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1 This article was downloaded by: [Glassman, Tavis] On: 26 May 2010 Access details: Access Details: [subscription number ] Publisher Routledge Informa Ltd Registered in England and Wales Registered Number: Registered office: Mortimer House, Mortimer Street, London W1T 3JH, UK Social Marketing Quarterly Publication details, including instructions for authors and subscription information: Confusion Surrounding Social Marketing Strategies and Social Norm Theory: To Prevent High-Risk Drinking Among College Students Tavis J. Glassman; Robert E. Braun Online publication date: 26 May 2010 To cite this Article Glassman, Tavis J. and Braun, Robert E.(2010) 'Confusion Surrounding Social Marketing Strategies and Social Norm Theory: To Prevent High-Risk Drinking Among College Students', Social Marketing Quarterly, 16: 2, To link to this Article: DOI: / URL: PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.

2 Confusion Surrounding Social Marketing Strategies and Social Norm Theory: To Prevent High-Risk Drinking Among College Students BY TAVIS J. GLASSMAN AND ROBERT E. BRAUN ABSTRACT High-risk drinking, the consumption of 5 or more drinks on one occasion, constitutes a serious public health issue among young adults, particularly college students. In an attempt to address this issue in a cost-effective manner, many universities have implemented social marketing interventions sometimes utilizing social norm theory and in other cases using more traditional strategies. However, some practitioners, school officials, and even researchers incorrectly use the terms social marketing and social norms marketing, interchangeably. Social marketing influences health behavior through the use of marketing principles, such as the use of the 4Ps (product, price, placement, and promotion) to increase knowledge, change attitudes, and motivate individual or societal change. Conversely, social norms represents a specific theory which can be applied using social marketing principles. Social norm interventions are designed to correct peoples misconceptions concerning the prevalence of a particular behavior. Theorists assert that by providing accurate information concerning the prevalence of the behavior of interest people will alter their behavior to fit the norm. Using social marketing approaches with or without social norms theory represents a promising cost-effective strategy for addressing high-risk drinking among college students. However, failing to understand and appreciate the conceptual underpinnings of how these two concepts relate to one another may result in ineffective interventions and conclusions concerning the efficacy of social marketing and=or social norms theory.

3 Background Many colleges and universities throughout the country struggle to address high-risk drinking. According to the 2008 National College Health Assessment, approximately 38% of college students, consumed five or more drinks the last time they partied or socialized (American College Health Association, 2009). Given the financial burden and human suffering that alcohol causes, the need for evidence-based alcohol interventions on college campuses is apparent. Social marketing campaigns, utilizing social norms theory, are frequently implemented because they can reach large numbers of people at a relatively low cost. However, the fidelity practitioners and researchers use while implementing social marketing campaigns using social norms theory can be problematic. In fact, often times the terms social marketing and social norms marketing are used interchangeably. Social norms denotes a particular niche within the field as many social marketing text books include sections on the subject (Kotler & Lee, 2008; Kotler, Roberto, & Lee, 2002). Social norms represent a specific health behavior change theory which can be applied using social marketing strategies. However, confusing the two concepts constitutes a disservice to both the intended audience and the respective fields overall. The purpose of our inquiry is to define social norms and social marketing, review the relevant literature of social norms theory pertaining to preventing high-risk drinking among college students, and examine how social norms theory can be used to design a social marketing campaign. Social Marketing Philip Kotler and Gerald Zaltman (1971) first introduced the concept of social marketing over 30 years ago when they published Social Marketing: An Approach to Planned Social Change. Since then a growing interest in the use of social marketing concepts, tools, and practices emerged and has evolved from simply designing messages to addressing complex environmental and community issues (Kotler & Lee, 2008). Social marketing influences behavior change which leads to better health for the individual or group. It can also be used to protect or contribute to the targeted community in a positive way (Kotler & Lee, 2008). While many definitions for social marketing exist, Kotler and Lee describe the concept succinctly: Social marketing is a process that applies marketing principles and techniques to create, communicate, and deliver value in order to influence target audience behaviors that benefit society (public health, safety, the environment, and communities) as well as the target audience. (Kotler, Lee, & Rothschild, 2006, as cited by Kotler & Lee, 2008, p. 7) SMQ Volume XVI No. 2 Summer

4 Social marketing can be used to change individual behavior, impact the social determinants of health, and to create policy change. The hallmark of social marketing campaigns involves the use of the marketing mix, or4ps: product, price, placement, and promotion. More specifically, the first P,inmarketing mix, product, is what is being sold, including the behavior and the associated benefits of that behavior. The second P, price, is the costs that target adopters have to make and barriers they must overcome. The third P, place, involves the channels by which the behavior change takes place and where it is supported and encouraged. The fourth P, promotion, includes the means by which the change is delivered to the intended audience (Hastings, 2007). The Centers for Disease Control and Prevention (2006) encourages programs to apply the principles of social marketing to public health problems to increase the effectiveness of interventions. The primary objective of social marketing is to influence the behavior of select audience members for the purpose of getting them to voluntarily change, maintain, or prevent behaviors. Social marketing programs do this by offering members of the target audience attractive benefits and=or by reducing barriers, which might prevent or otherwise discourage them from engaging in the desired behaviors (Glanz, Rimer, & Viswanath, 2008). Effective social marketing efforts offer products, services, or ideas members of the target audience perceive to be in their own best interests. Ideally, this is achieved through gaining a thorough understanding of the target population. The package of benefits must resonate among the intended audience. Perceived barriers to the desired behavior must be alleviated or lessened, and the alternative behaviors need to provide more compelling benefits (Glanz et al., 2008). The key is to determine what advantages people see in performing their current behavior. For example, college students may perceive that drinking alcohol will help facilitate dating and romantic relationships. Modifying alcohol expectancies or attitudes represents a fundamental step toward changing social norms (Wall, Hinson, & McKee, 1998). Conversely, it is also necessary to determine what negative effects people may see in their current behavior. Continuing with the example of college student drinking, students may determine a hangover represents a cost that is so severe they decide to moderate their drinking or quit all together. Only through extensive formative research can these motivational cues be determined. Social Norms Social norms constitutes a theory which can be utilized within social marketing, similar to other behavior change theories such as the Transtheoretical Model, 96 SMQ Volume XVI No. 2 Summer 2010

5 Health Belief Model, Social Cognitive Theory, and many others. Social norm campaigns specifically aim to correct misperceptions regarding the prevalence of a given behavior. Perkins describes social norm interventions: The basic idea of social norms is simply to communicate the truth about peer norms in terms of what the majority of students actually think and do concerning alcohol consumption. Thus the message to students is a positive one that the norm is one of safety, responsibility and moderation because that is what the majority of students think and do in most student populations. (Perkins, 2002, p. 169) Social norm theory emerged from college health settings to address the alarming rates of high-risk drinking and related consequences college students engaged in on a routine basis (Linkenbach, 1999). Wesley Perkins and Alan Berkowitz (1986), and subsequently other researchers, found that adolescents and young adults quite often overestimate the alcohol consumption rates of their peers (Graham, Marks, & Hansen, 1991; Hansen & Graham, 1991; Perkins, 2003; Prentice & Miller, 1993). Students mistakenly believe their peers consume more alcohol than they actually do. As a result, college students drink more in an attempt to match the norm, albeit a false norm (Haines, 1998; Prentice & Miller, 1993). According to Linkenbach, students are more concerned with what they perceive as normative than with what they discern as healthy. In the late 1980s health educators at Northern Illinois University (NIU) developed and implemented a social norm marketing campaign designed to curb alcohol abuse among students attending the university. NIU students mistakenly believed that 70% of the population engaged in high-risk drinking, yet at the time of the assessment, 43% of the students took part in this behavior (Carson, 1995). A campus-wide media campaign was implemented which exposed students to the following fact: Most NIU students have five or fewer drinks when they party (Haines, 1998). Classified advertisements, a weekly column, posters, and leaflets were used to communicate the true norm (Haines, 1998). Five years after the onset of the social norms marketing intervention, the perceived high-risk drinking rate had fallen and the actual high-risk drinking rate had been reduced to 28% (Carson, 1995). Over a nine-year period, NIU reported a 44% reduction in their high-risk drinking rate (Haines, 1998). Not surprisingly, the negative consequences associated with heavy drinking fell as well. For example, there was a 31% reduction in reported alcohol-related injuries to the individual and a 54% reduction of alcohol-related injuries to others (Linkenbach, 1999). SMQ Volume XVI No. 2 Summer

6 A major limitation of this research project involved the nonexperimental methods used to conduct the evaluation (Haines & Spear, 1996). Rather than randomly selecting participants, surveys were disseminated through undergraduate general education classes, which were reflective of the overall NIU undergraduate population. The response rate for the questionnaire averaged 89% over a five-year period. In any given year at least 600 students participated in the survey in a school that usually enrolls about 23,000 students (Haines & Spear, 1996). In addition, no control groups were used for this study, consequently any change in the drinking rates may be the result of external influences. Other college institutions benefited from implementing social norm marketing campaigns as well. The University of Arizona also placed ads in the school newspaper, stating, 64% of U of Arizona Students have four or fewer drinks when they party. According to Glider, Midyett, Mills-Nova, Johannessen, and Collins (2001), as a result of the social norms marketing campaign, the University of Arizona s high-risk drinking rate fell 29% in three years. Hobart and William Smith Colleges reported a 12% reduction in high-risk drinking over two years and Western Washington University had an 8% decrease in the high-risk drinking rate over a one-year period using similar social norms marketing strategies (Haines, 1998). In addition, during the summer of 2001, all 23 campuses in the California State University System initiated social norm campaigns (Frauenfelder, 2001) constituting a trend in higher education during the early millennium. However, research assessing the effectiveness of social norms interventions remains mixed. While the National Institute on Alcohol Abuse and Alcoholism s (NIAAA) (2002) Call to Action: Changing the Culture of Drinking at U.S. Colleges lists use of a social norms approach to alcohol consumption as a promising practice, other prominent alcohol researchers such as Henry Wechsler (Wechsler & Wuethrich, 2002) are more skeptical. A national assessment of social norms interventions revealed that almost half of the schools surveyed employed a social norms intervention, yet no decreases were found on the seven alcohol measures for the study (Wechsler, Nelson, Lee, Seibring, Lewis, & Keeling, 2003). In fact, there were increases in two of the five measures: alcohol use in the previous month and consumption of 20 or more drinks in the previous month. In addition, schools which implemented social norms interventions reported some increases in lower level drinking, a result anticipated by the original theorists Perkins and Berkowitz (1986). Social norm proponents maintain that practitioners do not truly understand social norms theory, and as a result, they compromise fidelity when implementing 98 SMQ Volume XVI No. 2 Summer 2010

7 this type of intervention. Conversely, opponents suggest that any documented success claimed by researchers is riddled with methodological flaws. In a later study, researchers found that traditional social norms campaigns which highlight the fact that most students have zero to four drinks when they party fail to reduce the high-risk drinking rate and may not even correct misperceptions regarding alcohol use (Thombs, Dotterer, Olds, Sharp, & Raub, 2004). Apparently students do not believe these messages and don t identify with most students. However, Thombs et al. caution that the conceptual underpinnings of social norms theory may still have potential, but they point to a need to develop more effective applications to the model. Perhaps, Turner, Perkins, and Bauerle (2008) were able to expand on the theory by addressing risk reduction strategies. In a conventional fashion, they first attempted to correct students misperceptions concerning alcohol consumption. Then they also provided normative feedback concerning the use of protective factors:...including not leaving friends who had been drinking alone with strangers, intervening to stop friends from drinking and driving, asking friends to slow down if they are drinking excessively, planning on a designated drive or alternative transportation, and eating before they choose to drink. (Turner et al., 2008, p. 86) The results indicated that first-year students reported decreased rates of negative alcohol related consequences and lower estimated blood alcohol content levels. However, once again, an experimental design was not applied to this research study; thus, the results must be interpreted with caution. Implications for Social Marketing Social norms is a theory practitioners and researches can utilize when designing social marketing interventions. However, regarding the specific message design, a great deal of consideration needs to be directed toward the benefit(s) or the exchange the receiver obtains from the message when using social norms theory within a social marketing intervention. For example, target audience members (supposedly) benefit from a social norms message by learning if their behavior (i.e., alcohol consumption) is consistent with their peers. The question or theoretical dilemma concerns whether this is an attractive benefit or exchange for college students? Traditional college students, from a developmental perspective, tend to seek out and need social approval from their friends. However, because social norm SMQ Volume XVI No. 2 Summer

8 messages are designed to correct perceptions, the target audience may exhibit difficulty believing and may even resent the message. Illuminating the actual and perceived discrepancies between the prevalence of a behavior represents the fundamental underpinnings of a social norms campaign. If no discrepancies existed between the actual behavior and the perceived behavior, then there would be no reason to implement this type of campaign. In addition, from a consumer marketing perspective is it reasonable to expect a campaign to yield significant behavior change when the message is unbelievable, unappealing, offensive, or threatening, as is the case with traditional social norm messages (Dodd, Glassman, Arthur, Web, & Miller, 2010)? Such shortcomings may help to explain the mixed results found in the literature on this topic. The efficacy of social norm campaigns may improve by identifying more attractive norms such as those related to dating (i.e., most students prefer to date someone who doesn t drink too much). Possibly another reason why social norm campaigns yield limited or mixed results is traditionally they focus on individual change. In Goldberg s (1995) seminal work he asks the quintessential question: Are we fiddling while Rome burns? Many researchers and practitioners believe prevention efforts should focus on the social, cultural, and economic determinants of behavior, rather than exclusively addressing knowledge, attitudes, and behaviors of individuals. Such philosophical underpinnings in the area of social marketing are commonly referred to as upstream marketing (Andreasen, 2006), where the emphasis is on policy and influencing key decision makers. How would this upstream approach work with social norms theory? Perhaps, decision makers and the public underestimate support for certain health promoting policies. A social norm intervention could be designed to correct these misperceptions while using social marketing principles to implement the campaign. Conclusion Social marketing campaigns using social norm theory are commonly implemented at colleges and universities with the goal of reducing the high-risk drinking among college students (NIAAA, 2002). However, some researchers and practitioners confuse the differences between these two concepts. Social marketing involves a comprehensive and complex set of techniques utilizing commercial and other strategies to yield change, whereas social norms denotes a particular health behavior theory which can be used to develop a social marketing campaign. Social norm campaigns aim to correct misperceptions concerning the perceived prevalence of a behavior. 100 SMQ Volume XVI No. 2 Summer 2010

9 To better determine the efficacy of these interventions more research is needed utilizing an experimental design. Comparing social marketing campaigns employing different theories warrants further investigation. Randomly assigning social marketing interventions with alternative theories to similar communities=clusters and evaluating key outcomes represents one promising approach to assessing the impact of these unique theoretical frameworks. However, implementing and evaluating the impact these types of populationbased interventions requires significant resources and expertise. Fidelity regarding the application of each of these respective interventions remains a concern. Not adhering to the fundamental foundations of social marketing or social norms theory, and failing to understand how and when to use social norms theory when designing a social marketing intervention, compromises the quality of the campaign leading to inaccurate conclusions. Failing to correctly implement these strategies may drain resources and decrease support for such interventions; consequently, health behavior does not improve. About the Authors Tavis J. Glassman, Ph.D., M.P.H., C.H.E.S., serves as an assistant professor in the Department of Health Education & Rehabilitative Services at the University of Toledo. He teaches a graduate-level social marketing class and has implemented a number of social marketing campaigas. Robert E. Braun, M.P.H., C.H.E.S., is a doctoral student at the University of Toledo studying health education. His academic pursuits involve the prevention of high-risk drinking among college students and social marketing. References American College Health Association. (2009). American College Health Association-National College Health Assessment Spring 2008 Reference Group Data Report (Abridged). Journal of American College Health, 57, Andreasen, A. R. (2006). Social marketing in the 21st century. Thousand Oaks, CA: Sage. Carson, E. (1995). Purging binging. Reason, 27(7), Centers for Disease Control and Prevention. (2006). Communication at CDC. Retrieved from Dodd, V., Glassman, T., Arthur, A. A., Web, M., & Miller, E. M. (2010). Why underage college students drink in excess: Qualitative research findings. American Journal of Health Education, 41, Frauenfelder, M. (2001, December 9). Social-norms marketing. New York Times Magazine, p SMQ Volume XVI No. 2 Summer

10 Glanz, K., Rimer, B., & Viswanath, K. (Eds.). (2008). Health behavior and health education: Theory, research, and practice (4th ed.). San Francisco, CA: Jossey-Bass. Glider, P., Midyett, S. J., Mills-Nova, B., Johannessen, K., & Collins, C. (2001). Challenging the collegiate rite of passage: A campus-wide social marketing media campaign to reduce binge drinking. Journal of Drug Education, 31, Goldburg, M. E. (1995). Social marketing: Are we fiddling while Rome burns? Journal of Consumer Psychology, 4, Graham, J., Marks, G., & Hansen, W. B. (1991). Social influence processes affecting adolescent substance use. Journal of Applied Psychology, 76, Haines, M. (1998). Social norms: A wellness model for health promotion in higher education. Wellness Management, 14, Haines, M., & Spear, S. F. (1996). Changing the perception of the norm: A strategy to decrease binge drinking among college students. Journal of American College Health, 45(3), Hansen, W. B., & Graham, J. W. (1991). Preventing alcohol, marijuana, and cigarette use among adolescents: Peer pressure resistance training versus establishing conservative norms. Preventive Medicine, 20, Hastings, G. (2007). Social marketing: Why should the devil have all the best tunes? Oxford, England: Elsevier Linacre House. Kotler, P., & Lee, N. (2008). Social marketing influencing change for good (3rd ed.). Los Angeles: Sage. Kotler, P., Roberto, N., & Lee, N. (2002). Social marketing improving the quality of life (2nd ed.). Thousand Oaks, CA: Sage. Kotler, P., & Zaltman, G. (1971). Social marketing: An approach to planned social change. Journal of Marketing, 35, Linkenbach, J. W. (1998). Building a bridge: Applying the social norms approach to sexual health. The Bacchus & Gamma sexual responsibility manual. Minneapolis, MN: Bacchus & Gamma Peer Education Network. National Institute on Alcohol Abuse, & Alcoholism. (2002). A call to action: Changing the culture of drinking at U.S. colleges. Retrieved from NIAAACollegeMaterials/TaskForce/TaskForce_TOC.aspx Perkins, H. W. (2002). Social norms and the prevention of alcohol misuse in collegiate contexts. Journal of Studies on Alcohol, 14(S), Perkins, H. W. (2003). The social norms approach to prevention school and college age substance abuse: A handbook for educators, counselors, and clinicians. San Francisco, CA: Jossey-Bass. Perkins, H. W., & Berkowitz, A. D. (1986). Perceiving the community norms of alcohol use among students: Some research implications for campus alcohol education programming. International Journal of Addictions, 21, Prentice, D. A., & Miller, D. T. (1993). Pluralistic ignorance and alcohol use on campus: Some consequences of misperceiving the social. Journal of Personality and Social Psychology, 64, SMQ Volume XVI No. 2 Summer 2010

11 THEORY AND REVIEW Thombs, D., Dotterer, S., Olds, S., Sharp, K., & Raub, C. G. (2004). A close look at why one social norms campaign did not reduce student drinking. Journal of American College Health, 53(2), Turner, J., Perkins, W. H., & Bauerle, J. (2008). Declining negative consequences related to alcohol misuse among students exposed to a social norms marketing intervention on a college campus. Journal of American College Health, 57(1), Wall, A. M., Hinson, R. E., & McKee, S. A. (1998). Alcohol outcome expectancies, attitudes toward drinking and the Theory of Planned Behavior. Journal of Studies on Alcohol, 59, Wechsler, H., Nelson, T. F., Lee, J. E., Seibring, M., Lewis, C., & Keeling, R. (2003). Perception and reality: A national evaluation of social norms marketing interventions to reduce student s heavy alcohol use. Journal of Studies on Alcohol, 64, Wechsler, H., & Wuethrich, B. (2002). Dying to drink: Confronting binge drinking on college campuses. Emmaus, PA: Rodale. SMQ Volume XVI No. 2 Summer