Funny Impact of Illicit Drugs on Our Society
Introduction
The use of mass media campaigns in drug prevention is both relatively common and not without controversy. Both policymakers and practitioners have hotly debated the effectiveness of such campaigns to reduce young people's drug use or their intention to use. This analysis aims to contribute to the debate via a review of available evidence on the topic.
Part of the 'Perspectives on drugs' (PODs) series, launched alongside the annual European Drug Report, these designed-for-the-web interactive analyses aim to provide deeper insights into a selection of important issues.
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1. Analysis: can mass media campaigns prevent young people from using drugs?
The use of mass media campaigns as a drug prevention intervention is relatively common, but it is not without controversy (1). Both policymakers and practitioners have debated the effectiveness of such campaigns in reducing drug use among young people, and there is a possibility that they may be counter-productive. In Europe, more than one-third of the 30 countries affiliated to the EMCDDA report that mass media campaigns on illicit drugs are either not carried out or have been cut back, in some cases because of concerns about their safety. This Perspectives on drugs contributes to the debate by reviewing the available evidence on the efficacy of mass media campaigns for drug use prevention.
The use of mass media campaigns to reduce health problems in society gained momentum in the 1970s, with an initial focus on improving cardiovascular health. The positive results obtained by the first campaigns led to their further use in areas as diverse as heart disease, cancer, HIV/AIDS prevention, family planning and domestic violence. From the 1970s on, media campaigns were increasingly used in the prevention of tobacco, alcohol and illicit drug use.
Mass media campaigns in public health disseminate information about health, or threats to it, in order to persuade people to adopt behavioural changes. They are usually implemented via television and radio, newspaper or magazine advertisements, billboards and road posters. They can also use the Internet, text messaging and email. Public health media campaigns are generally undertaken by public bodies and may be standalone interventions or they may be integrated into complex social marketing programmes, and may encompass several rounds of delivery.
The potential of mass media campaigns lies in their ability to propagate simple and focused messages to large audiences repeatedly, over time, at a low cost per capita. It is also assumed that they are able to reach a large and heterogeneous proportion of the population (Wakefield et al., 2010). However, a major ethical dilemma associated with such campaigns lies in the fact that the target population has generally not requested this kind of social intervention, and furthermore they might have negative effects (see below).
Where do public health media campaigns work?
Media campaigns have been successfully applied to the reduction of tobacco use and the promotion of road safety, and have shown moderately positive results in a number of areas including: the promotion of healthier nutrition, physical activity, participation in screening for breast and cervical cancer, organ donation and pre-hospital response times for potential heart attack symptoms (Wakefield et al., 2010). Media campaigns have been widely used for the prevention of illicit drug use in young people. They often address specific substances with the aim of reducing use and raising awareness about the associated problems. These types of campaign typically target young people because evidence shows that drug use often starts during adolescence, a time in life when young people may experiment with cigarettes, alcohol and illicit drugs. Relatively few drug prevention media campaigns have been formally evaluated, however, and most of the evaluations have solely focused on assessing whether people understood and retained the main messages, and if they liked them. Where stronger evidence is available, it is rarely conclusive.
A meta-analysis of evaluation studies on drug prevention media campaigns
A meta-analysis was carried out of studies that evaluate the effectiveness of mass media campaigns to influence drug use, intention to use, or the attitude towards illicit drugs of young people under the age of 26. A search of the scientific literature found 23 studies, which involved around 200 000 young people and were conducted in Australia, Canada and the United States between 1991 and 2011. Only 14 of these met the criteria for inclusion in the meta-analysis. The results of the analysis of the nine randomised controlled studies are presented below. Of the remaining studies, four showed a non-statistically significant reduction of use in the experimental groups or no effect, and one study found an unwanted effect (Hornik, 2006; Hornik et al., 2008).
Results
Randomised studies on mass media campaigns versus other interventions to reduce drug use
Explanation: The four randomised controlled studies analysed compared an experimental media campaign with no intervention (Lee et al., 2010; Newton et al., 2010; Schwinn et al., 2010; Slater et al., 2006). In the above graph, the black diamond summarises graphically the results of the meta-analysis. It overlaps with the vertical line '0', also known as the 'no effect line'. Statistically speaking, the diamond includes the 'null hypothesis' – that there is no difference between those exposed to media campaigns and those not exposed. Furthermore, in one study (Newton et al. 2010), drug use is lower in the group not exposed to media campaigns. A fifth study (Fang et al., 2010) that otherwise merited inclusion, however, was excluded from the meta-analysis because no measures of effect on reduction of drug use were available for the experimental group.
Randomised studies on mass media campaigns versus other interventions to reduce intention to use drugs
Explanation: The pooled results of these four studies, comparing an experimental media campaign with no intervention (Fang et al., 2010; Yzer et al., 2003; Zhao et al., 2006), a lower level of exposure to the intervention, a non-drug related intervention (Yzer et al., 2003), three different non-drug related interventions (Polansky et al., 1999), or a combination of interventions (Yzer et al., 2003) are weakly in favour of media campaigns.
In summary, this meta-analysis of randomised studies found no effect on reduction of use and a weak effect on intention to use illicit substances. It also identified reports of possible unwanted effects in terms of young people declaring that they would like to try drugs.
Few European evaluations
In Europe, a systematic evaluation of whether mass media campaigns are leading to changes in drug use attitudes and behaviours has yet to be carried out. A number of countries report having evaluated mass media campaigns in drug prevention (Bulgaria, Denmark, France, Netherlands, Sweden, United Kingdom), but most of the studies in question have merely assessed whether people had seen the campaign, had discussed the slogans with their friends, liked the idea or the slogans, or increased their knowledge. Although, the Scottish media campaign 'Know the Score'(2) was evaluated, the reports did not meet the inclusion criteria for our meta-analysis. Nevertheless, it is interesting to note that the report on cocaine did not exclude the possibility of the campaign having an unintended harmful effect. In a similar vein, a Dutch evaluation of a media campaign (Wammes et al., 2007) aiming to reduce cannabis use found that adolescents exposed to the campaign were slightly more likely to think that smoking cannabis with friends would be enjoyable compared with adolescents not exposed to the campaign.
Conclusions
The majority of the studies reviewed here assessed media campaigns conducted in the United States. Furthermore, the questionnaires that were used to ask young people about their use or intention to use illicit drugs are diverse, and rarely comparable. These two factors taken together limit the generalisability of the results and, in particular, the applicability of those results to the European context.
The pooled analysis of studies found that media campaigns had no effect on reduction of use and a weak effect on intention to use illicit substances. Reports of possible unwanted effects in terms of young people declaring that after having watched a media campaign they were willing to try drugs raises concern. This is particularly relevant for prevention interventions, which are provided without a demand from the target population. Campaigns might affect individuals differently, depending on their level of awareness. However, being informed might not have a direct effect on behavioural change, while perception of norms (the perception that everybody is using drugs) may have an impact.
Based on this review of the available evidence, it is recommended that such campaigns should only be provided in the context of rigorous, well-designed and well-powered evaluation studies.
References
- Wakefield, M. A., Loken, B. and Hornik, R. C. (2010), 'Use of mass media campaigns to change health behaviour', Lancet 376(9748), pp. 1261–71.
- Hornik, R. (2006), 'Personal influence and the effects of the National Youth Anti-Drug Media Campaign', The Annals of the American Academy of Political and Social Science 608(1), pp. 282–300.
- Hornik, R., Jacobsohn, L., Orwin, R., Piesse, A. and Kalton, G. (2008), 'Effects of the National Youth Anti-Drug Media Campaign on youths', American Journal of Public Health 98(12), pp. 2229–36.
- Lee, C. M., Neighbors, C., Kilmer, J. R. and Larimer, M. E. (2010), 'A brief, web-based personalized feedback selective intervention for college student marijuana use: a randomized clinical trial', Psychology of Addictive Behaviors 24(2), pp. 265–73.
- Newton, N. C., Teesson, M., Vogl, L. E. and Andrews, G. (2010), 'Internet-based prevention for alcohol and cannabis use: final results of the Climate Schools course', Addiction 105(4), pp. 749–59.
- Schwinn, T. M., Schinke, S. P. and Di Noia, J. (2010), 'Preventing drug abuse among adolescent girls: outcome data from an internet-based intervention', Prevention Science 11(1), pp. 24–32.
- Slater, M. D., Kelly, K. J., Edwards, R. W., Thurman, P. J., Plested, B. A. et al. (2006), 'Combining in-school and community-based media efforts: reducing marijuana and alcohol uptake among younger adolescents', Health Education Research 21(1), pp. 157–67.
- Fang, L., Schinke, S. P. and Cole, K. C. (2010), 'Preventing substance use among early Asian-American adolescent girls: initial evaluation of a web-based, mother–daughter program', The Journal of Adolescent Health 47(5), pp. 529–32.
- Yzer, M. C., Cappella, J. N., Fishbein, M., Hornik, R. and Ahern, R. K. (2003), 'The effectiveness of gateway communications in anti-marijuana campaigns', Journal of Health Communication 8(2), pp. 129–43.
- Ferri M., Allara E., Bo A., Gasparrini A., Faggiano F. (2013), 'Media campaigns for the prevention of illicit drug use in young people'
- Polansky, J. M., Buki, L. P., Horan, J. J., Ceperich, S. D. and Burows, D. D. (1999), 'The effectiveness of substance abuse prevention videotapes with Mexican American adolescents', Hispanic Journal of Behavioral Sciences 21(2), pp. 186–98.
- Wammes, A., Van Leeuwen, A., and Lokman, S. (2007), Evaluatierapport DVP-Campagne 2006 'Je bent niet gek als jeniet blowt'.
2. Interactive map
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France, 2011
Part of the campaign: "Contre les drogues, chacun peut agir"
Abre los Ojos, Spain, 2003
Ministry of Health and Social Services, Spain.
Italy 2008
Part of the campaign entitled 'No Droga"
United Kingdom, 2009, THINK! campaign
Campaign targetting drug driving: the messages is that for those caught while driving under the influence of drugs, the penalties are as severe as for those who drink and drive.
Netherlands, 2012
Campaign by the Trimbos Institute of Mental Health and Addiction. The aim of the video is to support partners and family members of addicted people and to motivate them to look for support groups/professional help. For more information see: www.verslaafdaanjou.nl/
Lithuania, 2006-11
Campaigned consisted of three television clips that were produced as a part of the national drug prevention campaign 'Never you', implemented and supported by the Drug Control Department. All clips may be viewed here:www.youtube.com/user/NTAKDLT/
2012, Belgium: Vereniging voor Alcohol- en andere Drugproblemen (VAD) vzw
Campaign aims to encourage youngsters to speak about their feelings with counsellsors or to contact a telephone helpline. The target area is Flanders.
2009, Sweden: Swedish Medical Products Agency (MPA)
This campaign aims to inform people of the risks of buying medicines from unknown Internet sites. Many of the medicines sold on these sites are counterfeit and may contain unknown substances, meaning that they pose potentially serious health risks.
2009, Czech Republic:
This 2009 campaign highlights the risks of driving while under the influence of drugs.
The map shows examples of media campaigns in different countries. Click on a thumbnail to watch the item and/or learn more about it.
Note: the videos featured on this page were selected on the basis of their being representative of different types of media campaigns. Inclusion here does not represent an endorsement of the approach by the EMCDDA. Videos are hosted on YouTube — all copyright remains with the holders.
3. Terms and Definitions
| Category | Objective | Target audience | Main message |
|---|---|---|---|
| Information campaign | Warning | General or youth population | Information about the dangers and risks of a range of illicit substances |
| Empowerment | General population, especially parents | Information about behaviours that will contribute to drug prevention | |
| Information about where and how to seek support, counselling and treatment regarding children's illicit drug use | |||
| Youth population | Information about where and how to seek support, counselling and treatment regarding illicit drug use | ||
| Support | General population | Information about existing prevention interventions or programmes in communities, in schools or for families, in order to strengthen community involvement and support for them | |
| Social marketing campaign | Correct false normative beliefs | General or youth population | The true, unexaggerated levels of drug use in peer populations ('you're not weird if you don't use because 80% of your peers don't either') |
| Setting or clarifying social and legal norms | General or youth population | Information that deglamourises and demystifies drug use and related behaviour (e.g. drug driving) and explains the rationale for community norms and control measures | |
| Setting positive role models or social norms | General or youth population | Promotion of positive lifestyles and behaviours that are not associated with drug use |
Source: https://www.emcdda.europa.eu/topics/pods/mass-media-campaigns_en
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