities, perceptions, and motivations, and have better media channel identification.

Palmer RS; Kilmer JR; Larimer ME. If you feed them, will they come? The use of social marketing to increase interest in attending a college alcohol program. Journal of American College Health 55(1): 47-52, 2006. (28 refs.)

The authors used social marketing to design and test advertisement components aimed at increasing students' interest in attending an alcohol program focused on reaching students who drink heavily, although the authors offered no such program. Participants were undergraduate students in introductory psychology courses (N = 551). Questionnaires included measures assessing demographic information, alcohol use and negative consequences, and interest in attending an alcohol program in response to exposure to 1 of 12 systematically varied advertisements. The authors found that approximately 20% of participants across all ad types indicated some level of interest in attending the alcohol program. Students who use alcohol reported more interest in attending when an informational message was used. Of the participants offered food, 41.9% indicated the food offered in the advertisement impacted their interest in attending. Results suggest market segmentation plays a role in developing effective advertisements to recruit different groups of students based on their reported drinking behavior.

Perkins HW, ed. Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians. San Francisco: Jossey-Bass, 2003. (317 refs.)

This book offers educators, counselors, and clinicians a handbook for understanding and implementing a new and highly successful alternative to traditional methods for preventing substance abuse among young people. The proven "social norms" approach outlined in this book identifies young people's dramatic misperceptions about their peers' norms and promotes accurate public reporting of actual positive norms that exist in all student populations. Step-by-step implementations of large-scale social norms campaigns in college, secondary schools, and community initiatives are presented. Also included are data that confirm the common misperceptions about peer alcohol, tobacco, and illicit drug use norms, and how revising these perceptions can reduce substance abuse. The use of print, electronic media, and curriculum infusion to reduce problem drinking and tobacco use are examined. Also discussed is how to target high-risk groups and build student support for school policies. The social norms approach examines how phenomena beyond the individual's personality and personal values are important determinants of behavior and offers information about how these influences can be changed. The 17 chapters presented here address specific techniques, programs, and field-tested results of the application of this method in a variety of school and community settings. This book shows how this approach works with different age groups and reveals the potential for applying a social norms approach, not only for problem drinking, smoking, and other substance abuse, but also for other areas of prevention work, including hate speech, sexual aggression, and eating disorders.

Perkins HW. Emergence and evolution of the social norms approach to substance abuse prevention. IN: Perkins HW, ed. Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians. San Francisco: Jossey-Bass, 2003. pp. 3-17. (32 refs.)

In this introduction the author reviews the development and growth of the social norms approach to substance abuse prevention. It offers an overview of the historical trends seen in substance prevention, and the evolution of the social norms approach, with its own theories of behavior and strategies for intervention. The strategy of the social norms approach, put simply, is to communicate the truth about peer norms in terms of what the majority of students actually think and do, all on the basis of credible data drawn from the student population that is the target. The message to students is a positive one: the norm is one of safety, responsibility, and moderation or abstinence because that is how the majority of students thinks and acts in most student populations. Any social norms intervention initiative must begin with collecting and assessing credible data identifying misperception and constructing data-based messages to counter them. It also reviews the books organization.

Perkins HW. Promise and challenge of future work using the social norms model. IN: Perkins HW, ed. Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians. San Francisco: Jossey-Bass, 2003. pp. 280-296. (2 refs.)

This chapter discusses the promise and challenge of future work using social norms model. The degree of success one experiences using the social norms approach varies according to many local factors and how the approach is implemented. A few conditions can maximize the positive impact of this approach: (1) students need to receive clear messages about the actual norms that exist among their peers; (2) constant and repeated reinforcing messages need to be used; (3) and, prevention targeting must go beyond identified high-risk groups. The lack of impact on perceived norms may occur for a variety of reasons. The intervention message may be confusing, the dosage may be too little, or the approach my be used for too short an interval. It is important to review the na�ve criticism sometimes voiced about social norms work in substance abuse prevention so that educators, counselors, and clinicians considering this approach in school and community environments will be equipped with responses to these challenges. No single approach, however successful, can be relied upon to eliminate the problem entirely, and combining the force of multiple approaches with demonstrated positive effect is likely to achieve a greater desired outcome overall. Offering traditional pharmacological education may produce a benefit when coupled with accurate social norms information. Even though social norms interventions can be quite cost-effective compared to other strategies, to skimp on this approach in order to keep other programs going that may not have demonstrated significant prevention potential is a recipe for a disappointing result.

Perkins HW; Craig DW. Hobart and William Smith Colleges experiment: A synergistic social norms approach using print, electronic media, and curriculum infusion to reduce collegiate problem drinking. IN: Perkins HW, ed. Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians. San Francisco: Jossey-Bass, 2003. pp. 35-64. (13 refs.)

This chapter reports on the social norm experiment at Hobart and William Smith Colleges (HWS). This experiment expanded applied intervention research on the social norms. A broad-based social norms strategy was tested in this small college setting. It seemed appropriate to see how effective this strategy could be in reducing alcohol abuse in an environment of traditionally heavy alcohol consumption. The design of the experiment was not only to use print media strategies as employed elsewhere, but also to combine them with new electronic media strategies and curriculum infusion. The HWS Alcohol Education Project had many years of data on alcohol use and perceived norms prior to the social norms intervention. During the years of social norm intervention, this data collection continued through surveys on incoming students and graduating seniors. Over the course of the four intervention years described in this chapter (1996-2000), more than 20 print media posters were created containing messages about actual norms for alcohol use. Electronic media campaigns brought this social norms intervention through desktop and laptop computers, multimedia sound and video, and a Campus Factoids Screen Saver program. Programs were developed to expand the conversation about alcohol use and campus norms into the classroom through the incorporation of discussion groups into the regular campus curricula. Class and mail surveys measured the perceived and actual drinking attitudes and behaviors among students before and after social norms intervention. Overall results indicated how the HSW project's strategy of integrating a comprehensive set of initiatives reduced harmful misperception about student norms.

Perkins HW; Craig DW. Imaginary lives of peers: Patterns of substance use and misperceptions of norms among secondary school students. IN: Perkins HW, ed. Social Norms Approach to Preventing School and College Age Substance Abuse: A Handbook for Educators, Counselors, and Clinicians. San Francisco: Jossey-Bass, 2003. pp. 209-223. (6 refs.)

It is suggested an impediment to social norm prevention efforts has been the difficulty school administrators encounter collecting accurate information on students' perceptions of and general use of substances. This chapter describes an Internet, web-based survey for collecting social norms data that is inexpensive, confidential and requires only 10-12 minutes to complete, used with middle and high school students. Questions concerning frequency of personal tobacco and alcohol use, and perception of peer use are included. Data show clearly the pervasive nature of misperception across substances, across grades, across small and large schools, and across geographical regions. Moreover, although exaggerated misperception of same-grade peer norms was seen for all substances across all grades, even greater misperception of 11th and 12th grade norms was held by many younger students, thus contributing to a greater peer pressure to consume substances.

Piacentini MG; Banister EN. Managing anti-consumption in an excessive drinking culture. Journal of Business Research 62(2): 279-288, 2009. (49 refs.)

A major contemporary challenge facing governments and health professionals is that of promoting sustainable and healthy approaches to alcohol consumption in a context where excessive alcohol consumption is the dominant trend [Plant M., Plant M., Binge Britain: the need for courage. Alcoholis 2006; 25, 3: 1.]. This article reports the results of a qualitative study examining the experiences of Higher Education students in the United Kingdom who are identifiable as anti-consumers because of their opposition to the alcohol norms that predominate. The article focuses on how these students deal with the challenges and consequences that can arise from resisting the prevailing norms and practices. This article demonstrates that existing frameworks and categorizations in the contexts of anti-consumption, product and brand avoidance and coping are capable of providing useful theoretical toots for the examination of anti-consumption within the social marketing context. The article identifies some of the implicit tensions of being an anti-consumer in an environment of excessive consumption and provides examples of how consumers seek to manage these tensions. The use of the above theoretical perspectives can usefully inform policy that aims to promote sensible drinking among young people and students in particular.

Rothschild ML; Mastin B; Miller TW. Reducing alcohol-impaired driving crashes through the use of social marketing. Accident Analysis and Prevention 38(6): 1218-1230, 2006. (20 refs.)

Over the past decade there has been little decrease in the number of alcohol-related driving fatalities. During this time most interventions have been educational or legal. This paper presents the results of a field experiment that used social marketing to introduce a new ride program into three rural communities. Almost all people in the 21-34-year-old target know that they should not drive while impaired, and most agree it is not a good thing to do, but for many the opportunity to behave properly does not exist. The Road Crew program was developed using new product development techniques and implemented by developing broad coalitions within the communities. A key feature of the program included rides to, between, and home from bars in older luxury vehicles. Results showed a significant shift in riding/driving behavior, especially among 21-34-year olds, a projected 17% decline in alcohol-related crashes in the first year, no increase in drinking behavior, and large savings between the reactive cost of cleaning up after a crash and the proactive cost of avoiding a crash. Programs have become self-sustaining based on fares and tavern contributions, and have become part of the life style in the treatment communities.

Rothschild ML; Mastin B; Miller TW. Reducing alcohol-impaired driving crashes through the use of social marketing. Accident Analysis and Prevention 38(6): 1218-1230, 2006. (20 refs.)

2006, Elsevier Science

Saunders JB; Rey JM, eds. Young People and Alcohol Impact, Policy, Prevention, Treatment. Chichester, UK: Wiley-Blackwell, 2011. (Chapter refs.)

This edited work is intended as a basic refernce in the area of adolescent alcohol use. It is divided into five sections. Part I reviews alcohol use patterns among adolescents, in terms of levels of consumption. The relationship of early onset drinking is also discussed. This section also highlights short- and long-term consequences of adolescent alcohol use, including risky sexual behaviour, increased risk of pregnancy, violence and sexual assault, and accidents. Part II sets forth basic information on the biological aspects resulting from drinking among adolescents. This includes the effects on the adolescent brain and impact of prenatal alcohol exposure, and also touches upon genetic influences. Part III deals with prevention and early intervention, including efforts to reduce high-risk drinking and alcohol-related damage among youth, including community-based prevention strategies, such as community mobilisation, environmental strategies, media advocacy, social marketing campaigns and policy change. It also focuses upon brief interventions with special populations, including schools, colleges and the military. Part IV, with three chapters considers assessment and diagnosis. A framework for comprehensive assesment is described, with the mnemonic "HEADS," referring to Home, Education, Activities, Drugs, Sexuality and Suicide. The importance of the clinical relationship is discussed. Part V, with six chapters focuses upon treatment. It includes material on the family-based interventions, psychosocial and pharmacological approaches. This section also discusses th epidemiology and clinical management of common co-occuring psychiatric disorders common - conduct disorder, attention deficit/hyperactivity disorder and mood disorders.

Scribner RA; Theall KP; Mason K; Simonsen N; Schneider SK; Towvim LG et al. Alcohol prevention on college campuses: The moderating effect of the alcohol environment on the effectiveness of social norms marketing campaigns. Journal of Studies on Alcohol and Drugs 72(2): 232-239, 2011. (14 refs.)

Objective: Evaluations of social norms marketing campaigns to reduce college student drinking have produced conflicting results. This study examines whether the effectiveness of such campaigns may be moderated by on-premise alcohol outlet density in the surrounding community. Method: Multilevel analyses were conducted of student survey responses (N = 19,838) from 32 U.S. colleges that took part in one of two 4-year randomized, controlled trials completed for the Social Norms Marketing Research Project (SNMRP). In the models, students by year were nested within treatment (n = 16) and control group (n = 16) campuses, which were characterized by the on-premise outlet density in their surrounding community. The moderating effect of outlet density was introduced into the models as an interaction between the treatment effect (i.e., the effect of the social norms marketing campaigns over time) and outlet density. The models were also stratified by campus alcohol outlet density (high vs. low) to examine the effect of the intervention in each type of setting. Results: There was a significant interaction between the treatment effect and on-premise alcohol outlet density for one of the drinking outcomes targeted by the SNMRP intervention, the number of drinks when partying, and marginal evidence of interaction effects for two other outcomes, maximum recent consumption and a composite drinking scale. In stratified analyses, an intervention effect was observed for three of the four outcomes among students from campuses with lower on-premise alcohol outlet density, whereas no intervention effect was observed among students from campuses with higher on-premise alcohol outlet density. Conclusions: The findings suggest that the campus alcohol environment moderates the effect of social norms marketing interventions. Social norms marketing intervention may be less effective on campuses with higher densities of on-sale alcohol outlets.

Szmigin I; Bengry-Howell A; Griffin C; Hackley C; Mistral W. Social marketing, individual responsibility and the "culture of intoxication". European Journal of Marketing 45(5): 759-779, 2011. (52 refs.)

Purpose - Social marketing initiatives designed to address the UK's culture of unhealthy levels of drinking among young adults have achieved inconclusive results to date. The paper aims to investigate the gap between young peoples perceptions of alcohol consumption and those of government agencies who seek to influence their behaviour set within a contextualist framework. Design/methodology/approach - The authors present empirical evidence from a major study that suggests that the emphasis of recent campaigns on individual responsibility may be unlikely to resonate with young drinkers. The research included a meaning-based and visual rhetoric analysis of 261 ads shown on TV, in magazines, on billboards and on the internet between 2005 and 2006. This was followed by 16 informal group discussions with 89 young adults in three locations. Findings - The research identified the importance of the social context of young people's drinking. The research reveals how a moral position has been culturally constructed around positioning heavy drinking as an individual issue with less regard to other stakeholders and how the marketing agents function in this environment. Calls to individual responsibility in drinking are unlikely to succeed in the current marketing environment. Research limitations/implications - The qualitative research was limited to three geographical locations with young adults between the ages of 18 and 25. Practical implications - The authors explore implications for social marketing theory and for UK alcohol policy. In particular, the authors suggest that the social norms surrounding young people's drinking need to be acknowledged and built into "sensible" social marketing campaigns. The authors suggest that shame, fear and guilt appeals should be replaced with more constructive methods of ensuring young people's safety when they drink. Originality/value - From the theoretical perspective of contextualism, the paper brings together empirical research with young adults and a critical analysis of recent social marketing campaigns within the commercial context of a "culture of intoxication". It provides both a critique of social marketing in a neo-liberal context and recognition of issues involved in excessive alcohol consumption.

Thomson G; Wilson N; Weerasekera D; Edwards R. Strong smoker interest in 'setting an example to children' by quitting: National survey data. Australian and New Zealand Journal of Public Health 35(1): 81-84, 2011. (24 refs.)

Objective: To further explore smoker views on reasons to quit. Methods: As part of the multi-country ITC Project, a national sample of 1,376 New Zealand adult (18+ years) smokers was surveyed in 2007/08. This sample included boosted sampling of Maori, Pacific and Asian New Zealanders. Results: 'Setting an example to children' was given as 'very much' a reason to quit by 51%, compared to 45% giving personal health concerns. However, the 'very much' and 'somewhat' responses (combined) were greater for personal health (81%) than 'setting an example to children' (74%). Price was the third ranked reason (67%). In a multivariate analysis, women were significantly more likely to state that 'setting an example to children' was 'very much' or 'somewhat' a reason to quit; as were Maori, or Pacific compared to European; and those suffering financial stress. Conclusion: The relatively high importance of 'example to children' as a reason to quit is an unusual finding, and may have arisen as a result of social marketing campaigns encouraging cessation to protect families in New Zealand. Implications: The policy implications could include a need for a greater emphasis on social reasons (e. g. 'example to children'), in pack warnings, and in social marketing for smoking cessation.

Thrasher JF; Huang LL; Perez-Hernandez R; Niederdeppe J; Arillo-Santillan E; Alday J. Evaluation of a social marketing campaign to support Mexico City's comprehensive smoke-free law. American Journal of Public Health 101(2): 328-335, 2011. (41 refs.)

Objectives. We aimed to assess the level of awareness and impact of a social marketing campaign to promote Mexico City's 2008 comprehensive smoke-free law. Methods. Four months after the smoke-free law was implemented but before the campaign launch, we collected data from a population-based, random sample of 961 inhabitants of Mexico City. We analyzed data from 786 respondents who completed follow-up at the end of the campaign to determine campaign exposure and the association between campaign exposure and changes in campaign-targeted knowledge and attitudes. Results. Recall of any of the 5 campaign materials was 69%, with a uniform distribution of exposure to 1, 2, and 3 or more campaign materials (25%, 25%, and 19%, respectively). Exposure to a greater number of campaign materials was associated in a monotonic relation with campaign-targeted knowledge of ammonia and arsenic in cigarette smoke. In models assessing support for, perceived benefits of, and perceived right to smoke-free places, campaign exposure accounted for a positive change in half of the indicators within each of these domains. Conclusions. Social marketing campaigns can reinforce knowledge and attitudes that favor smoke-free laws, thereby helping to establish smoke-free norms.

Trockel M; Williams SS; Reis J. Considerations for more effective social norms based alcohol education on campus: An analysis of different theoretical conceptualizations in predicting drinking among fraternity men. Journal of Studies on Alcohol 64(1): 50-59, 2003. (36 refs.)

Objective: Recent alcohol education campaigns targeting college students have focused on correcting the erroneous perception students have of the amount of alcohol their peers consume. This strategy is based on assumptions that college students overestimate the amount of alcohol their peers consume and that correcting that misperception will lessen the pressure they feel to consume heavily. However, other theoretical constructs of normative influence may be as or more valuable in improving effectiveness of social norms based education for high-risk college students. This study evaluates the effects of three social normative influence factors on alcohol consumption among fraternity men. Method: Participants were 379 members of randomly selected chapters from two large student fraternity organizations. We used hierarchical linear models to analyze the predictive value of normative influence variables in explaining alcohol consumption differences, both across individuals within chapters and across chapters. Results: Perceived consumption norms and perceived subjective norms were significant predictors of alcohol consumption levels. Both normative influence variables are significant in predicting differences in consumption within chapters and across chapters of fraternity men. General approval of alcohol use did not account for significant variance within chapters in consumption or any unique variance in consumption between chapters. Conclusions: Perceived subjective norms as defined by long-standing behavior theory may provide an alternative and potentially more promising intervention target for this high-risk student population than does the current focus on correcting students' errors in estimating the amount of alcohol their peers consume

Wakefield M; Flay B; Nichter M; Giovino G. Effects of anti-smoking advertising on youth smoking: A review. (review). Journal of Health Communication 8(3): 229-247, 2003. (76 refs.)

This paper reviews empirical studies, encompassing community trials and field experiments, and evaluates government-funded anti-smoking campaigns, ecologic studies of population impact of anti-smoking advertising, and qualitative studies that have examined the effects of anti-smoking advertising on teenagers. We conclude that anti-smoking advertising appears to have more reliable positive effects on those in pre-adolescence or early adolescence by preventing commencement of smoking. It is unclear whether this is due to developmental differences, or is a reflection of smoking experience, or a combination of the two. In addition, it is evident that social group interactions, through family, peer and cultural contexts, can play an important role in reinforcing, denying, or neutralizing potential effects of anti-smoking advertising. Although there is some research to suggest that advertising genres that graphically depict the health effects of smoking, emphasize social norms against smoking, and portray the tobacco industry as manipulative can positively influence teenagers, these findings are far from consistent. Finally, the effects of anti-smoking advertising on youth smoking can be enhanced by the use of other tobacco control strategies, and may be dampened by tobacco advertising and marketing. Overall, the findings of this review indicate that there is no single "recipe "for anti-smoking advertising that leads to reductions in youth smoking. Anti-smoking advertising can influence youth smoking, but whether it does in the context of individual anti-smoking campaigns needs to be the subject of careful evaluation.

Walsh G; Hassan LM; Shiu E; Andrews JC; Hastings G. Segmentation in social marketing: Insights from the European Union's multi-country, antismoking campaign. European Journal of Marketing 44(7-8): 1140-1164, 2010. (73 refs.)

Purpose - In 2005, the European Union launched a four-year antismoking television advertising campaign across its 25 Member States. This study aims to evaluate the second and third years (2006 and 2007) of the campaign based on telephone interviews with over 24,000 consumers (smokers, non-smokers, and ex-smokers). Design/methodology/approach - The study focuses on smokers and examines the potential for using segmentation and targeting in informing the campaign. Three important factors are used to identify clusters: attitude toward the campaign; comprehension of the campaign; and inclination to think responsibly about their smoking behaviour. Findings - Cluster analyses identify three distinct and significant target groups (message-involved, message-indifferent, and message-distanced) who respond differentially to the advertising. Furthermore, the percentage of respondents within each cluster varies across the EU Member States. Using Schwartz's cultural framework, the cultural dimension of "openness to change versus conservatism" is found to explain substantial cross-national variation in message-involved and messaged-distanced respondents. Research limitations/implications - Cluster solutions are shown to be stable across the two data waves. Implications of these results are discussed. Originality/value - This is the first study that seeks to better understand consumer reactions to social-marketing advertising across different segments of the overall target group.

Wechsler H; Nelson TF; Lee JE; Seibring M; Lewis C; Keeling RP. Perception and reality: A national evaluation of social norms marketing interventions to reduce college students' heavy alcohol use. Journal of Studies on Alcohol 64(4): 484-494, 2003. (53 refs.)

Objective: To evaluate a widely used intervention to reduce college student alcohol use, we studied student drinking patterns at colleges that employed social norms marketing programs and those that did not. Method: We examined responses of students in the Harvard School of Public Health College Alcohol Study (CAS) 1997, 1999 and 2001 data sets at 37 colleges that employed social norms marketing programs and at 61 that did not. Information about the students' drinking behavior and their familiarity with social norms marketing messages at their schools was analyzed, as were college administrators' reports about the implementation of social norms marketing campaigns. Schools were grouped on the basis of student reports of exposure to programmatic materials. Trend analyses were conducted on seven standard measures of alcohol consumption, including annual and 30-day use, frequency, usual quantity and volume consumed, heavy episodic use, and drunkenness. Results: Almost half of the CAS colleges sampled adopted social norms programs. Those that did were more likely to have large enrollments, not to be religiously affiliated and to have high rates of alcohol use. No decreases were noted in any of the seven measures of alcohol use at schools with social norms programs, even when student exposure and length of program existence were considered. Increases in measures of monthly alcohol use and total volume consumed, however, were observed at schools employing social norms programs. Conclusions: This study does not provide evidence to support the effectiveness of social norms marketing programs, as currently utilized, in reducing alcohol use among college students.

Wechsler H; Seibring M; Liu IC; Ahl M. Colleges respond to student binge drinking: Reducing student demand or limiting access. Journal of American College Health 52(4): 159-168, 2004. (22 refs.)

Administrators at 68% of 4-year colleges nationwide (N = 747) responded to a survey concerning the types of programs and policies they used in response to students' heavy drinking. Most schools conducted targeted alcohol education and invested in institutional prevention efforts; half conducted social norms campaigns; a sizeable minority restricted alcohol on campus. Schools that focused on demand reduction were less likely to ban alcohol use. One in 3 schools received funding for these programs from governmental agencies, and I in 5 from the alcohol industry. Such schools were more likely to conduct targeted alcohol education and social norms programs and were less likely to restrict alcohol use on campus or at college events. Colleges may want to reconsider prevention initiatives that focus exclusively on demand or supply. They may also want to examine the extent to which funding is the driving force shaping the direction of their alcohol initiatives.

Wu ZY; Luo W; Sullivan SG; Rou KM; Lin P; Liu W et al. Evaluation of a needle social marketing strategy to control HIV among injecting drug users in China. AIDS 21(Supplement 8): S115-S122, 2007. (27 refs.)

Objective: To evaluate the effectiveness of a needle social marketing strategy to reduce needle sharing and hepatitis C Virus (HCV)/HIV transmission among injecting drug users (IDU) in China. Design: Two-armed, prospective, community-randomized prevention trial. Setting: Four counties/townships in Guangxi and Guangdong provinces; one randomized to intervention the other to control in each province. Participants: Injecting drug users: 823 (443 intervention, 382 control) at baseline and 852 (415 intervention, 407 control) at the second cross-sectional survey 12 months later. Intervention: A needle social marketing programme, including promotion of safe injection norms and increased access to clean needles over a 12 month period. Main outcome measures: Cross sectional surveys at baseline and follow-up compared changes in drug using behaviours and HIV and HCV rates in the intervention and control communities. Results: Needle sharing behaviours were similar in the two groups at baseline (68.4 vs. 67.8%), and dropped significantly to 35.3% in the intervention community and remained relatively stable in the control community (62.3`%; P<0.001). In a subset of cohort of new injectors, the incidence of HCV was significant lower in intervention than in control in both provinces (P < 0.001, P=0.014) and overall (P< 0.001) but HIV was only significantly lower in intervention in Guangdong (P=0.011). Conclusion: Needle social marketing can reduce risky injecting behaviour and HIV/ HCV transmission among injecting drug users in China and should be expanded.

Yanovitzky I; Stewart LP; Lederman LC. Social distance, perceived drinking by peers, and alcohol use by college students. Health Communication 19(1): 1-10, 2006. (52 refs.)

Many colleges in the United States are employing social norms marketing campaigns with the goal of reducing college students' alcohol use by correcting misperceptions about their peers' alcohol use. Although the typical message used in these campaigns describes the quantity and frequency of alcohol use by the average student on campus, many students may find such a vague comparison to others to be socially irrelevant. This study compares the relative weight of perceptions about alcohol use by distant versus proximate peers in the prediction of college students' personal drinking behavior. The results of analyzing data collected from a sample of college students at a large public northeastern university (N = 276) show that, as hypothesized, perceived alcohol use by proximate peers (best friends and friends) was a stronger predictor of students' personal alcohol use than perceived alcohol use by more distant peers (such as students in general), controlling for other strong predictors of alcohol use by college students (age, gender, race, off-campus residency, and sensation-seeking tendencies). The implications of these findings for the design of more effective social norms messages are discussed.