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From the issue dated July 28, 2000

Colleges Use Peer Pressure to Encourage Healthy Behavior


Everybody's doing it.

Most college students are, at least. The cool ones, anyway. They sure look happy about it, too.

In its latest advertising campaign, Gustavus Adolphus College says that most students choose not to smoke cigarettes. At James Madison University, most male students respect a woman's decision when she says no to sex. At Hobart and William Smith Colleges, most students study hard and perform community service.

College officials are discovering the power of positive peer pressure.

It's called "social norms" marketing. Colleges hang up posters, display facts on World Wide Web sites, and give away key chains and T-shirts telling students that, contrary to popular belief, it's normal to engage in healthy behavior -- so they should. The messages often use statistics to support the assertions.

Consider one eye-catching poster at Virginia Commonwealth University.

"Do you want to grow up to be a proctologist?" the poster asks, showing an image of a gloved hand with two fingers extended. Then comes another random question: "Do you want to grow up to be a daily smoker?" And then the tie-in: "Most V.C.U. students say 'no way' to both!"

It doesn't provide data on aspiring proctologists, but the poster cites a 1999 survey showing that 61.5 percent of students on the campus had not smoked in the past 30 days and only 15.9 percent smoked daily.

The social-norms model was developed on several campuses in the early 1990's to change the perception among students that most of their friends were frequently getting drunk. Advocates of the model say that, after some colleges got out word that the norm among students was to drink responsibly or not at all, the level of heavy drinking fell significantly.

"College students tend to not realize they are as healthy as they are," says Michael P. Haines, coordinator of health-enhancement services at Northern Illinois University and one of the pioneers of the social-norms movement. "It's certainly been part of my hypothesis that some of the reason for this underappreciation of their health is because authorities on college campuses have focused on their problems and identifying all the ways they get into trouble."

Many colleges have already started campaigns to change perceptions, behavior, and tolerance toward smoking, unsafe sex, sexual assault, and racism and homophobia. Others are considering ways to use social norms to prevent eating disorders and encourage a wiser use of credit cards.

But some college-health experts are skeptical of the social-norms approach, saying there's no solid evidence to prove it's effective. Critics also say that the marketing campaigns may do more harm than good, by diverting resources away from creating programs and policies that might better address the problems that social-norms advocates are trying to play down.

"Pragmatically, I worry because what could be potentially a warm and attractive and hopeful idea has rapidly become adopted as the next saving grace of health education on campus," says Richard P. Keeling, editor of the Journal of American College Health.

One problem, he argues, is that a prevailing social norm doesn't exist among all students, just as there is no such thing as a "universal college student." But there are norms that influence certain groups of students and "many of the behaviors we'd like to change are in fact associated with groups of students who do sustain those unhealtier norms and who don't misperceive them," Dr. Keeling says. For instance, while college students in general may drink responsibly, the norm that matters to the small group of students who do not drink responsibly is that most of their true peers do get drunk frequently.

Since Dr. Keeling became editor of the journal in 1997, he says, the publication has received few submissions supporting the effectiveness of social norms on drinking, and "the ones that we have received have either produced negative results or have not been convincing pieces." He questioned the methodologies of those studies that link social-norms marketing with a decline in high-risk drinking, saying that the research does not take into account other factors that may have contributed to the results.

In September, the journal will publish research studies from some colleges that tried social-norms campaigns but saw little or no impact on curbing heavy drinking, Dr. Keeling says. He would not identify the colleges.

The idea of applying social-norms marketing to behaviors like smoking, unsafe sex, and violence is so new that most of the colleges that have tried such programs are not finished examining the results.

The third National Conference on the Social Norms Model, sponsored by the BACCHUS & GAMMA Peer Education Network, will be held this week in Denver. The meeting, which in the past has focused on high-risk drinking, will include sessions this year on how social norms can be applied more broadly.

Linda C. Hancock, a nurse practitioner who spearheaded the Virginia Commonwealth campaign, says she will present findings that show that students now have a more accurate perception of how many of their peers smoke, and that their attitudes toward not smoking have improved.

In addition to a series of funny posters, the campaign also included a mascot, "Darth Vapor," a take-off of the Star Wars character, who wandered the campus last year and asked students to guess how many of their peers at V.C.U. didn't smoke. A correct guess would be rewarded with either a $1 bill or a keychain with a message like, "Surgeon General's Warning: Don't eat the yellow snow. Oh yeah, and don't smoke."

BACCHUS, the association of students and health educators who advise students on health and safety issues, is working with nine colleges on a research project studying the effect of social-norms marketing on sexual health and tobacco use. The projects began in the spring of 1999, when each college surveyed students to obtain baseline statistics about their sexual practices or tobacco use. With a $5,000 grant from the Centers for Disease Control and Prevention, each institution then conducted a yearlong media campaign, with three different poster messages carrying the theme "people are a lot like you," as well as newspaper advertising and distribution of highlighters and candy bearing social-norms messages.

One poster shows a handful of students walking across an idyllic campus and reads: "Most University of Hawaii-Manoa students protect themselves in sexual situations." It cites the spring 1999 survey that found that 94 percent of the students at Hawaii's Manoa campus reduce their risk of sexually transmitted diseases, including H.I.V., by abstaining from sex, using a condom, or choosing to be in a monogamous relationship.

Jan L. Gascoigne, director of health promotions for BACCHUS & GAMMA, says that the results of the study are still being tabulated, but anecdotal evidence suggests that the campaigns have been effective.

At the campuses that studied the impact of social-norms marketing on students' tobacco use, officials said they noticed an increase in the number of students who visited the health center to ask about smoking-cessation programs.

"We would not be able to pinpoint that it happened because of social norming," Ms. Gascoigne acknowledges, "but we would hope that would've been one piece that caused students to look at their behavior."

James Madison University, which used social-norms marketing to reduce heavy drinking in 1998, is now applying it to sexual-assault prevention and tobacco use.

The sexual-assault campaign, which started last year as an experiment, consisted of a survey last fall of 425 men at James Madison, and a research study involving male athletes and fraternity members.

Based on the survey results, health educators chose to take an optimistic perspective and came up with this poster theme: "A man respects a woman; 9 out of 10 J.M.U. men stop the first time their date says 'no' to sexual activity."

Susan E. Bruce, who was then assistant director for health promotion at James Madison, says that men on the campus were randomly asked their opinions of the poster designs before they were used for the study. Many of them were bothered by the statistics: If nine out of 10 students stopped when a woman said no, that meant that 10 percent of men did not stop, they figured. Another poster indicated that three out of four men "think it's not okay to pressure a date to drink alcohol" to have sex. The men who saw the posters "looked around and asked, 'OK, who's the jerk, who's the one guy?'" Ms. Bruce says.

She explains that the surveyed students who did not agree with the statement, "It's not OK to pressure a date to drink alcohol," either were unsure about the statement, were neutral, or disagreed with the statement. In response to the question asking if they stopped when a date said no to sex, about 10 percent said they "sometimes," "rarely," or "never" stopped.

"We did hope that would raise some red flags and prompt some discussion," says Ms. Bruce, who is now director of the Center for Alcohol and Substance Education at the University of Virginia. "The majority saw it as a concern, but some students thought that nine out of 10 [who said they stopped when a date said no] was way too high. They thought it would be lower."

As part of the study, the posters were hung in a couple of fraternity houses and in locker rooms for some athletes, and those study participants were required to attend a play about male socialization, called Crimes Against Nature. Other fraternity members and athletes were used as a comparison group and were not exposed to the educational materials.

The students were surveyed again this spring. In response to the statement, "I stopped the first time my date said no," 88.5 percent of the men who were exposed to the posters and the play agreed, up from 85.2 percent before the project began. Of the control group, 85.3 percent agreed with the statement, down from 92.8 percent before the project began.

Ms. Bruce called the data "statistically insignificant," but she hopes the campaign will make a bigger impact when it goes campuswide this fall, with posters, newspaper ads, magnets, and telephone calling cards bearing the message, "A man respects a woman."

"We're sending out the message that being loyal to your friends doesn't mean whatever your buddy says is OK," Ms. Bruce says. "If you see a buddy hitting on a very drunk woman, loyalty means you need to stop your friend."

At Western Washington University, officials are using social-norms marketing to combat sexism, racism, and homophobia.

This fall, health educators will train dormitory advisers, student-government officers, athletes, and other groups on normative behavior toward those "social-justice issues." They are also planning a poster campaign that suggests that most students at Western Washington are intolerant of sexism, racism, and homophobia.

But that campaign, known as "ally-building," is short on statistics and long on assumptions. The project is based on focus-group discussions last year with students who were already active with social-justice issues.

"There are people in the social-norms movement who will tell you that using qualitative data is risky," says Patricia Fabiano, director of prevention and wellness services at Western Washington. "The way I justify it is that our common sense tells us that the majority of our students have not committed hate crimes or overt acts of bigotry and discrimination. There is latent in our students a desire to see a diverse community that lives in harmony."

At Hobart and William Smith Colleges, one of the first institutions to use social-norms marketing to promote responsible drinking, two faculty members have developed a multimedia campaign to promote academic and community-service work.

As part of the "campus factoids" program, H. Wesley Perkins, a sociology professor, and David W. Craig, a chemistry professor, post statistics in a newspaper column, on the campus Intranet, and on a computer screen-saver program, about students' health habits, scholarly efforts, and their opinions about the death penalty, abortion, and gay rights.

A few samples: "Twelve percent of the 1999 senior class had presented/published a paper off campus during their time at H.W.S." "One out of five spent more than 10 hours per week exercising or playing sports while 14 percent reported almost no exercise." "Over two-thirds of the class had participated in volunteer service during college."

"There are a lot of misperceptions in the campus community about what student priorities are, about what the campus culture is and what is expected," says Mr. Craig. "Students think that they're alone, that everyone else is partying and not studying, and they think, 'What's wrong with me? I guess I'm not so bright because I'm studying so much.'"

Aaron Frishman, who graduated last month from Hobart with a bachelor's degree in history, says that he was surprised by some of the factoids that dealt with student drinking, study habits, and community service. He thinks that the college can influence student behavior -- or at least their attitudes -- by explaining the true social norms on the campus.

"I don't think people see the factoids and say, 'I'm going to change my life,'" Mr. Frishman says. "But every time you turn on the computer, it's just a little reminder, and it's so repetitive that I think it changes the way people think."

Mr. Frishman says it was encouraging to learn that he was among the majority of students who studied hard and drank little. "Often I was made fun of for doing homework at times when other people were out having fun, so I could tell people that I'm not the one who's different," he says.

Mr. Haines, the health coordinator at Northern Illinois, says he is excited that his social-norms concept has attracted a loyal following, but he also worries that it could become overkill.

"We're concerned that people will wear it out," he says. "If we start seeing broad, one-size-fits-all, national campaigns, it could start looking like a gimmick."

Still, Mr. Haines, who will become director of the National Social Norms Resource Center when it opens this fall at Northern Illinois, does what he can to promote the model and encourage its use. At the conference, he plans to illustrate its success by talking about one of his earliest experiments with the strategy -- a campaign he started in 1990 to promote the use of condoms at Northern Illinois.

Posters and newspaper ads said that most students who were sexually active used condoms. In fact, Mr. Haines says, the surveys found that "it was actually non-normative to have sex, but people thought that students were getting laid all the time."

The social-norms campaign produced promising results: Between 1989 and 1997, condom use doubled, the intercourse rate declined by 4 percent, the number of sexually transmitted diseases dropped 66 percent, and the number of insurance claims for abortions fell by 42 percent.

"There is no other approach in the college health field that has outcome data as solid as the social-norms approach," Mr. Haines says.

Such examples of success explain why the social-norms movement is "exploding," he says. But there's probably another reason behind its growing popularity.

Because everybody else is doing it.

Copyright 2000 by The Chronicle of Higher Education