the issue dated July 28, 2000
Use Peer Pressure to Encourage Healthy Behavior
By LEO REISBERG
Most college students
are, at least. The cool ones, anyway. They sure look happy about it,
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.
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
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.
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.
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.
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.
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
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
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."
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,
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.
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."
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.'"
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.
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."
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.
else is doing it.
Copyright 2000 by
The Chronicle of Higher Education