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UPC1 CUR8 2020 Participant

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77 views272 pages

UPC1 CUR8 2020 Participant

upc curriculum 8

Uploaded by

ALELI DOCEJO

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The Colombo Plan Drug Advisory Programme (DAP) Training Series

Managers and Supervisors Series

Universal Prevention Curriculum for Substance Use (UPC)
Managers and Supervisors Series

Media-Based
Prevention Interventions

Participant Manual

April 2020 Edition

Acknowledgments
Managers and Supervisors Course 08: Media-Based Prevention Interventions is part of
a nine-volume Universal Prevention Curriculum for Substance Use (UPC) training series
developed for the Bureau of International Narcotics and Law Enforcement Affairs (INL),
U.S. Department of State.
Special thanks go to Thomas Browne, CEO, Colombo Plan, and Brian Morales, Branch
Chief, Office of Global Programs and Policies, Bureau of International Narcotics and
Law Enforcement Affairs, US Department of State, for their guidance and leadership
throughout the project’s development. From APSI, Zili Sloboda served as Project Director
and Lead Curriculum Developer, and Susan B. David served as Curriculum Developer.
Other members of the Curriculum Development Team contracted by APSI include J.
Douglas Coatsworth, William Crano, Rebekah Hersch, Chris Ringwalt and Richard Spoth
(See Appendix E).
We would like to thank the Expert Advisory Group members for their expertise in reviewing
the course content for the 2015 edition (See Appendix F). Their invaluable contribution
helped to ensure the quality of the final product.
Dr Josephine Choong, Project Manager - Curriculum Development (Prevention)
contributed significantly to the development of this publication.
Special thanks are extended to the pilot-test group members (see Appendix G) who
provided invaluable input for the first edition of this course.

Published April 2020

Sri Lanka

ii
Managers and Supervisors Course 08: Media-Based Prevention Interventions
CONTENTS

Part I—Participant Orientation

Participant Orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Part II—Training Modules

Module 0—U.S. Department of State. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Module 1—Training Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Module 2—Introduction to Media and Their Use in Prevention. . . . . . . . . 53
Module 3—The Nature of Media and Theories of How the Media
Affects Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Module 4—Practical Application of Theories of Persuasion in
Substance Use Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Module 5—The Two-Step Flow of Communication and Parental
Impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Module 6—Pre- and Post-Evaluation of Effects of Media-Based
Prevention Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Module 7—Review of Media-Based Prevention Interventions:
Application to Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

Part III—Appendices
Appendix A—Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Appendix B—Resources
Citations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Appendix C—Curriculum Developers. . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Appendix D—Expert Advisory Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Appendix E—Special Acknowledgment. . . . . . . . . . . . . . . . . . . . . . . . . . 267

iii
Public Domain and Dissemination Notice
All Universal Curricula (UC) materials appearing in this course except for those taken
directly from copyrighted sources are in the public domain and may be reproduced,
or copied by Training Providers (TPs) and their trainees without permission from the
U.S. Department of State/INL or the authors. Trainer manuals and trainer PowerPoint
slides may only be shared with designated Training Providers (TP)s and their authorized
users (e.g. TP training team members and administrators). To become a Training
Provider, a government, university, or civil society organization may contact a Regional
Coordinating Center to request access. Access is granted after the duly-filled Training
Provider Application Form is approved. The directory of current Training Providers is
available at: https://www.issup.net/training/education-providers
TPs may disseminate either the entire curriculum series, one or more entire courses,
or one or more entire modules. In these cases, all TPs are required to document any
UC training on the ISSUP website. TPs are also welcome to incorporate UC materials
into their own academic/training materials. In these cases, citation of the source is
appreciated.
This publication may not be distributed for a fee beyond the cost of reproduction
without specific, written authorization from INL.

Disclaimer
The substance use prevention interventions described or referred to, herein, do not
necessarily reflect the official position of INL or the U.S. Department of State. The
guidelines in this document should not be considered substitutes for individualized
client care.

April 2020 Edition

iv
Managers and Supervisors Course 08: Media-Based Prevention Interventions
PARTICIPANT ORIENTATION
Introduction
Welcome! This training will provide you with a comprehensive overview of over 20 years
of research on substance use prevention and how it can be applied in the “real world” of
prevention practice worldwide. Psychoactive substance use and substance use disorders
(SUDs) continue to be major problems around the world, taking a toll on global health
and on social and economic functioning. Learning about evidence-based prevention can
provide you with valuable, effective tools, which can make a difference in intervening with
affected populations in your country and community.
Congratulations for taking the time to become educated about the latest approaches to
substance use prevention available today!

This Training
Managers and Supervisors Course 08: Media-Based Prevention Interventions is part
of a training series developed through funding from the U.S. Department of State to
The Colombo Plan for the Drug Advisory Programme (DAP). Information about DAP can
be found at http://www.colombo-plan.org. The overall goal of the training series is to
reduce the significant health, social, and economic problems associated with substance
use throughout the world by building international prevention capacity through training,
professionalizing, and expanding the substance use prevention workforce.
Who is it for: This curriculum series is designed to provide extensive foundational
knowledge to Prevention Managers and Supervisors about the most effective evidence-
based (EB)prevention interventions that are currently available. Prevention Managers
and Supervisors, usually located at the community, state or country level, are prevention
professionals involved in the assessment and planning for prevention, organization,
selection and implementation of EB interventions, and monitoring and evaluation of
programming. Current plans include a follow-up series directed at Prevention Practitioners
working in programs with a greater focus on building skills to deliver these EB interventions
at the direct service level.
The nine modules in this training course may be delivered over five consecutive days (most
often), or may be offered over the course of several weeks. Your trainers have provided
you with a specific agenda.
The learning approach for the training series includes:
Trainer-led presentations and discussions;
Frequent use of creative learner-directed activities, such as small-group and partner-
to-partner interactions;
Small-group exercises and presentations;

1
Participant Manual: Participant Orientation
Reflective writing exercises;
Periodic reviews to enhance retention; and
Learning assessment exercises.
Your active participation is essential to making this a positive and productive learning
experience!

Goals and Objectives for Course 8

Training goals
To provide an overview and in-depth study of media and their use in substance use
prevention campaigns
To provide a comprehensive overview of persuasion theory
To facilitate understanding of how to develop theory-based persuasive anti-drug
media campaigns
To provide insight into what makes an effective vs. an ineffective media campaign
To provide a framework for participants to develop and evaluate their own effective
media campaigns to prevent substance use.

Learning objectives
Participants who complete Course 8 will be able to:
Demonstrate understanding of the ways media functions in prevention;
Understand various media theories and their effects at the group or community level;
Discuss and understand ad features that reduce or cause resistance to ad content;
Understand and describe the advantages and shortcomings of various types of persuasive
media: posters, radio, public service announcements, etc.;
Describe the importance of pre-and post-assessments of their audience to determine
campaign effectiveness, including measurement of knowledge, attitudes, norms,
reference groups, prior usage;
Explain targeting (or tailoring) and its importance in campaign design; and
Understand resistance to persuasion, and learn techniques to thwart it.

2
Managers and Supervisors Course 08: Media-Based Prevention Interventions
Training materials
Training materials include:
This Participant Manual. Please be sure to bring your manuals for each session; it has
valuable materials to help you follow along with the program. Sections include:
• Introduction to each module – At the beginning of each module, we will set aside
approximately 5 minutes for you to review this introduction on your own; it will
highlight the content of the module and touch on the major concepts to be covered.
• Training goals and learning objectives for each module
• A timeline
• Power Point slides with lines for taking notes.
• Resource Pages; these pages have information you’ll need for exercises, information
to read later, or exercise instructions.
• Summary of the module expanding on the introduction with citations for future
reference.
• Appendix A – Glossary
• Appendix B – Resources
Notebook for use as a journal and for making note of ideas you want to return to, later
on. These might include:
• Topics you would like to read more about;
• A principle you would like to think more about;
• Ways you might be able to add some of the ways you are learning to your practice;
• Possible barriers to implementing new practices;
• Questions you want to ask the trainers before the training ends.
International Standards for Drug Use Prevention – a copy of the PDF saved in a flash
drive for your use and review. This document was produced by the United Nations
Office of Drugs and Crime (UNODC) to serve as a guide for policy-makers on the
concept of ‘evidence-based’ prevention interventions and policies. This publication
also serves as the basic foundation of this curriculum series, which is designed to
help prevention practitioners put into practice the knowledge gleaned from more
than 20 years of prevention research. This document will also help as a resource as we
proceed through this course in understanding prevention science and its implications
for prevention service delivery.

3
Participant Manual: Participant Orientation
The European Drug Prevention Quality Standards is a joint production by the
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the
Prevention Standards Partnership, and presents and describes basic and expert level
quality standards for substance use prevention. The standards cover all aspects of
substance use prevention work, including needs and resource assessment, program
planning, intervention design, resource management, implementation, monitoring and
evaluation, dissemination, sustainability, stakeholder involvement, staff development,
and ethics. Since this is a very large document, it is best to order a free copy directly
from the EMCDDA at URL: http://www.emcdda.europa.eu/publications/manuals/
prevention-standards .

Getting the Most from Your Training Experience

To get the most from your training experience:
If you have a supervisor, speak to him or her before the training begins. Find out what
his or her expectations are for you.
Think about what you want to learn from each module.
Come to each session prepared; review the manual pages for the modules to be
presented—especially the Introduction which sets the stage for the module content.
Be an active participant: Participate in the exercises, ask questions, write in your
journal, and think about what additional information you want to know.
Speak to your supervisor (or co-workers, if you have no supervisor) after the training.
Talk about what you learned to be sure you understand how the information relates
to your job.
Discuss with your supervisor or co-workers ways that you can put your learning into
practice, and continue to follow up on your progress.
Have fun!

4
Managers and Supervisors Course 08: Media-Based Prevention Interventions
U.S. DEPARTMENT OF STATE
MODULE 0

5
-1-

_____________________________________________________________________________

7
Participant Manual: Module 0 —U.S. Department of State
Congratulations!

“ As a participant in this training, you are part of a rapidly

growing global community of substance use professionals

-2-
0.2

How is this global community of substance use

professionals expanding?
In the last decade, a growing number of people are:
 being trained
 being credentialed
 studying at universities with specialized addiction
programs
 operating in the context of a larger drug control
system
 adhering to science and research-based approaches
 joining professional substance use associations
 networking through professional associations

-3-
0.3

8
Managers and Supervisors Course 08: Media-Based Prevention Interventions
Who are the members of this global community of
substance use professionals?

Individuals working worldwide in the substance

use prevention and treatment fields in
government, non-governmental organizations,
civil society, and the private sector

Organizations that act as portals or

“doorways” for individuals to join the
global community

-4-
0.4

_____________________________________________________________________________

9
Participant Manual: Module 0 —U.S. Department of State
ISSUP stands for the International Society of Substance
Use Professionals
 ISSUP was launched by INL in 2015 as a global, not for
profit, non-governmental organization to
professionalize the global prevention and treatment
workforce.
 ISSUP provides members with opportunities to share
knowledge, exchange experiences, and stay abreast
with current research in the field

Cont.
-5-
0.5

ISSUP stands for the International Society of Substance Use

Professionals

 There are more than 10,000

ISSUP members worldwide
 Join one of ISSUPs four levels
of membership for free at:
www.issup.net
 You can earn credit for this
and other courses with ISSUP

-6-
0.6

10
Managers and Supervisors Course 08: Media-Based Prevention Interventions
ICUDDR stands for the International Consortium of
Universities for Drug Demand Reduction
 Global consortium of universities to promote academic
programs that focus on science-based prevention and
treatment
 Collaborative forum for individuals and organizations to
support and share curricula, particularly this Universal
Curriculum series, and experiences in the teaching and
training of prevention and treatment knowledge

Cont.
-7-
0.7

_____________________________________________________________________________

11
Participant Manual: Module 0 —U.S. Department of State
ICUDDR stands for the International Consortium of Universities
for Drug Demand Reduction

Learn about specialized addiction programs at universities

worldwide at www.icuddr.com

-8-
0.8

GCCC stands for the Global Centre for Credentialing and

Certification of Addiction Professionals
 The hours that you put into this training can be logged
at GCCC and qualify you for exams and professional
credentials
 GCCC credentials will help accelerate your career by
indicating your passion and commitment to high
standards

Cont.
-9-
0.9

12
Managers and Supervisors Course 08: Media-Based Prevention Interventions
GCCC stands for the Global Centre for Credentialing and
Certification of Addiction Professionals

Learn about how to apply the latest in research-based

prevention and treatment at: www.globalccc.org
-10-
0.10

_____________________________________________________________________________

13
Participant Manual: Module 0 —U.S. Department of State
Who funds and supports this
global community of substance
use professionals?
The U.S. Department of State’s
Bureau of International Narcotics
and Law Enforcement Affairs (INL)
which is funded by the U.S. taxpayer

-11-
0.11

Where does this global community of substance use

professionals meet?
 Digitally- through ISSUP and its networks and
 Face to face – through trainings, on university campus
settings, and at conferences held at the global, national
regional and local levels

-12-
0.12

14
Managers and Supervisors Course 08: Media-Based Prevention Interventions
How does this global community of substance use
professionals operate?
In the context of a larger international drug control
environment that includes:
 United Nation’s three international Drug Control
Treaties or “Conventions”
 Commission on Narcotic Drugs (CND)
 International Narcotics Control Board (INCB)

-13-
0.13

_____________________________________________________________________________

15
Participant Manual: Module 0 —U.S. Department of State
What are the key international organizations which operate
in the context of this larger drug control environment?

The Colombo Plan Drug Advisory Program (DAP)

The Inter-American Drug Abuse Control
Commission (CICAD) of the Organization of
American States (OAS)

The African Union Commission (AUC)

The United Nations Office on Drugs and Crime

(UNODC)

The World Health Organization (WHO)

-14-
0.14

How can I participate in this global community of substance use

professionals?
The easiest way is to become an active member of ISSUP!
 Register for free on the ISSUP website at www.issup.net
 Click on the “Apply for Membership” icon
 Select one of four levels of membership -all are free!
 Begin networking with others on an ongoing basis
It takes only a few minutes to register and you can immediately
connect with over 10,000 ISSUP members worldwide!

-15-
0.15

16
Managers and Supervisors Course 08: Media-Based Prevention Interventions
What are the benefits of being an active member of this
global community of substance use professionals?
You can:
 Stay informed
 Implement best practices
 Access training and mentoring
 Turn training into credentials
 Access job postings
 Access up-to-date research
 Join a professional network
 Interact with other professional networks

-16-
0.16

_____________________________________________________________________________

17
Participant Manual: Module 0 —U.S. Department of State
CALL TO ACTION
Next Steps Participate in ISSUP
1. Join ISSUP at  Post on ISSUP: Find easy
www.issup.net instructions for how to
2. Complete this training to post on the ISSUP website
earn credit  Engage ISSUP’s Networks:
3. Send your credit hours to Connect with colleagues
GCCC at www.globalccc.org and broaden your impact

-17-
0.17

_____________________________________________________________________________

18
Managers and Supervisors Course 08: Media-Based Prevention Interventions
MODULE 1
TRAINING INTRODUCTION

Content and timeline........................................................................................21

Training goals and learning objectives............................................................21
PowerPoint slides..............................................................................................22
Resource page...................................................................................................45
Summary.............................................................................................................50

19
Content and Timeline
Person
Activity Time
Responsible
Module 0 30 minutes
Ceremonial Welcome 30 minutes
Trainer welcome, housekeeping, and ground rules 15 minutes
Partner exercise: Introductions 60 minutes
Break 15 minutes
Presentation: Training materials 15 minutes
Why this training? 15 minutes
Large-group exercise: Training expectations 15 minutes
Large-group discussion: Examples of persuasion media 15 minutes
Small-group exercise: Substance use problems for
45 minutes
media interventions
Lunch 60 minutes

Module 1 Objectives
Learning objectives
Participants who complete Module 1 will be able to:
Explain the overall training goals and at least four objectives of the 3-day training;
State at least one personal learning goal; and
Briefly describe how persuasive media in advertising over the years influenced smoking
and other substance use.

21
Participant Manual: Module 1—Training Introduction
The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and
Managers and Supervisors
Supervisors
Course 08
Course 07
Media-Based
Prevention Interventions

MODULE 1—TRAINING INTRODUCTION

1.1

Learning Objectives

 Make a persuasive case of why it is important to

integrate substance use prevention strategies into
school settings
 Describe the importance, and provide examples, of
matching prevention strategies to students’
developmental stages
 Specify the nature and progression of youths’ use of
substances
 Specify five examples each of effective and ineffective
prevention practice in school settings
 State at least one personal learning goal
1.2

22
Managers and Supervisors Course 08: Media-Based Prevention Interventions
Partner Exercise: Introduction

 What is your name?

 What is your job title? What does your job
entail?

1.3

_____________________________________________________________________________

23
Participant Manual: Module 1—Training Introduction
Training Materials

 Master Agenda
 ParticipantManual
 Power Point slides
 Notebook for a journal
 UNODC International Standards on Drug Use
Prevention
 European Drug Prevention Quality Standards
(To be ordered)

1.4

Substance Use World-Wide

 The United Nations Office on Drugs and Crime

(UNODC) reports that, in 2018, about 275
million people between ages 15 and 64 used
illicit substances at least once
 Of those who use psychoactive substances,
31 million have substance use problems

1.5

24
Managers and Supervisors Course 08: Media-Based Prevention Interventions
Prevalence of Substance Use (18-29 Year
Olds)

Country Tobacco Alcohol T&A Cannabis Other drugs Other Drugs

W/Cannabis Initiations
Colombia 49.1 96.1 96.8 14.4 7.2 42.2

Mexico 64.4 91.5 92.1 11.5 9.6 58.3

USA 74.4 96.2 96.0 57.6 27.3 12.6

Belgium − 88.4 88.4 31.0 10.2 8.7

France − 94.5 94.5 52.9 11.0 21.7

Italy − 79.6 79.6 17.4 1.1 27.0

Netherlands − 92.6 92.6 38.9 15.5 40.7

Ukraine 81.1 99.7 99.4 15.2 2.6 32.1

Nigeria 9.0 62.1 63.1 3.1 0.4 93.1

South Africa 33.1 45.5 52.0 12.7 3.0 51.1

China 49.3 78.7 84.0 1.4 0.6 −

Japan − 97.2 97.2 4.5 4.8 77.3

New Zealand − 95.4 95.4 63.0 23.6 7.0

Degenhardt et al., 2010

1.6

_____________________________________________________________________________

25
Participant Manual: Module 1—Training Introduction
Why is Prevention of Health and Social
Problems Important for any Nation?

 Health is linked to:

 Rising incomes
 Increased productivity
 Children’s education
 Adult well-being

1.7

Why is Substance Use Prevention

Important?

 The primary objective of substance use prevention

is to help people, particularly young people, avoid or
delay the initiation of the use of psychoactive
substances, or, if they have started already, to avoid
the development of disorders (e.g. dependence).
 The general aim of substance use prevention is
much broader, the healthy and safe development of
children and youth to realize their potential and
become contributing members of their community
and society.

1.8

26
Managers and Supervisors Course 08: Media-Based Prevention Interventions
Managers and Supervisors : The Face of
Prevention

Managers and Supervisors:

 Translate prevention
science for policy-makers,
decision-makers and major
stakeholders, and the public
 Apply their understanding of
prevention science to
promote the quality delivery
of evidence-based
prevention programming
1.9

_____________________________________________________________________________

27
Participant Manual: Module 1—Training Introduction
Training Series Goal

 Toreduce the significant health, social, and

economic problems associated with substance
use throughout the world by:
 Building international prevention capacity through
training, professionalizing, and expanding the
substance use prevention workforce.

1.10

Overarching Themes (1/2)

 Substance use inclusion: Tobacco & alcohol,

illegal drugs, inhalants and the non-medical use
of Rx drugs
 The “science of prevention” and how it can
provide effective interventions for families,
schools, workplace and communities
 Evidence-based (EB) interventions and policies
and how to use them

1.11

28
Managers and Supervisors Course 08: Media-Based Prevention Interventions
Overarching Themes (2/2)

 Developmental nature of substance use

 The Etiology Model: Substance use is a result of
interactions between environmental factors and
the characteristics of individuals
 Prevention professionals need to be “expert” in a
multiple of disciplines
 Emphasis on the skills to convene stakeholders,
analyze data, and implement, monitor, and
evaluate outcomes
1.12

_____________________________________________________________________________

29
Participant Manual: Module 1—Training Introduction
Curricula in the Series

 Course 01: Introduction to Prevention Science

(5 days)
 Foundational and basic knowledge, not skills-based
 Overview of the science that underlies evidence-
based prevention interventions and strategies and
the application of these effective approaches in
prevention practice

1.13

Curricula in the Series

 Course 02: Physiology and Pharmacology for

Prevention Professionals (3 days)
 Foundational and basic knowledge, not skills-based
 Overview of the physiology and pharmacology of
psychoactive substances and their effects on the
brain to affect mood, cognition, and behavior and
the consequences of such use on the individual, the
family, and the community

1.14

30
Managers and Supervisors Course 08: Media-Based Prevention Interventions
Curricula in the Series

 Course 03: Monitoring and Evaluation of

Prevention Interventions and Policies (5 days)
 Skills-based
 Describes the primary evaluation methods used to
measure evidence-based drug use prevention
interventions; provides guidance in applying them
to “real-world” settings

1.15

_____________________________________________________________________________

31
Participant Manual: Module 1—Training Introduction
Curricula in the Series

 Managers and Supervisors Course 04 : Family-

Based Prevention Interventions (4 days)
 Foundational and basic knowledge, not skills-based
 Overview of the family as the primary socialization
agent of children, the science behind family-based
prevention interventions, and the application of such
evidence-based approaches to help prevent the
onset of substance use in children

1.16

Curricula in the Series

 Managers and Supervisors Course 05 : School-

Based Prevention Interventions (6 days)
 Foundational and basic knowledge, not skills-based
 Overview of the school in society, the science
behind school-based prevention interventions, and
the application of such evidence-based approaches
in school settings around the world

1.17

32
Managers and Supervisors Course 08: Media-Based Prevention Interventions
Curricula in the Series

 Managers and Supervisors Course 06 :

Workplace-Based Prevention Interventions
(4 days)
 Foundational and basic knowledge, not skills-based
 Overviews the role of work and the workplace in
society, how stresses and other work-related
influences affect people’s risk of substance use, the
science behind workplace prevention interventions,
and the application of such evidence-based
approaches in work settings around the world

1.18

_____________________________________________________________________________

33
Participant Manual: Module 1—Training Introduction
Curricula in the Series

 Managers and Supervisors Course 07 :

Environment-Based Prevention Interventions
(3 days)
 Foundational and basic knowledge; and
skills-based
 Overviews the science underlying evidence-based
drug use prevention environmental interventions
involving policy and community-wide strategies

1.19

Curricula in the Series

 Managers and Supervisors Course 08 : Media-

Based Prevention Interventions (3 days)
 Foundational and basic knowledge; and
skills-based
 Overviews the science underlying the use of media
for substance use prevention interventions

1.20

34
Managers and Supervisors Course 08: Media-Based Prevention Interventions
Curricula in the Series

 Managers and Supervisors Course 09 :

Community-Based Prevention Implementation
Systems (5 days)
 Foundational, and skills-based
 Overviews the science underlying systems
approaches to prevention interventions; presents
exemplars of evidence-based drug use prevention
systems; and provides guidance on developing
such approaches

1.21

_____________________________________________________________________________

35
Participant Manual: Module 1—Training Introduction
Learning Objectives

 Demonstrate understanding of the ways media function in prevention

 Understand various media theories and their effects at the group or
community level
 Discuss and understand ad features that reduce or cause resistance to
ad content
 Understand and describe the advantages and shortcomings of various
types of persuasive media: posters, radio, public service
announcements, etc.
 Describe the importance of pre-and post-assessments of their audience
to determine campaign effectiveness, including measurement of
knowledge, attitudes, norms, reference groups, prior usage
 Explain targeting (or tailoring) and its importance in campaign design
 Understand resistance to persuasion, and learn techniques to thwart it

1.22

Large-group Exercise: Training

Expectations

 Write two training expectations on your

remaining index card

1.23

36
Managers and Supervisors Course 08: Media-Based Prevention Interventions
Large-group Discussion

Examples of persuasion media

and substance use problems

1.24

_____________________________________________________________________________

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Participant Manual: Module 1—Training Introduction
1.25

1.26

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
1.27

_____________________________________________________________________________

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Participant Manual: Module 1—Training Introduction
1.28

1.29

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
1.30

_____________________________________________________________________________

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Participant Manual: Module 1—Training Introduction
1.31

1.32

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
1.33

_____________________________________________________________________________

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Participant Manual: Module 1—Training Introduction
1.34

Small-group exercise: Substance use

problems for media interventions

 Type of substance involved

 Who is the prime target for the intervention
 What type of intervention might you propose

1.35

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Resource Page 1.1: Colombo Plan Drug Advisory Programme
(DAP) Training Series, Universal Prevention Curriculum for
Substance Use (UPC) Managers and Supervisors Series

Course 1: Introduction to Prevention Science (5 days)

Foundational and basic knowledge; and
Overviews the science that underlies evidence-based prevention interventions and
strategies and the application of these effective approaches in prevention practice.
Course 2: Physiology and Pharmacology for Prevention Professionals (3 days)
Foundational and basic knowledge, not skills-based; and
Overview of the physiology and pharmacology of psychoactive substances and their
effects on the brain to affect mood, cognition, and behavior, and the consequences
of such use on the individual, the family, and the community.
Course 3: Monitoring and Evaluation of Prevention Interventions and Policies (5 days)
Skills-based; and
Describes the primary evaluation methods used to measure evidence-based substance
use prevention interventions; provides guidance in applying them to “real-world”
prevention settings.
Managers and Supervisors Course 04: Family-based Prevention Interventions (4 days)
Foundational and basic knowledge; and
Overviews the family as the primary socialization agent of children, the science behind
family-based prevention interventions, and the application of such evidence-based
approaches to help prevent the onset of substance use in children.
Managers and Supervisors Course 05: School-based Prevention Interventions (6 days)
Foundational and basic knowledge; and
Overviews the school in society, the science behind school-based prevention
interventions, and the application of such evidence-based approaches in school
settings around the world.
Managers and Supervisors Course 06: Workplace-based Prevention Interventions (4 days)
Foundational and basic knowledge; and
Overviews the role of work and the workplace in society, how stresses and other work-
related influences affect people’s risk of substance use, the science behind workplace
prevention interventions, and the application of such evidence-based approaches in
work settings around the world.

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Participant Manual: Module 1—Training Introduction
Managers and Supervisors Course 07: Environment-based Prevention Interventions (3
days)
Foundational and basic knowledge; and skills-based; and
Overviews the science underlying evidence-based substance use prevention
environmental interventions, involving policy and community-wide strategies.
Managers and Supervisors Course 08: Media-based Prevention Interventions (3 days)
Foundational and basic knowledge; and skills-based; and
Overviews the science underlying the use of media for substance use prevention
interventions.
Managers and Supervisors Course 09: Community-based Prevention Implementation
Systems (5 days)
Foundational and skills-based; and
Overviews the science underlying systems approach to prevention interventions;
presents exemplars of evidence-based substance use prevention systems; and
provides guidance on developing such approaches.

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Resource Page 1.2: Overarching Themes of the Universal
Prevention Curriculum for Substance Use (UPC) Managers
and Supervisors Series

There are several significant themes that need to be stressed throughout the UPC series.
The first is the definition of substance use, which includes the use of tobacco and alcohol
(which are usually illegal for children), the illegal drugs of abuse, inhalants and the non-
medical use of prescription medications.
Another theme is the science of prevention, which has shown how substance use has
affected individuals, families, schools, communities, and countries; and how it can be
addressed with effective strategies, policies and interventions. This is likely to be a new
concept for most of the participants in your training. That is one of the reasons why the
United Nations Office on Drugs and Crime conducted a thorough review of prevention
science to identify the most effective approaches to prevention that can have the strongest
impact on the population.
Those effective interventions, also known as evidence-based (EB) prevention
interventions and policies, are now available for implementation. This training is
designed to help prevention practitioners select those interventions and policies that
most likely address community need, implement these interventions and policies, and
monitor the quality of the implementation and the outcomes for the participants.
The science has also explained the developmental nature of substance use and similar
behavioral problems. This requires an understanding of how to intervene at various ages,
starting with very young children, progressing through the more vulnerable teenage and
young adult years, and continuing throughout the lifespan.
Another theme is that substance use and other problem behaviors are generally the
result of negative interactions between environmental factors and the characteristics
of individuals. EB prevention practices are designed to positively intervene in these
different environments—e.g., the family, school, workplace, and community-wide. That is
why we are producing curricula designed to assist prevention professionals in all of these
settings.
Trained prevention professionals also need to be knowledgeable in a wide range
of disciplines, including epidemiology, pharmacology, psychology, counseling, and
education. They will learn how to apply these skills to assess the nature and extent
of substance use in their area, identify the populations most at-risk, and select which
interventions are needed to make a difference.
They will also learn how to bring people together, analyze data, persuade stakeholders
of the value of EB programs and policies, and implement, monitor, and evaluate the
outcomes of these EB efforts.
THE OVERALL CURRICULUM SERIES THEME IS TO CREATE LEADERS IN EVIDENCE-
BASED PREVENTION IN COUNTRIES AROUND THE WORLD.

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Participant Manual: Module 1—Training Introduction
Resource Page 1.3: U. S. Society for Prevention Research:
Principles of Prevention Science

Developmental focus, which means that, as prevention professionals, we need to

understand that there are variations in the factors that influence behaviors as they
occur over the life course. It also means that, in any society, there are developmental
or age-related tasks that need to be accomplished as children grow. Any disruption of
the accomplishment of these tasks may lead to the occurrence of disorders or problem
behaviors at certain stages of development. All of this needs to be considered as we
look at potential prevention interventions we want to use in our efforts to prevent the
onset of drug use and its consequences.
Developmental epidemiology of the target population plays a critical role in
prevention. We recognize how transitions through different ages place children
at varying risks—e.g., a child’s transition from spending most of the time at home
and with caretakers, to spending most of the time in school. But we also need to
acknowledge the differences in factors related to the use of psychoactive substances
and outcomes within and across populations, this means that the factors or processes
leading to initiate substance use and to continue use vary across individuals, groups,
and populations. Such heterogeneity is critical to understanding risk variations in
processes and mechanisms that are reflected in intervention design.
Transactional ecological factors refer to the various environmental influences on
our beliefs, values and attitudes and behaviors. This includes the interaction of the
characteristics of the individual, family, school, community, and the larger socio-
political and physical environments. These interactions not only influence our beliefs,
attitudes, and behavior, but also are interdependent, affecting each other. Within
this overall framework, prevention science draws from a wide range of theories that
explain the dynamics of human development and behavior.
Human motivation and change processes focuses on human motivation and change
processes. Understanding these processes helps design effective interventions which
seek change in individuals and environments to prevent or treat substance use. Many
factors play a role in influencing behaviors and impacting decision-making, including
deciding not to use psychoactive substances or engage in other high-risk behaviors.
The transdisciplinary nature of prevention science means that we need to involve
transdisciplinary teams with an array of expertise to address the complexity of the
issues addressed by prevention science. This expertise includes understanding the
etiology of a range of problem behaviors; intervention development and practice
expertise; knowledge of research design, sampling and data collection and analysis,
as well as understanding program and policy implementation and analysis.
Professional ethical standards are based on values. Values are the basic beliefs that an
individual thinks to be true and are also seen as guiding principles in one’s life or the
bases on which an individual makes a decision. Clearly, the work of prevention involves
decisions, in regards to the treatment of others, in the most important settings of their

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
lives—family, school and workplace. But it also involves the community environment
where policies and laws dictate legal and illegal behavior. The prevention practitioner
needs to be guided by ethics and values that can help in these challenging areas of
life. We will go into detail about professional ethics in prevention in Module 6, but
these guide all aspects of prevention science.
Continuous feedback between theoretical and empirical investigations seeks to
explain the mechanisms that account for a behavioral outcome discovered through
empirical epidemiological investigations or evaluations of prevention interventions.
Improving public health is a vision that prevention science can serve through the
collaborative work of prevention scientists and community prevention practitioners
using their collective skills and particular expertise. Science, practice and policy must
be mutually informed by research in controlled and natural settings.
Social Justice is related to the Human Rights Movement and the Health as a Right
Movement. Social Justice is the ethical and moral imperative to understand why
certain population subgroups have a disproportionate burden of disease, disability,
and death, and to design and implement prevention programs and systems and policy
changes to address the root causes of inequities.

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Participant Manual: Module 1—Training Introduction
Summary of Module 1: Training Introduction
Global substance use problem
Psychoactive substance use and substance use disorders (SUDs) continue to be major
problems around the world, taking a toll on global health and on social and economic
functioning. The United Nations Office on Drugs and Crime (UNODC) reports that, in
2012, 162 to 324 million people between ages 15 and 64 used illicit substances at least
once. Of these about 10-14% will develop substance use problems.
Illicit substances in the survey included opioids, cannabis, cocaine, other amphetamine-
type stimulants, hallucinogens, and ecstasy, among others.
In addition, the World Health Organization (WHO) estimates that there are 2 billion
alcohol users and 1.3 billion smokers. Tobacco use and alcohol use are the second and
eighth leading causes of death and third and sixth leading causes of years of life lost due
to premature death and to disability. WHO also estimates that approximately 12% of all
deaths are attributable to tobacco and alcohol use. In addition to deaths, the number of
years of life lost due to premature mortality (early death) and due to living with disability
(called Disability Adjusted Life Years-DALYs) amount to 8% of total years of life lost
attributable to tobacco and alcohol use.
Substance use varies across the world. A study conducted internationally by a team
of epidemiologists with support from the World Health Organization found that most
countries have high rates of combined alcohol and tobacco use among 18-29 year olds.
The use of cannabis and other drugs varied across the world with New Zealand and the
USA leading with 87% and 85%, respectively and China and Japan reporting the lowest
rates of 2% and 9%, respectively.
We also know that the number of Disability-Adjusted Life Years varies by substance across
the world. Europe leads in DALYs for tobacco and alcohol, with the Eastern Mediterranean
countries and Africa having the lowest DALYs for these substances.

Why is prevention important?

There is growing recognition that health not only has a direct impact on human welfare, but
also is related to raising income levels through: worker productivity, children’s education,
savings and investment, demographic structure.
Substance use prevention stops people from beginning to use drugs and other
psychoactive substances, and can help those who have started to avoid progressing
to substance abuse and substance use disorders. But substance use prevention has a
broader intent: the healthy and safe development of children and youth to realize their
talents and potential. It does this by helping them positively engage with families, schools,
peers, workplace and communities.
But prevention has to work if it is to help. And that only happens if evidence-based
substance use prevention interventions and policies are implemented. What we mean
is, we are taking what we have learned in research to apply it in the “real-world” of

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
communities so we can be more successful in preventing problem behaviors that
impede healthy growth.

The training series

This course is part of a training series developed through funding from the U.S. Department
of State to The Colombo Plan for the Drug Advisory Programme (DAP). The overall goal of
the training series is to reduce the health, social, and economic problems associated with
substance use by building international prevention capacity through training about the
most effective evidence-based prevention interventions and strategies, professionalizing
the prevention coordinator and specialist standards, and expanding the global prevention
workforce. This curriculum series focuses on applying the key findings reported in the
International Standards for Drug Use Prevention to “real-world” communities around the
globe.

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Participant Manual: Module 1—Training Introduction
MODULE 2
INTRODUCTION TO MEDIA AND THEIR USE IN PREVENTION

Content and timeline........................................................................................55

Training goals and learning objectives............................................................55
Introduction to Module 2..................................................................................56
PowerPoint slides..............................................................................................58
Resource page...................................................................................................84
Summary.............................................................................................................86

53
Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 2 15 minutes
Presentation: Why use the media in substance use
15 minutes
prevention
Presentation and discussion: UNODC International
15 minutes
Standards on Drug Use Prevention: Media Campaigns
Presentation and discussion: Three successful
15 minutes
campaigns
Presentation and discussion: Research on past
30 minutes
campaigns: What works/what doesn’t work
Break 15 minutes
Large-group discussion: Scare tactics almost always
15 minutes
fail
Large-group discussion: Why do they fail? 20 minutes
Small-group exercise: Revising the ads 45 minutes
Summary and reflections 10 minutes
Reflections, Wrap-up and Module 2 evaluation 15 minutes
End of Day 1

Module 2 Objectives
Learning objectives
Participants who complete Module 2 will be able to:
Explain how the media can be used, and their proper function, in prevention campaigns;
Differentiate characteristics of successful vs. failed campaigns; and
Articulate the positive and negative features of various ads.

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
Introduction to Module 2
Mass media campaigns are often considered by policy-makers to be a “silver bullet” of
substance use prevention. The following are some of the reasons why:
Economy and reach: Media can be an economical and rapid way to reach a lot of
people.
Ability to target the audience: The use of the media by specific target audiences
means you can develop materials for that medium and reach that audience—e.g.,
using radio ads to reach long-haul truckers.
Rapid response: Easy to develop and place a message for addressing a serious
problem—alerting the public of a dangerous new drug on the “street.”
Influence opinion leaders: You can easily reach and influence decision- and policy-
makers through the media.
Affect the prevention agenda: Media alone can be effective; but can have greater
impact when combined with other evidence-based interventions.
You will also hear about the negative influences of media relating to the advertising of
cigarettes, for example, that contributed to the rise of smoking around the world. The
focus of this course is to understand how media can work positively to effectively prevent
substance use.
The following definitions will help you in this course:
Media: In this module, media means any form of mass communication, involving
television, radio, magazines, etc.
Communication (or Message): A communication is the message that is broadcast by
the media; if designed well, the message received by the audience is the same as the
intent of the message sent.
Messaging: This is the process by which the persuasive communication is developed.
Messaging is concerned with the persuasive components used to influence people’s
beliefs and actions.
Exposure: Also known as media reach – the extent to which the communication
reaches the intended audience.
Campaign: Involves a coordinated series of persuasive communications.
Media-based Prevention: The use of the mass media, usually through coordinated
campaigns, to prevent the initiation of substance use.
Module 2 will also provide an overview of the media-related recommendations offered by
the International Standards on Drug Use Prevention, which include some of the following
areas: audience targeting, theoretical foundation for the campaign, formative research
for message development, the use of the media with other evidence-based interventions,
to name a few.

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Three successful campaigns will be described as examples of well-designed and effective
media-based interventions. The module will also summarize common features of what
works in campaigns; and what doesn’t work. One general example of this is that highly
disturbing ads do not work because audiences often avoid punishing or unpleasant
media.

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and
Managers and Supervisors
Supervisors
Course 08
Course 07
Media-Based
Prevention Interventions

MODULE 2—INTRODUCTION TO MEDIA AND

THEIR USE IN PREVENTION

2.1

Introduction

2.2

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Learning Objectives

 Understand and explain how the media can be

used, and their proper function, in prevention
campaigns
 Understand how to differentiate characteristics
of successful vs. failed campaigns
 Understand and articulate the positive and
negative features of various ads

2.3

_____________________________________________________________________________

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
Why Use the Media in
Substance Use Prevention

2.4

Why Use the Media in Substance Use

Prevention Interventions?

 Economy and reach

 Ability to target
 Rapid response
 Can generate excitement and interest
 Influence opinion leaders
 Affect the prevention agenda in schools and the
community
 Cost-effective, if done properly

2.5

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Prevalence (%) of current smoking among adults aged
18 years or older in the greater Milwaukee area and in
the general U.S. population, by gender, 1935-1979

2.6

_____________________________________________________________________________

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
A More Fine-Grained Consideration of
Recent Smoking Rates for Men and Women

2.7

UNODC International
Standards on Drug Use
Prevention:
Media Campaigns

2.8

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Defining Terms

 Media
 Communication (or message)
 Messaging
 Exposure
 Campaign
 Media-Based prevention

2.9

_____________________________________________________________________________

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
UNODC International Standards on Drug
Use Prevention: Media Campaigns (1/4)

“Media campaigns are often the first and/or only

intervention delivered by policy makers concerned
with preventing the use of drugs in a population,
as they are visible and have the potential to reach
a large number of people relatively easily.”

UNODC (2013). International Standards on Drug Use Prevention. p. 32. 2.10

UNODC International Standards on Drug

Use Prevention: Media Campaigns (2/4)

Available evidence
 Three good reviews and three acceptable reviews,
reported findings with regard to this intervention
 According to these studies, media campaigns, in
combination with other prevention components, can
prevent tobacco use (reporting median reduction of
2.4%)
 However, no significant findings were reported for
alcohol abuse, and only weak findings with regard to
drug use
UNODC (2013). International Standards on Drug Use Prevention. pp. 32-33. 2.11

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
UNODC International Standards on Drug
Use Prevention: Media Campaigns (3/4)

Characteristics associated with positive prevention

outcomes:
 Precisely identify the target group of the campaign
 Based on a solid theoretical basis
 Design messages based on strong formative
research
 Strongly connect to other existing drug prevention
programs in the home, school, and community
 Achieve adequate exposure of the target group for
an adequate period of time
2.12

_____________________________________________________________________________

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
UNODC International Standards on Drug
Use Prevention: Media Campaigns (4/4)

 Systematically evaluated, including throughout

the campaign to adjust messages for maximal
effect
 Target parents, as this appears to have an
independent effect also on the children
 Aim at changing cultural norms about substance
use and/or educating about the consequences
of substance use and/or suggesting strategies to
resist substance use

2.13

Three Successful Media

Campaigns

2.14

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Three Successful Media Campaigns

These campaigns resulted in community wide

changes:
 Minnesota Heart Health Program
 Florida’s Truth Campaign (anti-tobacco use)
 Above the Influence – anti-drug use (youth)

2.15

_____________________________________________________________________________

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
Minnesota Heart Health Program

 Used epidemiological data to support the

dangers of smoking
 Community-based campaign
 Community response: Laws on sales and use
 Combined media with other prevention activities
 Increased knowledge of the relationship
between smoking and heart disease

2.16

Florida’s Truth Campaign

 Targeted adolescents and smoking

 Emphasized the hypocrisy of selling tobacco
products– how can the leaders of a company
say they care about their customers when they
sell a product known to be dangerous to health?
 Focused on smoking as a form of conformity not
rebellion
 Emphasized manipulation on the parts of
tobacco companies and adults
2.17

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Above the Influence

 Targeted adolescents
 Used reason to persuade
 Provides opportunities for adolescents to
interact with other adolescents through
Facebook and other social networking
 Incorporated community-based prevention
programming

2.18

_____________________________________________________________________________

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
Research on Past
Campaigns:
What Works/
What Doesn’t Work

2.19

Research on Past Successful Campaigns

Leads to These Conclusions

Successful media campaigns were:

 Always based on established theories of
persuasion
 They usually used subtle appeals (vs. extreme
threats/language)
 When adolescents were the target of the
campaign, the ads often appealed to parents, or
were associated with parental monitoring
 Successful campaigns sometimes involved larger
efforts, including school & community
2.20

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
A Poster From “The Truth” Campaign, Which
Was Designed To Deter Adolescent Tobacco Use

 We ♥ Smokers
 Heck, we love everybody. Our
philosophy isn’t anti-smoker or
pro-smoker. It’s not even about
smoking. It’s about the tobacco
industry manipulating their
products, research and
advertising to secure
replacements for the 1,200
customers they “lose” every
day in America. You know,
because they die.
2.21

_____________________________________________________________________________

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
More From “The Truth” Campaign:
Humor and Irony Often Succeed

2.22

Success of Florida’s Anti-Smoking “The

Truth” Campaign (1/2)

2.23

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Success of Florida’s Anti-Smoking “The
Truth” Campaign (2/2)

2.24

_____________________________________________________________________________

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
Lessons from “The Truth” Campaign
Outcome

 Lack of threat in these messages

 Stressed the manipulative intent of the tobacco
industry
 Targeted to a group exceptionally sensitive to
manipulation – young adolescents, who are
vulnerable to the slick marketing efforts of “Big
Tobacco.”
 Messages were humorous, ironic, and sarcastic

2.25

“Above the Influence” Campaign Ad

Branding
arrow
appears on
all ATI ads

2.26

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
“Above the Influence” Campaign: Revision
of a Prior Failure

 Above the Influence used a normative approach

to
 Stress the infrequency of substance misuse
 Bolster refusal skills
 Persuade nonusers that they are the majority of
their peer group
 Like “The Truth,” this campaign avoided use of
fear to control behavior

2.27

_____________________________________________________________________________

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
“Above The Influence” Ad Appealing to
Teen’s Need for Independence

2.28

Why Did These Campaigns Have a Good

Effect?

 Reinforced positive behavior

 Encouraged youth to seek out social support
 Did not attempt to frighten youth into abstinence,
but pointed out bad effects
 Used a measured tone to suggest that the
message receiver is a reasonable adult, and
should make reasonable decisions

2.29

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Two Ads That Did Not Work Well

2.30

_____________________________________________________________________________

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
Anti-Methamphetamine Ad Designed to
Frighten Potential Users

2.31

Large-group Discussion

 Scaretactics almost always fail

 Why do you think this is so?

2.32

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Highly Disturbing Ads Often Fail

2.33

_____________________________________________________________________________

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
Large-group Exercise

 Why did these ads fail?

 How did they differ from the earlier ones?
 If they do succeed, who will they influence?
 Whom will they fail to influence?

2.34

Small-group Exercise: Revising the Ads

 Think about the prevention ads presented

earlier. Reflect on our discussion of the kinds of
ads that succeed and those that failed
 Your job:
 You will be assigned one of the ads we’ve reviewed
 Revise the ad you’re given to make it more effective
 Be ready to tell us why it is better than the original
 Remember to consider who your audience is
 Choose the approach
 Be ready to tell us why this ad will succeed
2.35

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Summary of Module 2 (1/2)

 Successful ads were designed to put you in a

positive frame of mind, not disgusted or afraid
 They linked their message with positive
emotional responses
 They did not, as a rule, try to scare anyone

2.36

_____________________________________________________________________________

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
Summary of Module 2 (2/2)

 Punishing or unpleasant media often are avoided

by the people who need it most, so the money
used to produce such media often are wasted
 It is dangerous to “over-threaten.”
 Ifyou use a very frightening message regarding the
dangers of substance use, and the receiver knows
that most of the time, it’s not true, then the receiver
will often reject everything you say
 Successfulads did not exaggerate the dangers of
substance use
2.37

Large-group Exercise: Reflections

 What information that you learned in this module

is most important for your work as a Prevention
Manager and Supervisor?

 Why?

2.38

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Module 2 Evaluation
2.39

_____________________________________________________________________________

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
Resource Page 2.1

Why use the media in prevention of substance use?

Media can reach large portions of the population, rapidly and efficiently
Media can be adjusted to meet emerging trends
Media can generate interest and excitement
Media can engage the entire community – schools, community leaders, parents,
teachers, etc.
If properly implemented, media can be an efficient and inexpensive method of
disseminating substance use prevention materials
However, the media are not a magic solution to problems of substance use
Media messages must be based on established and empirically validated research
Mere frequency of exposure is not sufficient to create changes in attitudes, intentions,
or behaviors
What are some characteristics of successful media campaigns?
They are systematically evaluated throughout the campaign to adjust messages for
maximal effect.
They frequently target parents, as well as youth
They are consciously designed to affect cultural norms regarding substance use
They often target the entire community, as in the Minnesota Heart Health Campaign
Campaigns designed to influence youth often are designed to appeal to their rejection
of authority and dislike of being manipulated
They almost never “talked-down” to youth
They almost never tried to scare audience members into avoiding substances
They often provided audience members the opportunity to interact with people like
themselves
They often used humor and irony, but never diminished or made light of the importance
of prevention of substance use
They reinforced abstinence, encouraged users to quit, and encouraged audience
members to seek social support if they were having trouble with substance use, or
were considering initiating substance use
They used a measured tone, rather than hyperbolic language to make their point

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
They never exaggerated the problems entailed in substance use – there’s no need to
do so
They did not attempt to present substance use as repulsive – audience members
repulsed by a persuasive message will not be persuaded by it

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
Summary of Module 2: Introduction to Media and
Their Use in Prevention
Why Use the Media in Substance Use Prevention
The mass media have long been considered a “silver bullet” of substance use prevention.
There are several reasons for this.
Economy and reach: A good media campaign can reach a mass audience with
minimal expense – the cost per person reached in a campaign often is extremely low.
Ability to target: A campaign can be timed and broadcast so that the group most in
need of the prevention material (e.g., young adolescents, truckers, homemakers) can
be reached most effectively.
Rapid response: A prevention message can be created rapidly, to meet a rapidly
developing problem – for example, a new drug that is wreaking havoc in the community.
Entertain: If done properly, the media can entertain while still conveying its prevention
message.
Influence opinion leaders: The media can play a role in educating and influencing
opinion leaders.
Affect the prevention agenda: Media alone can be effective, but when combined
with other prevention oriented groups – schools, employers, community leaders – this
is when media-based prevention campaigns have their greatest impact. The media
can be the glue that holds together a multi-level attack on substance use. It can be
used to integrate the efforts of teachers, community leaders, and employers to create
a formidable force against substance use. In fact, that is when media-based prevention
campaigns are most effective.
Cost-effective: As we will see, using media in substance prevention campaigns need
not be extremely expensive. Sometimes, simple posters or flyers put up in public
places can start useful anti-substance use conversations, and help in the substance
prevention effort.
Most of the work cited in this module is based on research performed in North America
and Europe (Noar, 2006). However, the research focuses on fundamental features of
human responses to persuasion and is, thus, likely to hold across cultures.
This is not to suggest that the media are always a force for good. Strong examples of
extremely effective media use to promote unhealthy behaviors, and consequent effects,
are readily available. Some good examples come from epidemiologic data on smoking
trends in the United States before and after public health efforts to use environmental-,
behavioral-, and media-based prevention interventions. These data indicated reductions
in smoking among men and women after the release of the Surgeon General’s report in
1964 on the health effects of smoking. Of course, there were many other factors that might
have affected smoking rates in the US, but there can be little doubt that the mass media

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
played a major role in creating a willing audience for this behavior, and for persuading
this same audience, with a very different message, that this behavior was exceptionally
dangerous to good health.

Definitions
Before we review the science underlying substance use prevention campaigns, we need
to make sure that we understand some important terms.
Media: In this module, media is taken to mean any form of mass communication,
involving television, radio, magazines, newspapers, posters, billboards, and so on.
Almost any form of communication that reaches a mass audience can be viewed as an
example of the mass media.
Communication (or Message): A communication is the message that is broadcast by
the media. It can involve only words (as a text-based poster or a newspaper opinion
column), only pictures (as in a caricature of an unpopular politician), or a combination
of both words and pictures, with or without sound and color. It can be static or involve
movement such as in videos. The communication carries the message that we want
to convey. If it is developed properly, the communication that is delivered, and the
message the audience receives, are the same.
Messaging: This is a somewhat technical term. Messaging is the process by which the
persuasive communication is developed. Messaging is concerned with the persuasive
components used in an attempt to influence people’s beliefs and actions.
Exposure: This term refers to the reach of the media – the extent to which the
communication reaches the intended audience. A communication of high exposure
has been seen or heard or read by a large number of individuals. Ideally, these
individuals are the people who have been defined as most in need of the message.
Campaign: A campaign involves a coordinated series of persuasive communications.
In a good campaign, the effects of the communications that are used build upon one
another to create a greater cumulative effect than any single communication could
achieve. Ideally, the whole (i.e., the effect) of the campaign is greater than the sum of
its parts (i.e., each of the individual communications used in the campaign).
Media-based Prevention: Media-based prevention has to do with the use of the mass
media, usually through coordinated campaigns, to prevent the initiation of substance
use, or to encourage individuals to cease use of a targeted substance.

The Standards
The United Nations Office on Drugs and Crime (UNODC) published the International
Standards on Drug Use Prevention in 2013. The Standards set out evidence-based
prevention interventions and policies based on a rigorous review of the research literature.
Media campaigns were included in the Standards document.
“Media campaigns are often the first and/or only intervention delivered by policy-makers
concerned with preventing the use of drugs in a population, as they are visible and have
the potential to reach a large number of people relatively easily.”

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What is the available evidence in support of media campaigns? The developers of the
International Standards found several reviews of the research literature on the effectiveness
of media campaigns. The strongest findings came from those studies that examined
tobacco use; however, there were no similar findings for alcohol or for other substances.
The reasons for this lack of evidence are mostly based on the challenges of conducting
rigorous evaluations of media campaigns. Even so, despite the limited number of rigorous
evaluations of media campaigns, there is a considerable literature on the factors that
affect the quality and impact of the media on attitudes and behaviors. If substance use
behaviors are affected, at least in part, by users’ attitudes toward the substances they
are using, then the evidence of media effects on prevention is extremely relevant for our
purposes.
An important fact to keep in mind is that research on the issue of persuasion, and how it
relates to influencing various types of behaviors, has been ongoing for the past 50 years.
We therefore have been able to build a great store of empirically based knowledge about
the best ways to persuade, and how to construct persuasive messages that can effectively
impact attitudes and behaviors.
But, unfortunately, many media campaigns do not use this information on effective
persuasive methods. Instead, they rely on top-of-the-head ideas that have no empirical
basis.
The International Standards provide the following list of characteristics of campaigns with
positive outcomes.
1. It is important to precisely identify the target group of the campaign. Communication
research has found that “one size does not fit all.” It is pointless, for example, to
create a strong media campaign designed to encourage substance users to quit if
the audience is composed mostly of non-users. This has happened quite often in
prior campaigns. It is foolish to place an anti-substance ad in a media outlet (say,
a magazine) when the magazine’s audience is mostly women, and the substance is
used mostly by men. So, at a minimum, you must have your audience in mind when
using the media for purposes of substance prevention. Although the use of media to
deliver prevention messages can be quite cost effective, they are very expensive if
their messages are delivered to the wrong audience.
2. Media campaigns should be based on a solid theoretical foundation. There are many
different theories of persuasion, and all of them can prove useful depending upon the
circumstances encountered.
3. Messages should be designed on the basis of strong formative research using the
results of focus groups, key informant interviews, and surveys to help inform the
messages being designed.
4. If possible, media campaigns should connect to other existing drug or substance
use prevention programs in the home, school, and community. Media campaigns
are most effective when they are used as the means to connect with other ongoing
substance use campaigns. Campaigns need to build on and support other, ongoing
interventions.
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5. Adequate exposure of the target group should be achieved for an adequate period
of time. A one-time anti-substance use communication on the radio is practically
guaranteed to have no effect. However, if the communication is played at the right
time so it reaches the desired audience; if it is well-grounded in earlier qualitative
research (focus groups, surveys, etc.); and if the audience is exposed to it sufficiently;
then it has a chance of achieving a good outcome. So we recommend aiming for
maximal exposure, but the content of the persuasive message should change from
time to time to maintain interest in the messages. If the persuasive messages of the
campaign can be designed to reach the target audience at least twice a week, for
3-to-6 weeks, the campaign has a good chance of success.
6. Successful media campaigns are systematically evaluated. It is important that this
assessment continue throughout the campaign to adjust messages for maximal
effect. So, it is important for campaign designers to build in evaluation methods and
monitoring measures using surveys and focus groups to continually gather information
about how the campaign is being received and what changes are needed in message
strategies.
7. Prevention campaigns directed at children should target parents, as this appears
to have an independent effect also on the children. Parents have been found to
be successful communicators to their children in campaigns and in family-based
intervention research.
8. Campaigns should aim at changing cultural norms about substance use and/or
educating their audiences about the consequences of substance use and/or suggesting
strategies to resist substance use. Successful tobacco use prevention campaigns have
shown that they have had a serious influence on smoking norms in populations. We
believe this outcome has had an impact on smoking behaviors. (Brinn et al., 2006;
National Cancer Institute, 2008)

Three Successful Media Campaigns

Over the past 40 years, several successful substance use prevention campaigns have
been evaluated. Three are summarized here:
The Minnesota Heart Health Program (MHHP)
Florida’s Truth Campaign
The Above the Influence Campaign

Minnesota Heart Health Program

The Minnesota Heart Health Program (MHHP) used epidemiological data on cardiovascular
disease to support messages on the dangers of smoking and to increase preventive
behaviors such as physical activity and dietary risk behaviors. The media campaign
on tobacco use was part of the overall prevention campaign that included a variety of
interventions including screening and education of adults, professional education among
the health professions, youth-parent programs in local schools, market and restaurant

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programs, community events and mass media, devised and administered through locally
‘owned’ boards and task forces. The program resulted in strong community responses
and stricter laws regarding the sale and use of tobacco in public places. These findings
underscore the importance of combining media with other prevention activities going on
in the community (schools, the local community, etc.) to amplify prevention effects.
In the MHHP, the campaign was directed to the community as a whole, including
adolescents as well as adults. The success of the campaign was evident throughout the
entire community in terms of increased knowledge of the factors related to heart disease
including smoking. Although adults were the primary targets of the program, and were
the focus of many program evaluations, it is fair to assume that changes stimulated by the
campaign were likely to affect all age groups, as young adolescents are likely to model
the behavior of parents and other significant adults

Florida’s Truth Campaign

Florida’s Truth Campaign targeted adolescent smoking behavior. The campaign centered
on pointing out the hypocrisy of tobacco companies in selling a product that is known to
them to be dangerous to all its users. It used humor and sarcasm, both of which appeal
to adolescents, to sell their anti-smoking message. The Truth Campaign was designed
to persuade youth that smoking cigarettes was not a form of rebellion, but rather a
form of conformity. The campaign showed adolescents how tobacco companies were
manipulating them.
Youth are especially resistant to manipulation by adults, and this campaign used this fact
when designing their persuasive substance use prevention messaging. The campaign was
highly successful. So successful, in fact, that the tobacco companies tried unsuccessfully
to stifle it.
Instead of turning against parents and other authority figures, youth rejected cigarette
company ads as a result of the campaign. The campaign never used “high fear” or
disgust to scare youth from usage. Humor and irony were the tools used most frequently.
By convincing youth that they were being manipulated by the tobacco companies, the
campaign used the universal adolescent spirit of independence to reject tobacco(Dunlop,
2011; Farrelly et al., 2009; Holtgrave et al., 2009; Matthew et al., 2002; Niederdeppe et al.,
2004; Richardson et al., 2010; Sly et al., 2001).

Above the Influence

The Above the Influence campaign also targeted adolescents and used reason, not scare
tactics, to convey persuasive anti-substance use information in a logical and thoughtful
manner. It has proved to be highly successful with teens and has been incorporated into
other community-based prevention programming.
In addition, the campaign provided opportunities for adolescents to interact with other
adolescents through Facebook and other social networking, and incorporated community-
based prevention programming to enhance substance use prevention effects (Crano et
al., 2007; Green& Witte, 2006; Siegel et al., 2008; Skenderian et al., 2008; Witte & Allen,
2000; http://researchnews.osu.edu/archive/aboveinfluence.htm).

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Research on Past Campaigns: What Works/What Doesn’t
Work
What Works
It is instructive to consider the common features of successful interventions. First, it is
important that media Prevention Practitioners take advantage of more than 50 years
of scientific research on persuasion, because it is through persuasion and persuasive
methodologies that the media have their effect. The successful media-based prevention
models:
Always were based on an established behavioral and persuasive communication
theoretical framework that has been validated by considerable prior research (e.g.,
Fishbein, 2000).
They usually used irony and subtle persuasive appeals: They did not use extremely
strong or demanding language; they did not threaten; and they did not demand
compliance. For example, in one of their televised anti-smoking commercials, a singer
croons, “Oh, you don’t need to die from tobacco, sometimes they just cut out your
lung…” The ironic lyric appealed to many young adolescents.
Successful campaigns often appealed to parents or were associated with parental
monitoring while the target of the campaign was really youthful audience members.
(Dishion et al., 2002; Hawkins et al., 1992)
The most successful campaigns were not implemented alone. They were not
designed to do it all themselves. They involved attempts to motivate parents, school
administrators, or the entire community to share the prevention work. This multifaceted
model takes advantage of the mass media’s capacity to motivate and activate larger
sectors of the community. When that is done well, there are often powerful effects
(Buller et al., 2000; Burgoon, 1990; Crano et al., 2008; Hamilton et al., 1990;Witte &
Allen, 2000).

What Doesn’t Work: Highly Disturbing Ads Often Fail

There is research and evidence for why certain ads fail. Some of the reasons include:
They really don’t point to the proper behavior. Telling people to just say “no” does
not work well. Trying to scare people usually does not work well. Promising extreme
outcomes is a mistake – if audience members know people who used a drug without
the promised catastrophic effects, the credibility of the ad is lost, and the next
persuasive attempt is made less likely to succeed.
They are “over the top.” Most youth do not believe horrific pictures of addicted teens.
Such presentations usually prove too extreme, and their presentation does more
harm than good. Such messages generally focus on the negative without providing
any advice about how one should behave to avoid the promised consequences.
Attempting to scare people must be handled with great subtlety. These ads are not
subtle.

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If these ads have any influence, they will have a short-term effect on audience members
who already are resolutely determined not to use illicit or illegal substances. However,
even these people may be repulsed by the ads, so even in this case, no ads would be
better than these ads. (Barden et al., 2002; Barden & Tormala, 2014; Clarkson et al., 2008;
Clarkson et al., 2013; Green & Witte, 2006).

Summary
Successful ads are designed to encourage a positive emotion. They should not make
you feel threatened or depressed or disgusted, because if they do, you will not want to
think about the information contained in the ad. In addition, they should not try to scare
anyone.
Audiences often avoid punishing or unpleasant media. Thus, these types of ads have
no good effects, and the money used in their production is wasted. Furthermore,
failed communications often lead to the opposite of what is wanted. If people find the
media position incredible or unbelievable, they may change their attitudes in a way that
is opposite to the position being promoted. In this case, the negative reaction to the
“unbelievable” information/threats pushes the message receiver in the wrong direction!
Successful ads do not exaggerate the dangers of substance use. There is no need to do
so (Skenderian et al., 2008).

References
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Barden, J., & Tormala, Z. L. (2014). Elaboration and attitude strength: The new meta‐
cognitive perspective. Social and Personality Psychology Compass, 8(1), 17-29.
Brinn, M.P., Carson, K.V., Esterman, A.J., Chang, A.B. & Smith, B.J. (2006). Mass media
interventions for preventing smoking in young people (Review). The Cochrane Database
of Systematic Reviews, Issue 8.
Buller, D. B., Burgoon, M., Hall, J. R., Levine, N., Taylor, A. M., Beach, B. H., Bergen,
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Burgoon, M. (1990). Language and social influence. In H. Giles & W. P. Robinson (Eds.),
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Clarkson, J. J., Tormala, Z. L., & Rucker, D. D. (2008). A new look at the consequences
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Clarkson, J. J., Tormala, Z. L., Rucker, D. D., & Dugan, R. G. (2013). The malleable influence
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Crano, W. D., Gilbert, C., Alvaro, E. M., & Siegel, J. T. (2008). Enhancing prediction of
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Matthew C. Farrelly, M.C.,. Healton, C. G., Davis, K. C., Messeri, P., Hersey, J.C., &
Haviland, M.L. (2002). Getting to the Truth: Evaluating national tobacco countermarketing
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D. B. (1993). Increasing public understanding of heart disease: An analysis of data from
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Richardson, A. K., Green, M., Xiao, H., Sokol, N., & Vallone, D. (2010). Evidence for truth®:
The young adult response to a youth-focused anti-smoking media campaign. American
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Siegel, J. T., Alvaro, E. M., Crano, W. D., Skenderian, J., Lac, A., & Patel, N. (2008).
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Siegel, J. T., Alvaro, E. M., Patel, N., & Crano, W. D. (2009). ‘...you would probably want
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Trager, R. (1976). Adolescent reactions to educational media messages regarding drug
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public health campaigns. Health Education & Behavior, 27, 591-615.

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Participant Manual: Module 2—Introduction to Media and Their Use in Prevention
MODULE 3
THE NATURE OF MEDIA AND THEORIES OF
HOW THE MEDIA AFFECTS AUDIENCES

Content and timeline........................................................................................99

Training goals and learning objectives............................................................99
Introduction to Module 3................................................................................100
PowerPoint slides............................................................................................101
Resource page.................................................................................................128
Summary...........................................................................................................130

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Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 3 20 minutes
Presentation: Media-based prevention and the
15 minutes
community
Presentation and discussion: Theories and approaches
20 minutes
that guide effective media messages
Individual exercise: Setting the stage for message
15 minutes
construction
Large-group discussion: Setting the stage for message
20 minutes
construction
Break 15 minutes
Presentation and discussion: Theories and approaches
30 minutes
that guide effective media messages (continued)
Small-group exercise: Gain- or loss-framed ads 35 minutes
Presentation and discussion: Analyzing the audience
20 minutes
to target the message
Lunch 60 minutes
Small-group exercise: Developing a campaign
45 minutes
message
Presentation and discussion: Reinforcement or
20 minutes
associationism
Small-group exercise: Designing a poster 45 minutes
Reflections and Module 3 evaluation 15 minutes
Break 15 minutes

Module 3 Objectives
Learning objectives
Participants who complete Module 3 will be able to:
Explain the critical role of resistance in persuasion, and how well-designed
communications are designed to reduce resistance;
Discuss the effects of message repetition – and the limits on the effects of repetition;
and
Describe the role of reinforcement and simple association in persuasion and prevention.

Participant Manual: Module 3—The Nature of Media and Theories of How the Media 99
Affects Audience
Introduction to Module 3
In this module, we review some theories of message design that prescribe features
of communications that influence attitudes and then behavior, as evidence-based
research has shown. The Theory of Planned Behavior (TPB) and other theories from
the communication and persuasion literature suggest that all attitudes are learned.
Therefore, to change an attitude, information needs to be provided that is learned
and replaces the knowledge on which the old attitude is based. Hovland’s Message-
Learning-Reinforcement (MLR) Theory specifies the factors that must be present if a
communication is to persuade, and how these factors working together produce attitude
change.
This module discusses the critical role of resistance in persuasion, and how well-designed
communications are designed to reduce resistance. Also reviewed will be the effects of
message repetition and the role of reinforcement and simple association in persuasion
and substance use prevention.
The module will cover how the above theories not only form the basis for understanding
how persuasion can work, but also provide the means for constructing the most effective
messages. You will learn about countering resistance by building strong messages
and incentives for attitude change; and neutralizing resistance, by such approaches as
distraction, misdirection, facts and evidence, credibility of source, and message tone —
all approaches we see every day in advertising. In general, persuasion involves a contest
between the target of persuasion and the persuader. Understanding this process is a
major theme of this course.
The module will also focus on the importance of analyzing the audience to develop the
most persuasive approaches. The module will describe research that analyzed differences
among adolescent nonusers of substances and show differences in vulnerabilities
to becoming users. These differences should dictate the design of a different type of
message that would be the most effective for each non-using audience.
The module will also discuss features of message reinforcement, or audience exposure to
the media,which can affect the success or failure of a campaign.

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and
Managers and Supervisors
Supervisors
Course 08
Course 07
Media-Based
Prevention Interventions

MODULE 3—THE NATURE OF MEDIA AND

THEORIES OF HOW THE MEDIA AFFECTS
AUDIENCES

3.1

_____________________________________________________________________________

Participant Manual: Module 3—The Nature of Media and Theories of How the Media 101
Affects Audience
Introduction

3.2

Learning Objectives

 Explain the critical role of resistance in

persuasion, and how well-designed
communications are designed to reduce
resistance
 Discuss the effects of message repetition – and
the limits on the effects of repetition
 Describe the role of reinforcement and simple
association in persuasion and prevention

3.3

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Review of Module 2 (1/2)

 Associate message with pleasant emotional response,

even if the message deals with unpleasant events like
drug addiction
 Avoid fear arousal as your central persuasive approach
 People are affected by reinforcement
 They are attracted to positive outcomes
 They will repeat a behavior that produces pleasant feelings, but will
try to avoid watching/exposing themselves to unpleasant images
 If a message is punishing, disgusting or very unpleasant,
people at risk will not absorb it; rather, they will avoid
thinking about it

3.4

_____________________________________________________________________________

Participant Manual: Module 3—The Nature of Media and Theories of How the Media 103
Affects Audience
Review of Module 2 (2/2)

 Fear-arousing messages do not deter users of

substances, and usually do not reinforce non-users
– this results in a prevention failure, a waste of time,
scarce prevention funds and opportunities
 Do not over-promise the dangers
 Violation of expectations often leads to a “rebound”
effect, in which the negative reaction to
disconfirmed information/threats is worse than if
nothing had been said

3.5

Interaction of Personal Characteristics and

the Micro- and Macro-Level Environments

©UNODC 2013 3.6

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Media-Based Prevention
and the Community

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3.8

The Role of Media in Prevention Campaigns

 Agenda-Setting
 Messaging
 Supporting other Prevention Efforts

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Points of Environmental Intervention in
the Prevention-Socialization Framework

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Theories and Approaches
that Guide Effective Media
Messages

3.11

Theories and Approaches That Guide

Effective Media Messaging

 Theory of Planned Behavior

 Hovland’s Message-Learning Model of
Persuasive Message Development to Overcome
Resistance
 Gain- and Loss-Framing of Communication
 Conditioning and Association

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Theory of Planned Behavior (1/2)

Source: Icek Ajzen. (Website: http://people.umass.edu/aizen/tpb.diag.html#null-linkrce:) 3.13

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Theory of Planned Behavior (2/2)

Source: Icek Ajzen. (Website: http://people.umass.edu/aizen/tpb.diag.html#null-linkrce:) 3.14

Individual Exercise: Setting the Stage for

Message Construction (1/2)

 Community leaders wish to persuade youth to

refrain from using psychoactive substances
 This suggestion is contrary to some youths’
beliefs
 You are asked to develop a message and deliver
it through media popular with your audience (cell
phone, public service announcement on
television, etc.); the thrust of the messages is
always the same – avoid this substance

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Large-group Discussion: Setting the Stage
for Message Construction (2/2)

 What is your audience’s reaction?

 Theoretically, some will resist and develop counter-
arguments to the government’s proposals
 This resistance (or counter-arguing) may involve
logical disconfirmation of the government’s arguments
 Questioning the expertise or motives of the message
source (“they don’t know anything” or “they have lots to
gain from my compliance”) – this is called derogation
 Biased misunderstanding of the message so that it
“seems” consistent with one’s beliefs – this is called
distortion
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Countering Resistance: An Approach Based on
Hovland’s Learning-Based Theory of Message
Construction and Attitude Change (1/2)

 Thetheory recommends that a persuasive

message must accomplish three functions
 Raise a question in the receiver’s mind (“Are you
sure you’re correct about the effects of this
substance?)
 Answer the question (“Actually, it can be harmful”)
 Provide some reason or incentive for the audience
to agree with your message

3.17

Countering Resistance: An Approach Based on

Hovland’s Learning-Based Theory of Message
Construction and Attitude Change (2/2)

 The theory assumes that a persuasion

communication that threatens an established
belief will stimulate counter-arguments
 A counter-argument is a negative response to the
message that represents an attempt to defend
one’s attitude
 Overcoming this defensive response is the central
goal of persuasion

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Neutralizing Resistance (1/3)

 Make counter-argumentation
 Difficult
or impossible
 Or apparently unnecessary
 How can you do this?
 Distraction
 Misdirection
 Base message on facts and evidence
 Use credible spokesperson(s) – experts, leaders

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Affects Audience
Neutralizing Resistance: Facts/Evidence
and Message Source (2/3)

 Example: Which is more effective?

A study by Meier “showed that people who started
smoking marijuana heavily in their teens and had an
ongoing cannabis use disorder lost an average of eight IQ
points between ages 13 and 38. The lost mental abilities
did not fully return in those who quit marijuana as adults”.
Director, US National Institute on Drug Abuse
 “People who started smoking marijuana heavily in their
teens and had an ongoing cannabis use disorder lost an
average of eight IQ points between ages 13 and 38. The
lost mental abilities did not fully return in those who quit
marijuana as adults.” No Source/No Speaker
3.20

Neutralizing Resistance: Framing the

Message (3/3)

 The thrust of the message can be either positive (how a

goal may be achieved) or negative (how a loss may be
avoided)
 Positive frame: Message speaks to the benefits of adopting a
particular behavior that gain-framed messages were significantly
more successful at encouraging prevention behaviors
 Negative frame: Message speaks to the losses that may be
avoided by adopting a particular behavior
 Recent research has called into question the superiority of
one form of framing over the other
 Based on these conflicting results, either orientation can be
used successfully. What is important are the goals you wish
to promote
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Example of a Gain-Framed Ad

 Drink Welch’s Grape Juice! Welch’s

Grape Juice has been a favorite for
more than six generations
 Medical research suggests drinking
purple grape juice may contribute
to greater vitality and vigor!
 Growing evidence also shows that
diets rich in Vitamin C and iron lead
to better health and higher energy
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Affects Audience
Example of a Loss-Framed Ad

 Drink Welch’s Grape Juice! Welch’s

Grape Juice has been a favorite for
more than six generations
 Medical research suggests that
drinking purple grape juice may help
you avoid cardiovascular problems
 Growing evidence suggests that
diets rich in antioxidants may reduce
the risk of some cancers and heart
disease
3.23

Substance Use: What Kind of Message?

 Gain-Framed  Loss-Framed
 Healthy life style  Preventing consequences,
 Succeeding at school like interference with
 Having good friends
learning, getting kicked out
of school
 Create
 Avoiding addiction, death
communications that
anticipate a desired  Use credible sources of
goal information
 Suggest actions to  Show how avoidance will
attain the goal lower the odds of negative
outcomes
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Small-group Exercise: Gain- or Loss-
Framed Ads

 Gain-framed messages say “By not using

substances, you will experience positive
outcomes like success in school.”
 Loss-framed messages say: “By not using
substances, you avoid the negative
consequences of substance use, like poor
health.”

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Analyzing the Audience to
Target the Message

3.26

Analyzing the Audience: They May Be

Non-users, but They’re Not All Alike

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Fostering Persuasion: Focus Messages on
the Needs of Your Chosen Audience

 Ideally, you should match your goals to intended

audience
 Do you want to reinforce resolute non-users?
 Persuade those who are contemplating drug use to resist?
 Influence users to quit?
 Do you wish to encourage pregnant women to abstain from
substance misuse
 Do you want to encourage ex-users to remain substance-free

 Each of these “audiences” requires a different

persuasive approach; a single campaign probably will
not affect all groups equally
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Affects Audience
Small-group Exercise: Developing a
Campaign Message

 Develop a message-based substance prevention media campaign for

distinctly different user groups
 Resolute Non-users
 Vulnerable Non-users
 Users
 Address the questions:
 Would you use positive or negative message framing?
 Who is the source of the message?
 Would you try to induce fear about substances in this group?
 What type of media will you use?
 Think about, and tell us, about the cost-benefit analysis you have considered in
your group
 Would your approach succeed? Why?
 What specific problems can you envision?
 Can you resolve or work-around these problems? 3.29

Reinforcement or
Associationism

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Reinforcement or Associationism

 The idea of associationism is to link two objects

(people, products, etc.)
 We do this by continually pairing the objects,
either visually or through language
 With sufficient number of associations, the
objects will come to be evaluated similarly

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Linking a Popular Person with a Product

BRAND NAME “A pinch

“SKOAL”
is all it
takes.”

3.32

A Classic Tobacco Ad Using Association

to Sell the Product

WARNING
LABEL

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Using Principles of Reinforcement to Link
Smoking with Negative Emotions

 Poster designed to
counter the belief that
smoking is stylish or
attractive.

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Features of Reinforcement that Affect the
Success or Failure of High Media Exposure

 Exposure can make a difference, but usually is

effective only when the audience is not
acquainted with the topic or product
 Ifa prior attitude exists, mere exposure to
alternatives is not effective in changing attitudes
 However, it is useful in contexts in which no initial
attitude exists, and when substance use is
associated with a desired end-state or outcome
(e.g., popularity)

3.35

Exposure/Association and the Substance

Use Prevention Message

 Audience is acquainted with substance use

 Using substances may be used by the popular
and “in” group, which can reinforce the pro-
substance message

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Summary

 All persuasion involves a contest between the target of

persuasion and the persuader
 Assume resistance from those holding contrary beliefs
 Most extreme resistance comes from those committed to their
beliefs
 Simple association with pleasant outcomes may facilitate
attitude formation, but alone will not create a change
 Mere frequency of exposure is insufficient to change attitudes
 Communications that only draw attention are not sufficient to
persuade
 A target’s successful resistance renders future persuasion even
more difficult: Resistance results in greater future resistance
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Small-group Exercise: Designing a Poster

 Work in small groups to design a poster

 Must contain no more than 10 words
 Must link a substance with avoidance of negative
outcomes (negative framed ad) or the positive
outcomes that can be attained with sobriety
 The number of posters you would need to design
 You probably should try to create a “brand” by
including a common feature (logo, print font, etc.)
on every poster
3.38

Large-group Exercise: Reflections

 What information that you learned in this module

is most important for your work as a Prevention
Manager and Supervisor?

 Why?

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Module 3 Evaluation
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Resource Page 3.1

What are the roles of media prevention campaigns?

Setting the prevention agenda.
Developing communications that take advantage of strong research on persuasion.
Support other substance use prevention efforts.
What are some of the leading persuasion theories that have been used in substance use
prevention?
Theory of Planned Behavior.
Hovland’s Message Learning Model.
Gain and loss-framing of communications.
Conditioning and association principles.
What are some important features of the theory of planned behavior?
Assumes that attitudes, perceived behavioral control and subjective norms affect
behavioral intentions, which in turn affects behavior.
What are some important features of Hovland’s message learning theory?
Assumes audience will contest persuasive messages that are contrary to their
established beliefs.
Requires a persuasive message to:
• Raise question regarding a message receiver’s established belief;
• Supply an answer to the question; and
• Provide some reason for the audience member to accept your answer.
Typical defensive reactions to a persuasive communication:
• Resistance, or counter-arguing the source’s message;
• Derogating of message source; and
• Distortion of the message.
What do we mean by gain-framed and loss-framed persuasive communication?
In substance prevention, gain-framed communications emphasize the positive
outcomes that can be realized by avoiding substance use
In substance prevention, loss-framed communications emphasize the negative
outcomes that can be circumvented by avoiding substance use

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Remember that prevention messages should be based on the usage status of the group
to be influenced
What is meant by conditioning of attitudes or simple associationism?
These terms refer to the fact that merely associating a product with a reinforcing scene
or a popular personality will usually result in the originally neutral product to receive
positive evaluations.
A person or product can be associated with a pleasant or an unpleasant stimulus,
and will take on pleasant or unpleasant valence: thus, a particular substance can be
linked with an unpleasant picture or outcome, and the negative feeling evoked by the
unpleasant picture or person will “rub off” onto the substance.

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Summary of Module 3: The Nature of Media and
Theories of How the Media Affects Audiences
Introduction
The focus of this module is to review some theories of message design that prescribe
features of communications that influence attitudes, and then behavior, as evidence-
based research has shown. The Theory of Planned Behavior and other theories from the
communication and persuasion literature suggest that all attitudes are learned. Therefore,
to change an attitude, information needs to be provided that is learned and replaces the
knowledge on which the old attitude is based. This “message-learning theory” specifies
the factors that must be present if a communication is to persuade, and how these factors
working together produce attitude change.
Specifically this module discussed the critical role of resistance in persuasion, and how
well designed communications reduce resistance. In addition, the effects of message
repetition and the role of reinforcement and simple association in persuasion and
prevention will be reviewed.

Lessons from Module 2

Module 2 introduced the pros and cons of message development. It covered what to avoid
when developing media messages; it showed the importance of making media exposure
a pleasant experience for the audience. The key role of persuasive communications in
providing reinforcement and stimulating positive feelings, positive emotions, and positive
outcomes was clearly presented. People are attracted to positive contexts, and will
absorb the information presented in these contexts. Therefore, media messages must be
designed to leave people with a pleasant feeling, even if we are dealing with frightening
or unpleasant behaviors like substance use. Fear or anxiety-arousal or other messages
that are unpleasant or revolting should be avoided. Simply creating a negative emotional
tone can make the job of persuasion much harder than it needs to be.
Fear-arousing messages almost invariably fail with substance use. Why? Because those
who are at high risk of using psychoactive substances usually know about the dangers of
the substances they are using. They do not have to be reminded of it. The problem is that
an emotional ad that ignites fear will be avoided. People will try to determine how to solve
the “fear” problem, without solving the substance use problem. The easiest way for the
target audience to avoid unpleasant fear arousal is simply to refuse to process, or think
about the prevention message. If one does not think about a persuasive communication,
it will not persuade.
Even worse, high fear arousing messages usually are not the best approach to persuade
non-substance users. Why? Because they are already NOT involved with the substance,
and you want them to stay that way. By raising the emotional tone, there is a danger
of making the use of a substance more intriguing and more mysterious. Some people,
especially young people, are attracted to such contexts.

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In addition, if people find that the threats contained in the emotion-arousing
communication are false, or do not correspond to their experience (even if the message is
factually correct), their attitudes may change in a direction opposite to that recommended
in the persuasive communication. Over-promising dangers often has a rebound effect,
making people disbelieve the ad, and sometimes even to experiment with the substance
that is being attacked in the communication. At a minimum, messages that are rejected
often set the stage for rejection of later persuasive communications. This makes it all
that much harder for substance prevention practitioners to do their job of encouraging
people to avoid substance use.
In addition, presenting negative examples should be avoided. Many communities have
programs in which former (or reformed) addicts talk about their addiction and how they
were able to return to “the land of the living.” This is an appealing idea at first, but on
closer consideration, we can see why such programs usually fail. First, there’s the danger of
glamorizing drug use. The audience might think, “Why did the person become addicted
in the first place, if using the drug did not create a pleasant or desirable outcome? Why did
it take so much effort to become drug free, if drugs are so bad?” Second, these programs
often introduce youth to drugs and the “proper” methods of their use (injection, snorting,
eating) that the audience might never have considered or knew about. In our prevention
approaches, it is important not to show how and why a drug should be avoided, not how
it might be used.

Media-based Prevention and the Community

As prevention professionals, we need to view our community in total, understanding the
interrelationships of each part—family, religion, economy, safety and security, education,
and governance. If we were all shipwrecked on a deserted island, eventually these are
the aspects of any new community we would construct. How they would interact, how
they would communicate and work together, which aspect would take on the greatest
importance may all vary across time as this new community evolves. These are central
features that will be present in the development of any community. How these features
influence one another, and how they evolve, define the nature of the community.
The media is the glue that ties all of these features into a workable whole. The
communication that occurs among the community sectors helps define the “rules” of
their interaction. In a theistic society, where religion sets the rules of proper behavior in the
community, communications from religious leaders affect all the other factors involved,
but the communications usually are tempered by the other factors. An economic market-
driven community will differ from a theistic community in the ways its citizens behave,
how they think, and what they value – and in the communications that emanate from
the leaders of the community. However, these communities also are dependent on the
communications that emanate from the leadership, whose communications will take into
account the other factors that define the community (safety, education, family, etc.) if it is
to persist.

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Communication among the elements of the community is the integrator of the community.
But it is important to understand that communication involves more than the mere
exchange of information. It almost always involves a persuasive component as well, an
attempt to bring all the elements in line for the good of all (or the good of a few, depending
on the nature of the community). Persuasive communication may be a necessary, if not a
sufficient factor, in ensuring the vitality and continuance of a community.

The Role of Media in Prevention Campaigns

The media serve many roles. It can help set the agenda of issues the community should
consider. By focusing attention on issues of importance, like substance use, the media
can draw attention to these issues. By proper message development (messaging), the
media can persuade its audience to prioritize issues, like substance use, and mobilize
the community to develop programs that facilitate the prevention of substance use. In
addition, the media can support other efforts that are designed to ensure a healthier
lifestyle, including substance use prevention.

Points of Environmental Intervention in the Prevention-Socialization

Framework
Many of the interventions covered in this curriculum series focused on the micro-
environment of the individual, such as the family, schools, and the workplace. Like
environment-based interventions, the media also operates primarily at the Macro-Level
Environment, with both educational messages and messages that reinforce or influence
pro-social norms, values, and behaviours.
The media are aimed at affecting attitudes and intentions, along with social and cognitive
competencies and skills. These factors, in turn, affect individual behaviour’s.

Theories and Approaches that Guide Effective Media

Messaging
As indicated in the introduction, a number of theories deal with factors that affect the
power of media messages to influence people. The first of these to be discussed is the
Theory of Planned Behavior (TPB), which is widely used in structuring intervention
development and research in prevention. It has been discussed with reference to a
number of evidence-based prevention interventions. It is one of the most popular models
used in prevention.
Another useful theory that has been used in prevention of substance use is Hovland’s
Message-Learning Model of persuasive message development to overcome resistance.
This theory focuses on the persuasion process, and the implications of this theory for
developing persuasive messages (i.e., for messaging).
An important aspect of this theory is message framing. Message framing is concerned
with the focus of the persuasive message: do we develop a substance use prevention
message that focuses on the problems that may be avoided by refraining from substance
use, or the positive features of abstinence. Both approaches can succeed if structuring
the prevention message properly.

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Finally, the Conditioning and Association Model will be described, which has been used
in prior campaigns to help form positive or negative attitudes toward products.

Theory of Planned Behavior (TPB)

The Theory of Planned Behavior (TPB) has been the primary theory used throughout this
course (Ajzen & Fishbein, 1972, 2008) series. This model is concerned specifically with the
causal influence of people’s attitudes, norms, and perceived control on their intentions
to behave in a particular way. Subsequently, these “behavioral intentions,” as they are
called, have been shown in considerable research to affect their actions.
The model establishes a sequence of decision making that influences intentions and
ultimately behavior. The theory holds that positive or negative attitudes toward a specific
behavior (e.g., initiating or refusing to initiate use of a particular substance), the likelihood
that you feel you can achieve this behavior or outcome, and your estimate of the feelings
of significant others (parents, close friends, boss or teachers) about your initiating the
behavior will determine whether or not you will engage in the behavior. It is important to
understand that strong attitudes predict behavior, but weak attitudes do not.
A creative and important component of the model has to do with the individual’s
perceptions of the normative nature of the behavior as judged by influential others.
Do significant others think you ought to perform the behavior? We call these estimates
“subjective norms.” The views and encouragement of significant others –subjective
norms – play a critical role in substance use and prevention. The stronger the perception
of positive subjective norms regarding an attitude object (e.g., an illicit substance), the
more likely are the intentions to act on the attitude. Thus, if a person thinks that most
of his/her closest friends are smoking, drinking alcohol, or using other substances, or
approve of their use, the person is likely to think more positively about substance use. If
the subjective norms regarding the substance use are negative, on the other hand, the
person is more likely to intend to avoid the substance.
Finally, the model shows that having the skills and abilities that impede or facilitate a
behavior (e.g., substance use) and perceptions of one’s ability to control the behavior
are also important. Most of us know smokers who would love to quit smoking, but feel
they cannot. In this model, they would be said to lack “perceived behavioral control.” This
means that although their attitudes toward the behavior (quit smoking) are positive, and
everyone they know is encouraging them to quit, they do not. Why? Because they feel
they cannot. They do not possess the skills or ability to do so. In this case, the relation of
the causal factors to intentions is broken, and the behavior (quitting) is not likely to occur.
The interaction of these three preliminary causal components--attitudes towards the
behavior, perceptions of the normative nature of the behavior, and having the skills
to avoid or embrace the behavior--is theorized to affect an individual’s intention to
perform the behavior; and then, if the individual has the skills and resources to engage
in the behavior (actual and perceived behavior control), the intention is realized, and the
behavior occurs. Thus, if an individual has the intention to use a substance, but cannot
obtain it, his or her actual behavioral control is lacking, and the behavior will not (cannot)
occur. If the substance becomes available, actual behavioral control is enhanced, and the
behavior occurs.

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This, in a nutshell, is the Theory of Planned Behavior. It has been verified in numerous
studies in substance use prevention, and in many other areas as well. It provides a very
fine general model of the interaction of attitudes and intentions, and their subsequent
effects on behavior.
However, the model is not the end of the story. Although it provides a very useful general
model of the variables that must be affected in influencing the performance of a desired
behavior, it gives very little specific advice about how to do so. The model states that we
need to affect attitudes, for example, but does not tell us how to do it. It does not tell
us how to affect people’s sense of behavioral control, or their perceptions of subjective
norms surrounding a particular behavior.
To learn how to do this, we need to go into detail about ways to construct media messages
that bring about attitude change.

Countering Resistance: An Approach Based on Hovland’s

Learning-Based Theory of Message Construction and Attitude
Change
Established attitudes can be very difficult to change through persuasive media. People
resist media that suggests their cherished beliefs are incorrect. The most common
resistance tactics are counter-arguing, derogation, and distortion. What does this
mean? Counter-arguing means the audience member will try to see the weak spots
in the message arguments, and thereby justify rejecting the message. Therefore it is
important that the media message be strong, logical, data-based, and thus, difficult to
fault. Pre-testing messages on members of the audience – in focus groups, for example
– often provides a good idea of how the audience will respond to the arguments that are
developed.
Another tactic people use to reject a persuasive message is to devalue or denigrate its
source. So having a credible, well-established source for the message is important.
Carl Hovland’s Message Learning Theory of Persuasion, like the Theory of Planned
Behavior, has contributed greatly to the understanding of message development. The
premise of the theory is the logical assumption that people learn their attitudes – they
weren’t born with them. Thus, to change people’s attitudes, they need to learn an
alternative belief to take the place of the one that’s being changed. (Hovland et al., 1953;
Hovland & Weiss).
Hovland’s theory explicitly considers the dangers of resistance processes. It is not easy
to change people’s attitudes, especially attitudes that are well established and important
to the individual. People will resist persuasive communications designed to change their
attitudes. Hovland theorized that to defeat resistance (or, counter-argumentation, as
he called it), messages must be constructed in a persuasive campaign that fulfills three
functions:
The message must be strong enough to raise a question in the receivers’ minds about
the correctness of their established beliefs.

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The message must offer an alternative belief, an answer to the question that the
message has raised.
The message must provide some reason for the person to change – this might be that
the “new” belief is shared by a well-liked public figure, for example.
These requirements of persuasive messages must be met if they are to succeed
in persuading a resistant audience. Failing to succeed at any step usually means the
persuasion attempt will fail.
Hovland’s theory assumes that a persuasive communication that threatens an established
belief will not simply be accepted by the audience. Rather, it will stimulate counter-
arguments. A counter-argument is a negative cognitive response to the message
that represents an attempt to defend one’s established attitude. We expect counter-
argumentation to occur in any persuasive context, which by definition involves attempting
to change a person’s established beliefs. Overcoming this defensive response is the
central goal of persuasion. How is this done?

Neutralizing Resistance – or Overcoming Counter-argumentation

If counter-arguing is the basis of resistance, then reducing it will lower resistance and
make it easier to reach the persuasive goals. The idea is to create a context in which the
target audience can process the information being presenting, while at the same time
limiting the audience’s capacity to raise contrary ideas to counter the communication.
There are many ways to do this. Some possibilities present themselves, based on theory
and found through research to be effective.
1. Distraction: One possibility that seems to work well is distraction. If the message is
presented under somewhat distracting conditions, the audience will not be able to
devote as much attention to countering it. Distraction can be built into the message.
For example, loud music that interferes somewhat with the audience’s capacity to do
more than process the content of the message, but interferes with the cognitively
demanding operations of counter-argumentation, helps induce message acceptance.
Almost anything in a persuasive communication that makes the message somewhat
difficult to process makes it more difficult to counter-argue. Ideally, the presentation
format is arranged so that the message can be processed, but the individual’s capacity
to do more than this is diminished. In this way, distraction detracts from a person’s
ability to counter-argue. This tactic is most effective for short-term, but not long-term
attitude change, because the resultant (changed) attitude is not based on well-learned
knowledge.
2. Misdirection: Directing a persuasive anti-substance use message to people other
than those we really want to target (making sure the real targets are exposed to the
message) creates a very strong possibility for persuasion (Crano et al., 2007). So, if a
message is played on TV that is anti-substance use, but it is apparently addressed to
parents, it will be more persuasive to youth than the same message addressed directly
to the youth, because the youth will not feel as strong a need to defend pro-substance
use beliefs.

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3. Facts and Evidence: Another persuasive tactic is to ensure that the message is based
strongly on facts that have been uncovered by scientific research. It is important also
to match the emotional context of the ad and the factual nature of the issue. So if a
particular substance is considered primarily in emotional terms, the message ought
to operate at the emotional level. If the substance is more linked to objective, rational
factors, the persuasion message should be objective and rational. In other words,
match the ad approach with the perceptions and evaluations of the audience to the
substance in question.
Issues that are based on strong evidence, from established research organizations or well-
known researchers carry considerably more weight than simple unattributed statements.
Consider the following statement:
A study by Meier and colleagues (2012) “…showed that people who started smoking
marijuana heavily in their teens and had an ongoing cannabis use disorder lost an
average of eight IQ points between ages 13 and 38. The lost mental abilities did not
fully return in those who quit marijuana as adults.”
This message, which was made by the director of the U.S. National Institute on Drug
Abuse, and is backed by a well-designed scientific research, is considerably more
persuasive than one that simply states the “People who started smoking marijuana
heavily in their teens and had an ongoing cannabis use disorder lost an average of
eight IQ points between ages 13 and 38. The lost mental abilities did not fully return
in those who quit marijuana as adults.” In the former case, the statement based on
evidence and research, coupled with a source whose job is to know about drug use
effects. The second statement, which contains almost the identical words, will prove
to be considerably less influential. Facts, established on good research, are more
persuasive than opinions based on the guesses of a source of unknown expertise.
4. Credibility of Message Source: A strong persuasive feature is the reputation of
the message communicator. Respected scientists or religious figures, sports heroes,
and others of this type who have been shown to be highly credible for the specific
target audience are considerably more influential than sources that lack this quality
of credibility. People tend to believe what these sources say, and do not strongly
resist their message. So if a spokesperson is used in a persuasion message, it is more
effective to use a person the audience knows and respects. It is important that the
speaker is not just popular, but can be viewed as an expert on the topic. Thus, a sports
hero who advises youth against substance use may be less effective than a less well-
known researcher who is known to be highly knowledgeable about substance use. If a
sports hero is used, it is important that he or she establish her knowledge of the issue
before giving advice. In this way, the popularity of the sportsperson (and the attention
they generate) can be combined with some evidence of knowledge and expertise.
5. Message Tone: In addition, the general positive or negative tone of a communication,
that is, how the message is framed, has a considerable effect on its persuasiveness.
Research has shown that messages that emphasize the desired gains that can be
achieved by adopting the proper behavior or action can be quite effective (Gallagher
& Updegraff, 2012). However, the opposite side of the coin also is true. Messages that

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
emphasize the losses that can be avoided by adopting the proper behavior or action
also can be quite effective. If one wishes to promote a product or outcome, the focus
should be on the gains to be achieved by framing the message in terms of these
gains. If one wishes to prevent the adoption of a product or an outcome, one should
focus on the losses to be avoided if a particular action is taken.

Substance Use: What Kind of Message?

You might be wondering which of these different framings you should use in your prevention
work. The answer is that both approaches work well, if they are done properly. Often,
prevention professionals focus on loss-framed ads when trying to prevent substance use.
This is acceptable so long as the framing is used correctly, and fear arousal is not a central
part of the approach. These loss-framed media communications should have three major
components:
They should point to outcomes people wish to avoid,
Use highly credible sources and information, and
Show how avoidance of substance use will help them lower the odds of unwanted
outcomes.
On the other hand, positively framed ads also can be effective, and are less likely to give
rise to the temptation to use high fear-arousing communications. In positively framed
messages, the researcher is concerned with:
Creating communications that anticipate a desired goal, and
Suggesting that actions leading to a healthy lifestyle (temperance, physical activity,
etc.) will foster attainment of the goal.

Analyzing the Audience to Target the Message

Credible data and other information help us understand who our audience is and how
best to approach them with our messages. For instance, in earlier research in the US,
young teens who had never used marijuana, the majority of the entire population of
youth, 12-18 years of age were the target audience for an anti-drug use campaign. They
were studied for 4 years (Round 1-4). What was learned in a re-analysis of the data is that
the non-users at Round 1 were not homogeneous but consisted of two groups: a resolute
group who had no intention of ever using marijuana, and a group of vulnerable non-
users, who were not so sure whether they would use marijuana sometime in the future
(Crano et al., 2008).
Four years after baseline data were collected, dramatically different initiation rates of
marijuana use were noted. Sixty-six percent of the nonusers classified as vulnerable had
become users a mere 4 years later, whereas 26% of the non-users classified as resolute had
become users after four years. These groups were differentially susceptible to substance
use, even though their use levels at the first time period were identical.
This information supports the potential importance of considering features of groups you
wish to target in a substance use prevention campaign. These differences began to be

Participant Manual: Module 3—The Nature of Media and Theories of How the Media 137
Affects Audience
evident as early as one year after the initial baseline measure. When targeting audiences,
messages need to take these types of differences into account. In this instance, knowing
that the non-using group actually consisted of vulnerable and resolute groups would
have helped tailor prevention messages that could reach both groups more effectively.
What would be the focus of these different substance use prevention messages? We
need to know whom we want to persuade, their motives for substance use, and then
create messages that adequately and persuasively address these issues.

Focusing Messages on Audience Needs

In commercial marketing, a single audience is sometimes assumed. For example,
manufacturers introducing a new soft drink often will use the same ad for all audiences.
This approach works best if the product is new (that is, for people who have not already
formed an opinion about it), and can be used by the population at large.
But often some companies target specific audiences. Depending on the time of day or
the content of a TV show that is sponsored by some company, for example, advertisers will
use different approaches. For example, products that appeal to children usually are aired
on the weekends or after school. Products designed to appeal to men are advertised at
sports venues, and at night, whereas products designed to appeal to women often are
shown during the afternoon. We need to make the same kinds of considered decisions
when designing media based prevention interventions.
Different “audiences” require different persuasive approaches; a single campaign
probably will not affect all groups equally. We wouldn’t want to direct a strong scare
campaign, for example, to those already addicted to a substance. These individuals will
find the information too threatening to process, and will be reluctant to process your
appeal with an open mind. Nor would we promote the services of a treatment center if
our audience was resolutely anti-substance use.

Reinforcement or Associationism
We will now switch gears and consider an approach that is less message-intensive. You
may recall commercial ad campaigns that used very few words – they simply linked their
product with a well-loved public figure, or even with some beautiful background scenery.
This approach depends on principles of reinforcement and simple association.
The reinforcement principle is simple, but has been an important feature of psychology
almost from its beginning. Reinforcement theory suggests that if a neutral object comes
to be associated with a pleasant mood or feeling or outcome, your feelings toward that
neutral object will become reinforcing for you. That is, the previously neutral object will
become a source of pleasure for you, even in the absence of the reinforcer.
Suppose you can identify a well-loved public figure (a politician, movie star, sports idol).
You follow this person in the media, and he or she is continually pictured with another
person (whom you do not know). This simple pictorial association will have an effect on
your attitude toward that “unknown” other person. The positive feelings you have for
your hero will become associated with the previously unknown person.

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Features of Reinforcement that Affect the Success or Failure of High Media
Exposure
An important feature of reinforcement is exposure. It can help publicize a product or
action, raise awareness, even educate. It is a necessary feature of any media-based
substance prevention campaign. However, exposure is not always effective, and it can
be overdone. Thus, constant ads for a product may not be worth the money it takes to
guarantee high levels of exposure.
Exposure works best when the product is “new,” and is being newly presented to the
audience. If you’ve never seen a pack of KOOL cigarettes, and suddenly saw beautiful ads
that liked the product with beautiful people or beautiful scenery, then chances are that
you might form a positive association with KOOLs – unless you were strongly antagonistic
to smoking. In that case, exposure would make very little difference. Associationism is not
an effective way to change beliefs or behaviors. The “mere exposure” effect operates
best in contexts in which no initial attitude exists about a ‘product’ or ‘message’.

Exposure/Association and the Substance Use Prevention Message

Now think about illicit drugs or other substances of use. In most cases, the “audience”
may be well-acquainted with the “product.” They know about the substance, and it would
seem that the reinforcement model would predict a failure in this case. However, before
we accept this interpretation, we must analyze more deeply. Often, in young audiences,
substance use is associated with a highly desirable outcome (popularity) or group (the
leaders or most popular members of the class). If the leadership is using a substance, and
the leaders are valued positively, then it is likely that the substance will “absorb” some of
this positive feeling. The association between the leaders and the product (in this case, a
substance like, say, marijuana or amphetamines or alcohol) will be made.
So, although exposure and reinforcement would not seem to matter in the case of
popular or well-known substances, reinforcement theory does provide some insight into
the ways in which popular students might inadvertently influence others, many of whom
they might not even know. This suggests that the effects of substance use prevention
media campaigns might work through the beliefs and behaviors of popular individuals –
but we’re getting ahead of ourselves. We’ll consider this possibility in a theory that talks
of “opinion leaders” later in the course.

Summary
All persuasion involves a contest between the target of persuasion and the persuader. In
any persuasive contest, we need to assume that people holding beliefs contrary to our
message will resist (counter-argue).
The most extreme resistance comes from those who are most committed to their
beliefs.
Simple association with pleasant outcomes may facilitate attitude formation, but alone
will not create attitude change.

Participant Manual: Module 3—The Nature of Media and Theories of How the Media 139
Affects Audience
Mere frequency of exposure is insufficient to change attitudes, though in a mass media
context, exposure frequency can be helpful, as it helps assure that many have seen or
heard the persuasive message.
Communications that only draw attention are not sufficient to persuade.
A target’s successful resistance renders future persuasion even more difficult:
Resistance results in greater future resistance.

References
Ajzen, I., & Fishbein, M. (1972). Attitudes and normative beliefs as factors influencing
behavioral intentions. Journal of Personality and Social Psychology, 21(1), 1-9.
Ajzen, I., & Fishbein, M. (2008). Attitudinal and normative variables as predictors of
specific behaviors. In R. H. Fazio & R. E. Petty (Eds.), Attitudes: Their structure, function,
and consequences. (pp. 425-443). New York, NY, US: Psychology Press.
Crano, W.D. et al. (2007). Overcoming adolescents’ resistance to anti-inhalants appeals.
Psychology of Addictive Behaviors, 21, 516-524.
Crano, W. D., Siegel, J. T., Alvaro, E. M., Lac, A., and Hemovich, V. (2008). “The at-Risk
Adolescent Marijuana Nonuser: Expanding the Standard Distinction,” Prevention Science,
9, 129-137.
Gallagher, K. M., & Updegraff, J. A. (2012). Health message framing effects on attitudes,
intentions, and behavior: A meta-analytic review. Annals of Behavioral Medicine, 43, 101-
116.
Hovland, C.I., Janis, I., & Kelley, H.H. (1953). Communication and persuasion. New Haven,
CT: Yale University Press.
Hovland, C. I., & Weiss, W. (1951). The influence of source credibility on communication
effectiveness. Public Opinion Quarterly, 15, 635-650.
Meier MH, Caspi A, Ambler A, et al. (2012). Persistent cannabis users show
neuropsychological decline from childhood to midlife. Proceedings of the National
Academy of Sciences, 109, E2657-2664.
Van’t Riet, J., Cox, A. D., Cox, D., Zimet, G. D., De Bruijn, G., Van den Putte, B., De
Vries, H., Werrij, M. Q., &Ruiter, R. C. (2014). Does perceived risk influence the effects of
message framing? A new investigation of a widely held notion. Psychology & Health, 29,
933-949.doi:10.1080/08870446.2014.896916

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
MODULE 4
PRACTICAL APPLICATION OF THEORIES OF
PERSUASION IN SUBSTANCE USE PREVENTION

Content and timeline......................................................................................143

Training goals and learning objectives..........................................................143
Introduction to Module 4................................................................................144
PowerPoint slides............................................................................................145
Resource page ................................................................................................162
Summary...........................................................................................................164

141
Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 4 15 minutes
Presentation: Classic approaches to persuasion 10 minutes
Presentation and discussion: Creating messages that
20 minutes
conform to the formula
Large-group discussion: Audience and message 20 minutes
Presentation and discussion: Overcoming resistance 15 minutes
Small-group exercise: Understanding counter-arguing 45 minutes
Reflections and Module 4 evaluation 20 minutes
End of Day 2

Module 4 Objectives
Learning objectives
Participants who complete Module 4 will be able to:
Discuss the components that persuasive messages must consider;
Explain the importance of the question: “WHO says WHAT, to WHOM, and with what
EFFECT?”; and
Use these components in developing or judging the likely success of persuasive
communication.

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Substance Use Prevention
Introduction to Module 4
Applying theory to practice is often challenging. But prevention professionals are tasked
with the goal of using evidence-based practices in their prevention work in communities,
including media interventions. Most evidence-based media interventions involve the
application of persuasion theory, and follow a series of guidelines and components that
have been shown to be important in prior empirical research on persuasion.
The guidelines are summarized by the formula, “WHO says WHAT to WHOM, and
with what EFFECT.” The following describes these elements in the “classic persuasive
communication formula:”
WHO – Source of the communication– who is delivering the persuasive message?
WHAT – Content of the communication.
TO WHOM – Audience.
HOW – Messaging and medium to address the audience we seek to reach.
With what EFFECT – How we will measure the success or failure of the campaign.
Module 4 will review the basis for message development from Hovland’s MLR model,
which considers persuasion to be the process of changing audience attitudes by replacing
them with your message. This involves: Raising a question in the receiver’s mind about
his/her established beliefs; the message providing an alternative answer to the question;
then convincing the receiver to accept the message—this last point involves an incentive
for accepting the message. The incentive can involve the source of the communication;
the message—content--itself, or how the message is conveyed.
Also dealing with effective message development, the module will explain why it is
advisable to avoid the tendency in substance use prevention to design communications
based on negative reinforcement, fear, or punishment. Research has shown that they do
not work except under highly constrained circumstances.
The module will also describe the importance of the credibility of the source, whose
features should generally be matched to the audience. But the audience may also need
to be motivated to attend to the message. Other requirements for effective messaging
are that the message itself has to be credible, with strong arguments. Further, there needs
to be a reinforcement to accept the communication message or position.
Lastly, special attention needs to be paid to defining the specific audience for the message
if it is to be effective.

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and
Managers and Supervisors
Supervisors
Course 08
Course 07
Media-Based
Prevention Interventions

MODULE 4—PRACTICAL APPLICATION OF

THEORIES OF PERSUASION IN SUBSTANCE
USE PREVENTION

4.1

_____________________________________________________________________________

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Substance Use Prevention
Introduction

4.2

Learning Objectives

 Discuss the components that persuasive

messages must consider
 Explain the importance of the question: “WHO
says WHAT, to WHOM, and with what
EFFECT?”
 Use these components in developing or judging
the likely success of persuasive communication

4.3

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Review of Module 3 (1/2)

 Allpersuasion involves a contest between the

target of persuasion (the audience) and the
persuader
 Assume resistance from those holding contrary
beliefs
 Most extreme resistance comes from those
committed to their beliefs
 Simple association with pleasant outcomes may
facilitate attitude formation, but alone will not
change established attitudes
4.4

_____________________________________________________________________________

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Substance Use Prevention
Review of Module 3 (2/2)

 Mere frequency of exposure is insufficient to

change attitudes
 Communications that only command attention
are not sufficient to persuade
 A target’s successful resistance renders future
persuasion even more difficult: Resistance
results in greater future resistance

4.5

Classic Approaches to
Persuasion

4.6

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
The Classic Persuasive Communication
Formula

 “Who says” refers to the source of the communication

 “What” refers to the content of the communication –
the words and images that are used
 “To Whom” refers to the audience, and audience
variations
 “How” concerns the message context and subtle
variations in message content, and the medium
through with the communication is transmitted
 “With what Effect” refers to the necessity of valid
measurement of the campaign’s outcome: How is its
success or failure to be evaluated?
4.7

_____________________________________________________________________________

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Substance Use Prevention
The Message-Learning-Reinforcement
(MLR) Model Revisited (1/2)

 This MLR Model assumes a cognitive contest –

your audience will resist, and you must devise a
way to overcome resistance
 To succeed, the persuasive message must
accomplish three critical functions
 Raise a question in the receiver’s mind
 Answer the question
 Offer some kind of reinforcement to the receiver for
agreeing with the answer that is provided

4.8

The Message-Learning-Reinforcement
Model Revisited (2/2)

 What are the incentives?

 They are based on features of your message:
 The message SOURCE (who says it)
 The CONTENT of the message (what is said)
 HOW the message is conveyed (how it is said)
 Communications that fail to incorporate all of
these features usually do not succeed

4.9

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Creating Messages That
Conform to the Formula

4.10

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Substance Use Prevention
Creating Messages That Conform To the
Formula: WHO? (1/2)

 Match the source with salient and important

features of the target audience
 These features may include age, gender, race,
social status, etc.
 Inyouth substance use prevention campaigns,
prevention models usually match targets with
peers as message sources

4.11

Creating Messages That Conform to the

Formula: WHO? (2/2)

 Matching your source to the audience usually

succeeds
 The exception, however, is when a substance
use prevention campaign targets an audience
which includes individuals who are at risk or are
using substances and are worried about the
damaging effects of the substance
 In those cases, an authority (e.g., a physician, a
professor or researcher on the topic, etc.) is
often a more effective message source
4.12

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Creating Messages That Conform to the
Formula: WHAT AND HOW? (1/2)

To succeed, your message must

 Motivate audience to attend to it – target must
be motivated to think about your position – but
merely gaining attention is not enough
 Present strong, credible arguments that are
difficult to deny
 Provide some reinforcement for accepting your
position

4.13

_____________________________________________________________________________

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Substance Use Prevention
Creating Messages that Conform to the
Formula: WHAT AND HOW? (2/2)

 Messages should be tested in small-scale

studies before going into the field with the
campaign. To neglect this preliminary testing
phase usually results in the campaign’s failure
 Experience with prior failed campaigns showed
that most of the intended audience did not
understand the messages that were produced
and shown on the media at great expense

4.14

The Signature Ad of the National Youth

Anti-Drug Media Campaign

4.15

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Creating Messages that Conform to the
Formula: TO WHOM?

 Insubstance use prevention, it is important to

decide upon the target of the campaign
 Do you want to ensure resolute non-users continue
to be abstinent?
 Do you want to persuade high risk, vulnerable non-
users to resist substance use initiation?
 Do you wish to persuade users to quit?
 The campaign will take different forms
depending on your intentions

4.16

_____________________________________________________________________________

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Substance Use Prevention
Large-group Discussion:

 Who were your audiences?

 What were the messages you were conveying?
 Did they fit some of the features of good
campaign design we have been discussing?

4.17

Overcoming Resistance

4.18

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Receivers’ Common Reactions

 How do receivers respond to a communication

message?
 To protect their established belief, receivers will
resist (that is, disagree, or counter-argue)
 This assumes they have noticed the message
(messages need to compel attention)
 The more important or established the belief, the
stronger is the defense of the belief

4.19

_____________________________________________________________________________

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Substance Use Prevention
The MLR Model: Overcoming Resistance
(1/2)

 We assume people find it reinforcing to be

associated with a source of expertise and high
trustworthiness
 We assume that a strongly argued, logical message
will prove more memorable and persuasive than
one that does not share these features
 Data-or research-based messages are more
persuasive than those based on emotion alone
 Any message feature that renders counter-
argument difficult will enhance persuasion
4.20

The MLR Model: Overcoming Resistance

(2/2)

 Reinforcement and the place of negative

reinforcement/punishment
 Dangers of fear-arousing messages in media
 Message acceptance/rejection
 Control of fear rather than the actual danger of
substance use

4.21

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Small-group Exercises: Understanding
Counter-Arguing

 Groups 1 and 2: Design a persuasive substance use

prevention communication that relies heavily on SOURCE
effects. Show how the source will interact with your planned
audience
 Groups 3 and 4: Design a persuasive substance use
prevention communication that relies heavily on MESSAGE
effects. Show how the message will interact with your
planned audience
 For both groups:
 What is your message?
 How does its construction/design make it difficult to counter the ad?
 How did you take advantage of the association of source (or
message) and features of your audience?
4.22

_____________________________________________________________________________

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Substance Use Prevention
Large-group Exercise: Reflections

 What information that you learned in this module

is most important for your work as a Prevention
Manager and Supervisor?

 Why?

4.23

Module 4 Evaluation
4.24

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_____________________________________________________________________________

_____________________________________________________________________________

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Substance Use Prevention
Resource Page 4.1

When considering the quality of a persuasive substance use prevention communication,

you should consider the classic formula: “Who says what to whom, how, and with what
effect:
Who refers to the source of the communication.
What refers to the communication’s content.
To whom refers to the intended audience.
How refers to subtle variations in message content, and the medium through with the
communication is transmitted.
With what effect refers to the outcome or evaluation of the communication’s effect.
Using the formula:
WHO: The message source should generally match the characteristics of the chosen
audience (age, gender, ethnicity), or be a person who the audience likes and respects
• If the central aim of the communication campaign is to get users to stop using a
dangerous substance, an authoritative message source (e.g., physician, researcher)
often is more effective than a source who shares the characteristics of the audience.
WHAT and HOW
• Message should motivate audience to attend to it.
• Its arguments should be strong, but also credible – don’t overstate the case.
• The communication should offer some inducement for acceptance
{ Message might imply widespread acceptance of the stated position.
{ Message might show strong scientific support.
• Communication must be understood by the audience
{ Strong need to pre-test communications to ensure audience understands its
intended meaning
• Gaining attention is not enough – it is merely the first phase in persuasion. The
message should provide the attending audience member with useful information
that adheres to the guidelines presented earlier.
• Messages should be tested in small scale test runs to ensure meaning is clear and
audience finds them credible, useful, and interesting.

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
To WHOM
• Remember, one size does not fit all: Must target the audience you most wish to
influence
{ Targeted audience can consist of (for example)
Resolute nonusers: never used substance, and determined never to do so
Vulnerable nonusers: never used, but considering
Users
Also, other (demographic) categories of potential users:
» Pregnant women;
» Homeless adults; and
» Street children, etc.
Overcoming resistance
• Assume audience will not immediately accept a message that is contrary to their
established beliefs (and possibly, behaviors).
• Communication should provide an alternative response to the position the audience
member holds, and then provide some form of reinforcement for agreement with it.
• Strong messages, based on logic, presented by an attractive source of high expertise
and trust, will facilitate persuasion.
• Overly emotional or threatening communications are rarely successful.

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Substance Use Prevention
Summary of Module 4: Monitoring and Evaluation:
A Case Study
Introduction
Applying theory to practice is often challenging. But prevention professionals are tasked
with the goal of using evidence-based practices in their prevention work in communities,
and these may include media interventions. Most evidence-based media interventions
involve the application of persuasion theory, and follow a series of guidelines and
components that have been shown to be important in earlier empirical research on
persuasion.
The guidelines are easily summarized by the formula, “Who says What to Whom, and
with what Effect.” This was the formula for persuasive communication made famous by
Harold Lasswell (Lasswell, 1949). This formula is easy to recall, and it provides a framework
that should be considered when creating or judging the merits of a persuasive message.
It emphasizes features that a communication should have to convince an audience to
avoid initiating the use of a dangerous substance, or to desist in further use. The formula
presented supplies a guideline. It is not a set of rules, all of which must be followed to
perfection. There’s room for creativity in substance use prevention using the media – but
this creativity should be bounded by empirically based research.

Classic Approaches to Persuasion

Classic Persuasive Communication Formula
The classic “formula” for persuasion lists all the components to be considered when
creating, or judging, the goodness of a persuasive communication.
WHO refers to the source of the communication– who is delivering the persuasive
message?
WHAT refers to the content of the communication, including the use of particular
words and images that are used to convey the message.
TO WHOM refers to the audience. We must be aware of audience variations, and which
parts of the audience we are particularly interested in reaching with our persuasion
message. Of course, in some cases we wish to address everyone who is exposed to
our message; at other times, however, we are interested in specific sub-groups of the
larger audience, such as young adolescents, pregnant women, the elderly, and so on.
HOW concerns messaging, the context and subtle variations in message content used
to address the audience or audiences we seek to reach, and the particular medium by
which we will transmit the message. By medium, then, we mean the way the message
is delivered to the audience– via radio, television, newspaper, poster, billboard, etc.
And finally, with what EFFECT, relates to how we will measure the success or failure
of our substance use prevention messages. Without a good estimate of effect, we will
not have a clear idea of the success or failure of our persuasive efforts.

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All of these factors must be considered when designing or planning a substance use
prevention media campaign.
These same features also are useful when judging why a campaign succeeded, or why
it failed. For example, if a substance use prevention campaign has not had the desired
effect, it may be that the “WHO” in the communication formula was not a source that
the audience trusted or respected. Or, the particular medium we used to convey our
persuasive information (the HOW) was not a medium that was regularly used by the
intended audience (the WHOM). These considerations alert us to factors that matter and
that provide good insights into program successes or failures (Baran & Davis, 1995).

The Message-Learning-Reinforcement (MLR) Model Revisited

The Classic Message-Learning Model (Hovland et al., 1953) assumes that attitudes and
beliefs are learned from a variety of sources, including those in the micro-level environment
such as our parents and family members, teachers, and religious leaders, and also from
those in the macro-level environment, such as the community.
We were not born with attitudes, we have to learn them. To change beliefs, then, an
audience has to be motivated to accept and retain new information. This is what is called
the cognitive contest. As was stressed in the last module, this means that persuasion
involves a debate between the persuader and the audience member, who actively
considers the message and decides to accept or reject it. Persuasion involves the study
of how to win this contest. The contest is carried out largely at the cognitive level, that
is, inside the head of the audience member. For example, to persuade youth to avoid
substance use we need to win this contest.
More than simple learning is involved, however, because the audience possesses beliefs
that might be different from those we want them to learn. We need to learn how to
overcome resistance to our messages.
Here’s how the MLR model works.
The message must first raise a question in the receiver’s mind about the legitimacy or
correctness of his or her attitude or behavior.
The message also must suggest an answer to this question.
The message must convince the receiver to accept our answers rather than maintaining
his or her own established position. To accomplish this goal, some type of incentive
should be provided through the source of the communication, the message itself, or
the way the message is conveyed.

What is meant by incentives?

One type of incentive involves the SOURCE of the message: Suppose a young adolescent
is listening to a substance use prevention communication delivered by his favorite athlete.
To be in agreement with the athlete is reinforcing to the youth. He wants to be like his
hero. In this case, the source of the message may provide the incentive to agree with the
message.

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On the other hand, what if he thought all athletes used drugs? How would that affect his
reception to the message from this source?
The next incentive could be CONTENT: What is said also can be an incentive for agreement.
If a message is logical and strong, and the audience member sees the strength of the
argument, the message’s very strength may prove to be an incentive for agreement. For
example, we know from research that one of the strongest arguments for support for
restrictive policies for alcohol was the “belief in the effectiveness of restrictive measures
and in the harm caused by drinking” (Stovall et al., 2014).
HOW Conveyed: Finally, how the message is presented – the formal properties of its
format, the colors used, the attractiveness of the actor(s) presenting it, the music, etc.,
may all provide an incentive for agreement.
Communication researchers have found that features like these strongly enhance the
effectiveness of persuasive communications (Cho, 2012).

Creating Messages That Conform To the Formula

WHO Is the Source
It’s important that the audience perceives that the source of the message is expert and
trustworthy; that is, the source possesses valid information, and has nothing to gain from
compliance (Hovland & Weiss, 1951).
It often is useful to match features of the source with those of the audience in terms
of age, social status, gender, ethnicity, and race. We tend to affiliate with, and be
attracted to, those who appear to be more like us, in terms of attitudes and demographic
features (Byrne, 1977; Condon & Crano, 1988).This means that the persuasive campaign
designer needs to know the important or salient features of the group that is to be the
main audience of the campaign. If adolescent girls are the target of the substance use
prevention campaign, for example, it is reasonable to use adolescent girls (or slightly
older women) as the communicators. If young athletes are the primary audience of the
communication campaign, then other young athletes, or perhaps a famous athlete, would
serve as a good message source.
Matching your source to the audience usually succeeds. But if the audience is already
using the substance whose use is to be prevented, and the risk of the substance’s use for
physical health is well known, then using an authority (such as a physician or respected
researcher) often is your best choice for spokesperson (Crano et al., 2007). This is true
even with adolescent audiences.

The WHAT and HOW

It is important to motivate people to attend to the communication message. To do this,
messages need to be created that draw attention. But drawing attention is not enough.
Once we have the audience’s attention, the message has to be strong. This is why the
message content, along with the source of the message, is so important (Petty &
Cacioppo, 1986). It means that the message source is someone (or some organization)
who the audience finds believable (either because the source is an expert, a well-loved
person, a trusted peer, a respected organization, etc.).
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There are three features that must be included in substance use prevention messages:
Motivation for the audience to listen to it
Strong credible arguments that are difficult to deny
Some type of reinforcement for the audience to accept the communication’s message
or position.
Strong messages are messages that contain facts that are bolstered by strong evidence,
not just someone’s opinion (Krosnick & Petty, 1995).
These strong arguments need to reinforce the audience for accepting them. For example,
the message might suggest that smart people all agree with the message. In many
contexts, the audience will want to be included in that group. As such, accepting the
message is reinforcing to the audience member. This means, of course, that it is critical to
know what is reinforcing to the members of our audience.

Audience Motivation
Motivation for the audience to attend to our message requires strong arguments, and
reinforcement. These are features of the message that should be tested in advance to
ensure that they are as effective as possible.
Media ads are costly. They should not be brought to the field without first being pre-
tested with a group or groups of people who are similar to the audience to be persuaded.
Sampling and use of focus groups for such testing are addressed in more detail in Course
3: Monitoring and Evaluation.
It should be emphasized that merely gaining attention is not enough. Expensive but not
effective media campaigns to prevent substance use are a relatively common feature of
the communication research literature. Many may have successfully gained considerable
attention. In fact, people have remembered then years after they appeared on television,
but research showed that the ads really didn’t persuade many people to avoid substance
use. There’s a big difference between gaining attention and persuasion.

TO WHOM is the Message Directed?

Many campaigns have lost many important opportunities by failing to target their
communications to a specific audience. It is important to specify in advance who is to
be the major target of the prevention campaign. One size does not fit all in substance
use prevention. Some people we reach in our campaigns do not use substances, have
not used them in the past, and are absolutely determined never to do so. We need to
reinforce these people for their healthy, intelligent, and reasonable behavior. We don’t
need to persuade them not to use substances – they’ve already made that decision.
Rather, our communications should reinforce them to ensure they maintain their decision
to remain abstinent.
Other people might not have ever used, but might be considering initiating substance
use. We need to find out their motivational thinking. Why would they consider trying a
substance? When we can answer that question, we can intelligently design our media
campaign to confront their reasoning.

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Substance Use Prevention
So, for example, a young adolescent might be considering substance use such as alcohol
because many of his popular schoolmates are experimenting with this substance. In this
case, we need to reinforce abstinence, as with the resolute nonusers, but also we must
point out the lack of connection between popularity and usage, or question whether it is
worth taking the risks of substance use for popularity (Siegel et al., 2009).
For users, we also need to determine motivation. Are they using substances as a means
of self-medicating? If so, help-lines may be a useful adjunct to a campaign. Are they using
merely for the experience, the fun? Possible reasons not to do so are readily available,
and should be presented – but not in a way designed to scare the audience (Fishbein et
al., 2002).
Remember, there is evidence from years of research that indicates that fear alone is not
a strong motivator – it usually does not work the way we want it to. The message should
appeal to reason, it should persuade, not attempt to scare the audience (Maddux &
Rogers, 1983).

Overcoming Resistance
Receivers’ Common Reactions
Just as with any prevention intervention, it is important to think about how the message
will be received by the audience that is being targeted. How will audience members
defend established beliefs about substance use? How will these beliefs be combated
with appropriate evidence that is conveyed in the persuasive communications?
In substance use prevention campaigns, for example, the target might respond to a
substance use prevention message with the following thoughts: “Should I abstain from
substances to stay healthy and make my family proud of me, or should I use substances
to self-medicate, or to fit in with my friends? Which is most important to me?”
If the standard responses to substance use prevention communications can be anticipated,
communications can be developed that are more persuasive than those based on a
mere assumption of the audience’s motivations. This suggests that the communication
developer talk to potential audience members before going into the field, to try to
anticipate defenses and build communications that deal with them.

MLR Model: Overcoming Resistance

The secret to developing persuasive messages is to create communications that question
the audience member’s established beliefs on a topic (say, substance use), provide an
alternative response to the one they would come up with, and then provide some form of
reinforcement for agreement with your (the communicator’s) message.
Strong messages, based on logic, presented by a source of high expertise and trust, will
be more likely to persuade than any other. Use this information in developing (or judging
the value of) communications (Petty et al., 1988, 2005).
There’s a strong tendency of substance use prevention media developers to design
communications based on negative reinforcement or punishment. This is a mistake, even
though it is common.

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People do not like to be told that their beliefs or actions will cause them to experience
problems. It is easier to avoid a high-fear arousing message than to process it. That is,
it is painful to think about the negative things that will happen if a habitual behavior is
continued, so people often will simply not think about your persuasive substance use
prevention communication. When people are confronted with a strong fear-arousing
message about a substance they are using, they will try to control the resultant fear rather
than deal with the danger (Maddux & Rogers, 1983; Witte & Allen, 2000).
In this circumstance, you will find that the highly emotional respondents have not
processed your substance use prevention message. They will resist, distort, and otherwise
try to shield themselves from it. This resistance will render acceptance of your ideas very
unlikely.
Fear arousal may work well with people who already are avoiding the use of a psychoactive
substance, but it will alienate users. A much better strategy is to develop an approach that
appeals both to users and non-users alike. This maximizes the impact of your prevention
expenditures.

References
Baran, S. & Davis, D. (1995). Mass Communication Theory: Foundations, Ferment, and
Future. Belmont: Wadsworth.
Byrne, D. (1971). The attraction paradigm. New York: Academic Press
Cho, H. (2012). Health communication message design: Theory and practice. Thousand
Oaks, CA: Sage.
Condon, J. W, & Crano, W.D. (1988). Inferred evaluation and the relation between attitude
similarity and interpersonal attraction. Journal of Personality and Social Psychology, 5,
789-797.
Crano, W. D., Siegel, J. T., Alvaro, E. M., & Patel, N. M. (2007). Overcoming adolescents’
resistance to anti-inhalant appeals. Psychology of Addictive Behaviors, 21, 516-524.
Fishbein, M., Cappella, J., Hornik, R., Sayeed, S., Yzer, M., & Ahern, R. K. (2002). The role of
theory in developing effective antidrug public service announcements. In W. D. Crano &
M. Burgoon (Eds.), Mass media and drug prevention: Classic and contemporary theories
and research. (pp. 89-117). Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers.
Hovland, C. I., & Weiss, W. (1951). The influence of source credibility on communication
effectiveness. Public Opinion Quarterly, 15, 635-650.
Hovland, C. I., Janis, I. L., & Kelley, H. H. (1953). Communication and persuasion;
psychological studies of opinion change. New Haven, CT, US: Yale University Press.
Krosnick, J., & Petty, R.E. (1995). Message strength: Antecedents and consequences.
Hillsdale, NJ: Erlbaum.
Lasswell, H. D. (1949). The structure and function of communication in society. In L. Bryson
(Ed.), The communication of ideas. (pp. 37-51). Oxford, England: Harper.

Participant Manual: Module 4—Practical Application of Theories of Persuasion in 169

Substance Use Prevention
Maddux, J. E., & Rogers, R. W. (1983). Protection motivation and self-efficacy: A revised
theory of fear appeals and attitude change. Journal of Experimental Social Psychology,
19(5), 469-479.
Petty, R.E., & Cacioppo, J.T. (1986). Communication and persuasion: Central and peripheral
routes to attitude change. New York: Springer-Verlag.
Petty, R. E., Cacioppo, J. T., & Kasmer, J. A. (1988). The role of affect in the elaboration
likelihood model of persuasion. In L. Donohew, H. E. Sypher & E. T. Higgins (Eds.).
Communication, social cognition, and affect. (pp. 117-146). Hillsdale, NJ, USA: Erlbaum.
Petty, R. E., Cacioppo, J. T., Strathman, A. J., & Priester, J. R. (2005). To Think or Not to
Think: Exploring Two Routes to Persuasion. In T. C. Brock & M. C. Green (Eds.). Persuasion:
Psychological insights and perspectives, 2nd ed. (pp. 81-116). Thousand Oaks, CA, US:
Sage.
Siegel, J. T., Alvaro, E. M., Patel, N., & Crano, W. D. (2009). ‘...you would probably want
to do it. Cause that’s what made them popular’: Exploring perceptions of inhalant utility
among young adolescent nonusers and occasional users. Substance Use & Misuse, 44,
597-615.
Stovall, E.E., Rossow, I., & Rise, J. (2014), Changes in attitudes towards restrictive alcohol
policy measures: the mediating role of changes in beliefs. Journal of Substance Use, 19,
38-43.
Witte, K., & Allen, M. (2000). A meta-analysis of fear appeals: Implications for effective
public health campaigns. Health Education & Behavior, 27, 591-615.

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
MODULE 5
THE TWO-STEP FLOW OF COMMUNICATION
AND PARENTAL IMPACT

Content and timeline......................................................................................173

Training goals and learning objectives..........................................................173
Introduction to Module 5................................................................................174
PowerPoint slides............................................................................................175
Resource page.................................................................................................189
Summary...........................................................................................................191

171
Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 5 15 minutes
Presentation: Two-Step Flow of Communication Model 20 minutes
Presentation and discussion: Parental influence on
25 minutes
children’s substance use: Current research
Small-group exercise: Opinion leader communication 30 minutes
Reflections and Module 5 evaluation 15 minutes
Break 15 minutes

Module 5 Objectives
Learning objectives
Participants who complete Module 5 will be able to:
Explain the basic features of the Two-Step Flow of Communication Model;
Describe the ways in which we can take advantage of the model in substance use
prevention; and
Discuss how the effects of persuasive substance use prevention media filter through
intermediaries to affect the larger population.

Participant Manual: Module 5—The Two-Step Flow of Communication and Parental 173
Impact
Introduction to Module 5
Module 5 describes how to apply the Two-Step Flow of Communication model to the
development of a substance use prevention campaign to reach youth. The theory
underlying the model, developed by Paul Lazarsfeld and colleagues (1944), suggests that
the mass media are not as effective at persuading individuals as face to face interpersonal
communication. So, a media strategy that encourages opinion leaders to communicate a
message to their followers—the two steps--can be an effective approach.
In fact, research has shown that a media-based substance use prevention campaign
targeted to parents did indeed reach their children with effective prevention messages.
While many believe that children no longer listen to their parents when they become
teens, media and other prevention research has shown that parents continue to have
influence over their children, even into their young adulthood. In the substance use
prevention area, however, it is important for parents to know more than their children
about substances and substance use, and have the confidence in that knowledge to
speak with their children.
The module provides an overview of the research on the U.S. “Parents” campaign that was
found to be effective in reaching children with substance use prevention messages. The
research showed that the more parents were exposed to the campaign communications,
the more favorable were their attitudes about talking with their children about substances
and substance use. Other findings will also be discussed.

174
Managers and Supervisors Course 08: Media-Based Prevention Interventions
The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and
Managers and Supervisors
Supervisors
Course 08
Course 07
Media-Based
Prevention Interventions

MODULE 5—THE TWO-STEP FLOW OF

COMMUNICATION AND PARENTAL IMPACT

5.1

_____________________________________________________________________________

Participant Manual: Module 5—The Two-Step Flow of Communication and Parental 175
Impact
Introduction

5.2

Learning Objectives

 Explain the basic features of the Two-Step Flow

of Communication Model
 Describe the ways in which we can take
advantage of the model in substance use
prevention
 Discuss how the effects of persuasive substance
use prevention media filter through
intermediaries to affect the larger population

5.3

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Review of Module 4

 Recall the classic prevention formula

 Source, message, audience, and delivery format all
affect the persuasiveness of a communication
 The cognitive contest
 The three functions of a persuasive
communication
 Raise a question
 Answer the question
 Provide incentives to accepting the message of the
communication
5.4

_____________________________________________________________________________

Participant Manual: Module 5—The Two-Step Flow of Communication and Parental 177
Impact
Two-Step Flow of
Communication Model

5.5

The Two-Step Flow of Communication

Model (1/4)

 The Two-Step Flow of Communication Model is

a theory of media effects on audiences
 It holds that ideas flow from media to local
“opinion leaders” who in turn pass them on to
those with more limited knowledge, or “opinion
followers

5.6

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
The Two-Step Flow of Communication
Model (2/4)

 Person-to-person persuasive efforts are usually

more effective than media-based efforts
 This does not imply that the media are
ineffective, but rather that we might be focusing
on the wrong audience and on the wrong
messages
 We should be attending to the media’s effects on
opinion leaders

5.7

_____________________________________________________________________________

Participant Manual: Module 5—The Two-Step Flow of Communication and Parental 179
Impact
The Two-Step Flow of Communication
Model (3/4)

5.8

The Two-Step Flow of Communication

Model (4/4)

The Two-Step Flow of Communication Model

specifies the best way to use media to persuade
youth. Potential targets include…
 Peers. Yes, but their influence often is
destructive or, at best, unpredictable
 Parents. Who knows their children better?

5.9

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Parental Influence on
Children’s Substance Use:
Current Research

5.10

_____________________________________________________________________________

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Impact
Parents as Central Targets of a Youth
Substance Use Prevention Media Campaign

Two-Step Flow of Communication suggests:

 If we enable parents to take on the role of
prevention specialist for their children;
 And, if they are motivated and informed;
 We will have created an ideal context for
persuasion

5.11

Parents as Substance Use Preventionists

The central question is the potential efficacy of parents in

disseminating media-based substance use prevention
information
 Parents remain the primary socialization agents for their
children throughout their lives
 Some may think that adolescents grow apart from
parents and rely on their peers
 Yes, as children grow, they become more dependent on
peers
 However, parental influence continues well into young
adulthood
5.12

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
The “Parents” Campaign

 Parents – the anti-drug campaign

 The Parents campaign showed parents how
best to discipline their children when they had
used marijuana
 This part of the campaign was successful, for
two possible reasons
 Parents learned how to discipline their children who
had used marijuana
 Children were persuaded by the parent message

5.13

_____________________________________________________________________________

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Impact
How Do Parents Impart Influence?

Parental Monitoring
 The study investigated the link between parental
monitoring and adolescents marijuana use
 Analysis disclosed a statistically significant
relation between monitoring and marijuana use
 The relation was stronger among girls, and
when monitoring was defined only by knowledge
(vs. intense surveillance)

5.14

A More Direct Test of the Two-Step Flow of

Communication Model (1/3)

 Studied effects of parents’ exposure to

substance prevention media ads, then on
parents’ prevention-oriented conversations with
their children
 In the second year, children’s perceptions of
parents’ behaviors, and their subsequent
intentions to use marijuana was studied

5.15

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
A More Direct Test of the Two-Step Flow of
Communication Model (2/3)

 Parents’ exposure to the substance use prevention

media was positively linked with their attitude to
communicate with their children
 Greater exposure also was associated with parents’
expectations that their significant others (friends, etc.)
would approve of their talking with children about
substance use
 Favorable attitudes toward communicating with their
children and the perceived approval by significant
others both anticipated parents’ intentions to speak
with their children about substance use
5.16

_____________________________________________________________________________

Participant Manual: Module 5—The Two-Step Flow of Communication and Parental 185
Impact
A More Direct Test of the Two-Step Flow of
Communication Model (3/3)

 Parents’ intentions to speak with their children about

substance use were linked with children’s reports of
actually speaking with their parents about substance
use
 Children who reported higher levels of
communication with their parents about substance
use reported stronger intentions to avoid substance
use
 And, as considerable research has shown,
behavioral intentions are strongly associated with
actual behavior
5.17

Small-group Exercise: Opinion Leader

Communication

Based on what you have learned so far, across all

the modules, please design a communication that
 Takes advantage of the insights of the Two-Step
Flow of Communication
 Encourages opinion leaders to talk with their
followers about the dangers of substance
misuse
 Gives leaders the necessary skills to do so

5.18

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Large-group Exercise: Reflections

 What information that you learned in this module

is most important for your work as a Prevention
Manager and Supervisor?

 Why?

5.19

_____________________________________________________________________________

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Impact
Module 5 Evaluation
5.20

_____________________________________________________________________________

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Resource Page 5.1

The Two-step Flow of Communication Model explains how the media can influence an
audience.
It suggests that the mass media are not particularly effective at persuading individuals.
Rather, face to face, interpersonal communication is much more effective.
How do the media persuade?
By persuading individual opinion leaders, the people that others listen to.
These opinion leaders, in turn, convey the media’s message to those who are
responsive to them.
The implications of the Two-step Flow of Communication Model are that
Peers may be highly influential; however, it might be dangerous to seek out opinion
leaders among a youth’s peer group, as such leaders often suggest destructive
behaviors, like substance use.
Parents have been a somewhat neglected force in prevention – they can play a strong
role as opinion leaders for their children.
• However, media must inform parents about substance use issues to play an effective
role in prevention.
• Parents must be motivated to do so; often, knowing what to say is sufficient to engage
parents in substance use prevention.
A media campaign focused on parents’ working with their children had a strong impact on
adolescent substance use in the US. This effect was attributed to the change in parents’
behavior.
Also possible that the adolescents were persuaded by the message aimed at parents,
as they were unlikely to strongly defend any contrary beliefs , as the message was not
apparently intended for them (this is called a “misdirection effect”).
Recent research has shown the strong effect of parental monitoring on their children’s
substance use
A recent study combining data from 17 independent studies, and more than 35,000
research participants showed the strong effect of monitoring on their children’s
marijuana use.
• These results were strongest in families in which parents knew about their children’s
behavior because their children talked with them about it.
• This suggests the importance of family warmth.

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Impact
Another study showed that when parents responded positively to preventive substance
use media, they were more likely to discuss substance use with their children, and
• These conversations affected their children’s attitudes.
• The children’s attitudes affected their substance use behavioral intentions.
• We know from much prior research that behavioral intentions are causally linked to
subsequent behavior.

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Summary of Module 5: Building and Using Logic
Models in Monitoring and Evaluation
Introduction
This module described how to construct and evaluate persuasive communications in
media substance use prevention campaigns. Specifically, the module focused on the
application of the Two-Step Flow of Communication model (Lamb & Crano, 2014; Miller
et al., 2013; Napper et al, 2014; Pinchevsky et al., 2012).
The training goals for this module were:
Describe a theory of media - the Two-Step Flow of Communication - that suggests the
ways in which persuasion is induced through mass media communications;
Show how parents can play an important role in prevention, especially for their
adolescent children; and
Describe the ways in which parental monitoring and family warmth fit with the
requirements of the Two-Step Flow theory.
The foundation for the application of the Two-Step Flow of Communication model to the
interface between parents and their children is based on research that has demonstrated
the effectiveness of parents in lowering the risks of their children’s involvement in
substance use.

The Two-Step Flow of Communication Model

The Two-Step Flow of Communication model suggests the ways the media impart
influence. We will cover this model in detail because it specifies how the media work, and
also, how media effects should be evaluated. In the case of adolescent substance use, the
model suggests that parents may be effective transmitters of media-supplied substance
use prevention information. The media, in other words, work through the parents, who
interpret and transmit the information for their children.
Often, more is expected of media-based substance use prevention than the technique
is capable of providing. It is important to understand what the media can do to prevent
substance use, and what they cannot do. The Two-Step Flow model provides this
understanding.
The theory developed by Paul Lazarsfeld and colleagues in 1944 suggests that the mass
media are not particularly effective at persuading individuals. However, face to face,
interpersonal communication is much more effective. So how do the media persuade?
By persuading individual opinion leaders, the people that others listen to. These opinion
leaders, in turn, convey the message of the media to those who are responsive to them.
Research suggests that person-to-person communication often can be more effective
than traditional mass media (TV, radio), and this may be especially true for adolescents.

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Impact
When youth discuss issues with friends and peers, adults’ views may be discounted
as irrelevant, possibly because the adults do not know how to convey substance use
prevention information. If they could do so, then we might succeed in producing strong
prevention effects. We might be able to do this by focusing our youth prevention
campaigns on informing adults how to act as opinion leaders. This suggests, perhaps,
that we have been measuring the wrong outcome variables when engaging in media
campaigns. Why?
Because in substance use prevention media campaigns aimed at youth, the theory
suggests that success can be predicted by evaluating the actions of adults: community
leaders, teachers, parents, etc. If they are attending to the media, and if the media-
based communications are informative and persuasive, there is a high likelihood that the
program will succeed with youth. The “opinion leaders” will have been reached, and their
influence will affect youth.
Peers can be very influential. However, the ways they influence others may be destructive.
They might hold beliefs that are anti-social or delinquent, pro-substance, pro-
experimentation, etc., so it is risky to target youth as potential opinion leaders of their
peer group, even though they might have considerable influence. It is the way they use
this influence in the peer group that is questionable.
Parents know the unique issues their children must face. They are proven and effective
sources of influence (despite the youth’s growing attention to peers). However, many
parents are not confident in their knowledge about the many substances that seem so
readily available. Because of this, they may avoid having discussions about substance use
with their children. By providing information to parents that they can understand and use,
we may take advantage of the two-step flow concept, while taking advantage of a very
powerful opinion leader, the parents of the youth.

Parental Influence on Children’s Substance Use: Current

Research
Parents can be the ideal opinion leaders for their children. However, they must know
more than their children about substances and substance use, and be confident enough
in their knowledge to speak with their children.
The media therefore must motivate and inform parents to transmit the information from
the media to the child. This is an ideal context for persuasion, assuming that the media
messages are clear and informative, and also motivate the parent to take on this difficult
task.

Parents as Substance Use Preventionists

Can parents effectively influence their children?
Are parents teachable?
Can the average parent affect their children’s substance use?

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
There is considerable evidence that suggests parents can be ideal collaborators in our
substance use prevention efforts. Some may think that adolescents grow apart from
parents and rely on their peers. However, parental influence continues well into young
adulthood (Elkins et al., 2014; Scull et al., 2014; Wang et al., 2013). The following are some
of the studies that show how effective this can be.

The “Parents” Campaign

A part of a national substance use prevention campaign in the U.S. used the media to
show parents how best to discipline their children when their children had been caught
using marijuana.
It is important to understand that the communication media encouraged parents to monitor
their children, to ensure they avoided substance use, and to provide consequences if they
used substances. The parents in the ads were positive models. They were not mean or
nasty; rather, they were firm and authoritative. They stressed the children should not use
substances, and that there were consequences if they did. However, they did it in a warm
and loving way. The message conveyed parental love and concern for their children and
at the same time emphasized their authority as parents. This section of the campaign
worked very well. Apparently, parents were encouraged by this set of communications,
and used the information they contained to guide their responses to their children.
This campaign had a nationwide impact on adolescent substance use in the U.S.
This effect was attributed to the change in parents’ behavior, brought about by the
communications that were used in the campaign. It also is possible that children watched
the communications as well, and did not resist them, as they were directed toward their
parents.
Remember our discussion of the “mis-direction” effect? Let’s consider how parents might
affect their children’s substance use (Crano et al., 2007).

Parental Monitoring
A recent study combined the results of every published study that focused on parental
monitoring of children’s marijuana use. Data involving 17 independent studies, and more
than 35,000 research participants was analyzed (Lac & Crano, 2009). The results revealed a
statistically significant effect of monitoring: Greater parental monitoring of their children
was associated with significantly lower levels of marijuana use by their children. This same
effect also was noted in the course on family-based prevention interventions.
This relation was stronger for girls than for boys, suggesting either that girls are more
sensitive to parental monitoring, or that parents monitored their girls more closely than
their boys.
Finally, the results were strongest when monitoring was defined in terms of parental
knowledge of the child’s actions when they were not being monitored. How did the
parents know? The children told them. This suggests that a close parent-child bond is a
strong protective factor against substance use. Recent research has strongly reinforced
the importance of combining a warm family environment with monitoring to achieve the
most powerful substance prevention effects for youth (Donaldson, Nakawaki, & Crano,
2015).

Participant Manual: Module 5—The Two-Step Flow of Communication and Parental 193
Impact
A More Direct Test of the Two-Step Flow Model
A study was conducted to study the effects of parents’ exposure to substance use
prevention media ads. It was designed to see if parents’ exposure to substance use
prevention media affected their substance communication behaviors with their children
(Huansuriya et al., 2014).
This study used data from a nationally representative sample in the United States to test
the Two-Step Flow model. It was focused directly on the effects of parents’ exposure to
substance use prevention media, their reactions to this exposure, their communication
with their children about substance use, and the children’s ultimate intentions to use
substances. As we have seen already, research has found that intentions to use are usually
followed by actual usage.
The parents’ data were collected in the first year of the study; the children’s data in Year
2 of the study. The study was repeated two years later, with identical results, so we’ll just
talk about the first set of results.
Specifically the study showed that the more parents were exposed to the substance
prevention media communications, the more favorable was their attitude about talking
with their children about substances and substance use. The study also showed that the
more parents were exposed to the anti-substance use media, the more certain they were
that their significant others (friends, etc.) would approve of their talking with their children
about substance use prevention.
These two factors – favorable attitudes toward communicating with their children and the
perceived approval by significant others both anticipated their intentions to speak with
their children about substance use.
The measure of parents’ intentions to talk with their children was associated with children’s
reports of the extent to which parents actually did talk with them about substances.
Parents’ intentions were reflected in their children’s reports. The parents’ reports were
valid. But, did their communication with their children matter? Children who reported
higher levels of communication with their parents about substance use reported stronger
intentions to avoid substance use.
And, as considerable research has shown, behavioral intentions are strongly associated
with actual behavior (Ajzen & Fishbein, 1972; Ajzen & Fishbein, 2008; Armitage & Conner,
2001; Fishbein, 2008; Noar et al., 2006; Sheeran & Taylor, 1999).

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References
Ajzen, I., & Fishbein, M. (1972). Attitudes and normative beliefs as factors influencing
behavioral intentions. Journal of Personality and Social Psychology, 21(1), 1-9.
Ajzen, I., & Fishbein, M. (2008). Attitudinal and normative variables as predictors of
specific behaviors. In R. H. Fazio & R. E. Petty (Eds.), Attitudes: Their structure, function,
and consequences. (pp. 425-443). New York, NY, US: Psychology Press.
Armitage, C. J., & Conner, M. (2001). Efficacy of the theory of planned behaviour: A meta-
analytic review. British Journal of Social Psychology, 40(4), 471-499.
Crano, W. D., Siegel, J. T., Alvaro, E. M., & Patel, N. M. (2007). Overcoming adolescents’
resistance to anti-inhalant appeals. Psychology of Addictive Behaviors, 21, 516-524.
Donaldson, C.D., Nakawaki, B., & Crano, W.D. (2015). Variations in parental monitoring
and predictions of adolescent prescription opioid and stimulant misuse. Addictive
Behaviors, 45, 14-21.
Elkins, S. R., Fite, P. J., Moore, T. M., Lochman, J. E., & Wells, K. C. (2014). Bidirectional
effects of parenting and youth substance use during the transition to middle and high
school. Psychology of Addictive Behaviors, 28(2), 475-486.
Fishbein, M. (2009). An integrative model for behavioral prediction and its application
to health promotion. In R. J. DiClemente, R. A. Crosby & M. C. Kegler (Eds.), Emerging
theories in health promotion practice and research (2nd ed.). (pp. 215-234). San Francisco,
CA, US: Jossey-Bass.
Huansuriya, T., Siegel, J. T., & Crano, W. D. (2014). Parent–child drug communication:
Pathway from parents’ ad exposure to youth’s marijuana use intention. Journal of Health
Communication, 19(2), 244-259.
Lac, A., & Crano, W. D. (2009). Monitoring matters: Meta-analytic review reveals the
reliable linkage of parental monitoring with adolescent marijuana use. Perspectives on
Psychological Science, 4(6), 578-586.
Lamb, C. S., & Crano, W. D. (2014). Parents’ beliefs and children’s marijuana use: Evidence
for a self-fulfilling prophecy effect. Addictive Behaviors, 39(1), 127-132.
Lazarsfeld, P. F., Berelson, B., Gaudet, H. (1944). The People’s Choice: How the voter
makes up his mind in a Presidential campaign. New York: Columbia University Press.
Miller, S. M., Siegel, J. T., Hohman, Z., & Crano, W. D. (2013). Factors mediating the
association of the recency of parent’s marijuana use and their adolescent children’s
subsequent initiation. Psychology of Addictive Behaviors, 27(3), 848-853.
Napper, L. E., Hummer, J. F., Chithambo, T. P., & LaBrie, J. W. (2014). Perceived parent
and peer marijuana norms: The moderating effect of parental monitoring during college.
Prevention Science.

Participant Manual: Module 5—The Two-Step Flow of Communication and Parental 195
Impact
Noar, S. M., Carlyle, K., & Cole, C. (2006). Why Communication Is Crucial: Meta-Analysis
of the Relationship Between Safer Sexual Communication and Condom Use. Journal of
Health Communication, 11(4), 365-390.
Pinchevsky, G. M., Arria, A. M., Caldeira, K. M., Garnier-Dykstra, L. M., Vincent, K. B.,
& O’Grady, K. E. (2012). Marijuana exposure opportunity and initiation during college:
Parent and peer influences. Prevention Science, 13(1), 43-54.
Scull, T. M., Kupersmidt, J. B., & Erausquin, J. T. (2014). The impact of media-related
cognitions on children’s substance use outcomes in the context of parental and peer
substance use. Journal of Youth and Adolescence, 43(5), 717-728.
Sheeran, P., & Taylor, S. (1999). Predicting intentions to use condoms: A meta-analysis and
comparison of the theories of reasoned action and planned behavior. Journal of Applied
Social Psychology, 29(8), 1624-1675.
Wang, B., Stanton, B., Li, X., Cottrell, L., Deveaux, L., & Kaljee, L. (2013). The influence
of parental monitoring and parent–adolescent communication on Bahamian adolescent
risk involvement: A three-year longitudinal examination. Social Science & Medicine, 97,
161-169

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
MODULE 6
PRE- AND POST-EVALUATION OF EFFECTS OF
MEDIA-BASED PREVENTION INTERVENTIONS

Content and timeline......................................................................................199

Training goals and learning objectives..........................................................199
Introduction to Module 6................................................................................200
PowerPoint slides............................................................................................201
Resource page.................................................................................................232
Summary...........................................................................................................235

197
Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 6 15 minutes
Presentation and discussion: Processes involved in
10 minutes
evaluation of a media program
Presentation and discussion: Baseline measures of the
30 minutes
problem
Presentation: Process assessment of implementation 10 minutes
Presentation and discussion: Outcome assessment 30 minutes
Lunch 60 minutes
Presentation: Common research designs for media 15 minutes
Presentation and discussion: Campaign
15 minutes
implementation assessment
Small-group exercise: Measuring the Two-Step Flow
30 minutes
Model
Closing comments, reflections and Module 6
15 minutes
evaluation
Break 15 minutes

Module 6 Objectives
Learning objectives
Participants who complete module 6 will be able to:
Develop measures of the media campaign’s audience’s knowledge, attitudes, and
intentions to use psychoactive substances;
Describe the importance of pre-and post-assessments of these measures to determine
campaign effectiveness;
Determine if persuasive effects found on immediate post-campaign measurement
persist over time, at the individual and community levels; and
Describe the data necessary to inform the development of effective substance use
prevention campaigns in your home context.

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 199

Prevention Interventions
Introduction to Module 6
Module 6 will outline the processes involved in monitoring and evaluating a media-
based prevention campaign. As with all evidence-based prevention efforts, Prevention
Managers and Supervisors need to monitor and evaluate to assess the effectiveness of
their work. The elements of the media-based evaluation include:
Baseline measures—e.g., surveys of the problem; archival data;
An assessment of the logic upon which the intervention program is based;
A process assessment, which measures the program’s implementation (number and
characteristics of the target audience reached, etc.); and
An outcome assessment, which is designed to determine the extent to which the
intervention achieved its planned objectives--in the short-term, intermediate, and
long-term.
The baseline measures essentially define the nature of the substance use problem in
the community. These are composed of descriptive and analytic information. Descriptive
information includes: The types of substances being used; the characteristics of users;
the consequences of use; and perceptions of use among the community population.
Analytic information describes the origins and progress of substance use and identifies
the determinants and the interaction of factors that are associated with the initiation of
substance use.
The second element will consider the logic model of the intervention, which is the theory
on which the intervention is based. It is informed by the problem assessment, and in
turn helps guide all subsequent aspects of the intervention design, development and
implementation, and its evaluation.
The process assessment is a critical evaluation component because it monitors the
implementation of the campaign. The process assessment focuses fundamentally on the
reach of the intervention. This means that it is concerned with whether or not the intended
targets of the intervention actually were exposed to the media intervention. After reach,
then the WHO, WHAT, TO WHOM, and HOW questions form the other aspects of
monitoring/process evaluation. You will learn how to evaluate whether the source was
the right message giver; the content was effectively formatted and understood; and the
medium was the best way to reach and hold the audience’s attention.
You will also learn about the best methods for evaluating the outcome of a campaign
(the outcome evaluation), which can be more challenging than other interventions. You
will learn about the advantages and disadvantages of various methodologies. Essential
to this is an assessment of campaign implementation, the measure of reach described
above. Individual level assessments are critically important. They are used to determine
whether the audience responded as expected. You will see some standardized questions
that measure substance use behavior and attitudes. You will also learn about community-
level assessments which look at community-wide data sources, such as police reports,
school attendance, overdose deaths, etc. Depending on the campaign focus, these would
be monitored over time to determine changes in response to the campaign.
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Managers and Supervisors Course 08: Media-Based Prevention Interventions
The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and
Managers and Supervisors
Supervisors
Course 08
Course 07
Media-Based
Prevention Interventions

MODULE 6—PRE- AND POST-EVALUATION OF

EFFECTS OF MEDIA-BASED PREVENTION
INTERVENTIONS

6.1

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 201

Prevention Interventions
Introduction

6.2

Learning Objectives

 Develop measures of the media campaign’s audience’s

knowledge, attitudes, and intentions to use psychoactive
substances
 Describe the importance of pre-and post-assessments
of these measures to determine campaign effectiveness
 Determine if persuasive effects found on immediate
post-campaign measurement persist over time, at the
individual and community levels
 Describe the data necessary to inform the development
of effective substance use prevention campaigns in your
home context
6.3

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Processes Involved in
Evaluation of a Media-
Based Program

6.4

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 203

Prevention Interventions
Monitoring and Evaluation System

6.5

The Processes Involved in Evaluation of a

Prevention Intervention

 BaselineMeasures of the Problem

 Assessing Program Design/Logic
 Assessing Implementation
 Assessing Outcome

6.6

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Baseline Measures of the
Problem

6.7

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 205

Prevention Interventions
Baseline Measures

 Data available from

 Police/arrest reports
 Hospitals
 Reports from coroners, medical examiners, pathologists,
toxicologists, school truancy officers, etc.
 For whom does the problem exist
 Determine the group in need of the intervention
 What problems do your target group encounter in avoiding
substance use?
 Is substance use normative?
 Is there pressure put on non-users?
 Is it dangerous to refuse to use substances?

6.8

Defining the Problem (1/3)

A study of the initial situation is conducted using

epidemiological information
 Descriptive: What the problem looks like
 Informationon substance use, patterns, and trends
 Consequences of substance use
 Substance-related perceptions
 Analytic: Why it’s happening
 Origins, or etiology, and pathways, or progression
 Identifies the determinants associated with substance
use
European Drug Prevention Quality Standards: A Manual for Prevention Professionals. EMCDDA, 2013) 6.9

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Defining the Problem (2/3)

How is information to be obtained from

respondents, either individually or in groups?
 Focus Groups
 Key Informants
 Surveys of youth and adults

6.10

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 207

Prevention Interventions
Defining the Problem (3/3)

Substance use may be attributable to many

different problems
 Do community members lack knowledge about
the dangers/effects of a particular substance?
 Or, do people hold improper attitudes or beliefs
about substance use?
 Do their Intentions lead them to substance use?

6.11

Assessing Program Design: The Logic

Model

 The logic model is the explicit proposal about

how the media intervention is supposed to affect
substance use
 Requires some hypotheses or theory about how
the media intervention is expected to operate to
prevent or lessen substance use
 This theory, in turn, guides the media
intervention and its evaluation

6.12

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Process Assessment of
Implementation

6.13

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 209

Prevention Interventions
Process Assessment (Implementation)

 Process analysis evaluates how the program is

being implemented--“Who says What to Whom”
 It is designed to learn if the target group is being
reached, and if people are receiving the intended
media intervention
 This often involves a measure of exposure (for example,
“Have you seen the recent anti-drug TV ad?”), or,
showing an ad to a respondent, and asking, “Have you
ever (or how frequently have you) seen this ad on TV?”
 Or, it might involve a simple measure of frequency of
attendance at a substance prevention program
6.14

WHY and HOW the Campaign Succeeds

PROCESS EVALUATION OUTCOME EVALUATION

 WHO is the most effective SOURCE  With what EFFECT refers
for your audience to the proper measurement
 WHAT is the most persuasive of the campaign’s
CONTENT of the communication – outcome: How is its
e.g., words and images that are used success or failure to be
evaluated
 TO WHOM−Is it actually reaching the
audience you intend to REACH, and
audience variations
 HOW is the right combination of the
message context and subtle
variations in message content, and
the MEDIUM through which the
communication is transmitted
6.15

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Outcome Assessment

6.16

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 211

Prevention Interventions
Outcome Assessment (1/2)

 Outcome assessment involves an examination

of the extent to which the media intervention
affected planned responses, as defined in the
logic model
 Positive outcomes support the logic model
 Negative outcomes sometimes can be
informative as well

6.17

Outcome Assessment (2/2)

 Outcome assessments often repeat the

measures used in the needs assessment to
illustrate change in knowledge or attitudes or
intentions from pre- to post-intervention
 The potential causes of a substance use
problem are measured in the analysis, along
with usage, which usually is the critical
information that is sought

6.18

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Simple Measure of Usage Status

Have you ever, even once, used {SUBSTANCE}? Yes/No

 If “Yes”, then ask, “Have you quit using this substance?
Yes/No
 If “NO”, then ask, “Do you intend to use {SUBSTANCE} in
the coming 12 months?
Response choices:
1. Definitely not
2. Probably not
3. Uncertain
4. Probably will
5. Definitely will
6.19

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 213

Prevention Interventions
Categorizing Respondents by Response

 YES, have used, and continuing to do so: USER

 Yes, have used, but quit: EXPERIMENTER
 No, never used and does not expect to use in
the next 12 months: RESOLUTE NONUSER
 No, never used, but may use in the next 12
months: VULNERABLE NONUSER or AT-RISK
NONUSER

6.20

Theory of Planned Behavior

Source: Icek Ajzen. (Website: http://people.umass.edu/aizen/tpb.diag.html#null-linkrce:) 6.21

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Attitude Measures Take This Form

Attitude Measures {SUBSTANCE} makes me…

 Designed to assess  Relaxed
respondents’ evaluations of a  Smarter
substance
 Creative, hungry, sleepy, etc.,
 Respondents are asked to depending on drug
respond to a common stem:
Response Scale:
 Creative
 Relaxed
1. Strongly agree
 Smarter 2. Agree
 Lazy 3. Neither
4. Disagree
5. Strongly disagree
6.22

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 215

Prevention Interventions
Example of Possible Items to Assess
Attitudes Toward Using Marijuana

Please read each statement and check the box

that best represents your feelings, for each
statement
Strongly Strongly
Agree Neutral Disagree
Agree Disagree
Marijuana is
5 4 3 2 1
harmless
Marijuana helps
5 4 3 2 1
me be creative
Marijuana helps
5 4 3 2 1
me relax
Marijuana is
1 2 3 4 5
dangerous

6.23

Example of Possible Items to Assess

Attitudes Toward Using Marijuana

Another way of assessing attitudes toward a substance:

“Please mark the scale that best describes your feelings
toward “substance.”
Substance
Good _X_:___:___:___:___:___:___ Bad
Pleasant ___:___:___:___:___:___:___ Unpleasant
Smart ___:___:___:___:___:___:___ Stupid
Wise ___:___:___:___:___:___:___ Foolish
Safe___:___:___:___:___:___:___ Dangerous

6.24

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Example of a Very Good (but not
Extremely Good) rating

Substance
Good ___:_X_:___:___:___:___:___ Bad
Pleasant ___:___:___:___:___:___:___ Unpleasant
Smart ___:___:___:___:___:___:___ Stupid
Wise ___:___:___:___:___:___:___ Foolish
Safe___:___:___:___:___:___:___ Dangerous

6.25

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 217

Prevention Interventions
Example of a “Good” Rating

“Please mark the scale that best describes your

feelings toward “substance.”

Substance
Good __:___:_x_:___:___:___:___ Bad
Pleasant ___:___:___:___:___:___:___ Unpleasant
Smart ___:___:___:___:___:___:___ Stupid
Wise ___:___:___:___:___:___:___ Foolish
Safe___:___:___:___:___:___:___ Dangerous
6.26

Example of a Neutral Rating toward the

Substance

“Please mark the scale that best describes your

feelings toward “substance.”
Substance
Good __:___:___:_X_:___:___:___ Bad
Pleasant ___:___:___:___:___:___:___ Unpleasant
Smart ___:___:___:___:___:___:___ Stupid
Wise ___:___:___:___:___:___:___ Foolish
Safe___:___:___:___:___:___:___ Dangerous

6.27

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Intention Measures Take the Following
General Form

 Designed to assess respondents’ likelihood of enacting

specific substance-relevant behaviors
 Respondents are asked to express their intention to use or
avoid a specific substance
 Over the next year, do you intend to use marijuana (or
opium, or methamphetamines, etc.). The possible
response options are:
1. Definitely Not
2. Probably Not
3. Maybe
4. Probably
5. Definitely Yes
6.28

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 219

Prevention Interventions
Common Research Designs
for Media Evaluations

6.29

Common Research Designs Used in Media

Evaluations

 Randomized Control Trial Design (RCT)

 One Group Pre-test and Post-test Design
without Control Group
 Quasi-Experimental Pre-test−Post-test Control
Group Design (without Random Assignment)
 Interrupted Time Series Design

6.30

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
A Graph of Substance Use by Respondents at
Different Ages as a Function of Experimental/Control
Condition

6.31

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 221

Prevention Interventions
Randomized Control Trial (RCT)

6.32

Randomized Control Trial (RCT)

without Pre-test

6.33

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
One Group Pre-test and Post-test Design

6.34

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 223

Prevention Interventions
Interrupted Time Series Design: Drunk
Driving Campaign

6.35

Campaign Implementation
Assessment

6.36

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Post-test Assessment (1/5)

 Assessing Implementation (Process measures)

 Outcome measures
 Decide on the unit: Is this an individual- or a
community-level evaluation

6.37

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 225

Prevention Interventions
Post-test Assessment - Implementation
Assessment (2/5)

 Implementation assessment provides an

indication of the number of people who have
made contact with the intervention
 Measuring implementation allows us to obtain
important information
 Poor results may be a function of poor
implementation

6.38

Post-test Assessment—Individual Level

Assessment (3/5)

For individual level assessments, we can

measure:
 Attitudes
 Perceptions of norms
 Intentions regarding substance use
 Behavioral resistance skills
 Knowledge
 Evaluation of the message and the messenger

6.39

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Post-test Assessment—Community-Level
Assessment: What Happened? (4/5)

 In community-level evaluations, measurement of the

media intervention effects differs from that involving
individuals
 Rather than measuring individual attitudes,
intentions, and behaviors, community level
assessments are concerned with measures such
as:
 Police reports of substance use
 Hospital admittances for substance problems, news
stories related to substance use
 Deaths due to overdose, etc.
6.40

_____________________________________________________________________________

Participant Manual: Module 6—Pre- and Post-Evaluation of Effects of Media-Based 227

Prevention Interventions
Post-test Assessment—Two-Step Flow of
Communication Model (5/5)

For media interventions based on the Two-Step

Flow of Communication Model, assessments
involve opinion leaders. These might include
 Parents
 Teachers
 Community leaders
 Popular students in schools

6.41

Small-group Exercise

For community-level measurement using the Two-

Step Flow Model, we need data from opinion
leaders.
 What kind of data would you collect?
 How would you measure whether substance use
by adolescents has become more salient with
the community at large?
 What measures would you use to determine the
success of your media intervention?
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Postscript on Evaluation

 The importance of evaluating the effectiveness

of our media-based interventions cannot be
overestimated
 The evaluation should establish the
effectiveness (or ineffectiveness) of our work,
and show where improvements are needed
 If the evaluation does this, it will prove highly
useful for future prevention
 Nothing ever works perfectly, but we can
gradually improve our prevention work
6.43

_____________________________________________________________________________

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Large-group Exercise: Reflections

 What information that you learned in this module

is most important for your work as a Prevention
Manager and Supervisor?

 Why?

6.44

Module 6 Evaluation
6.45

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_____________________________________________________________________________

_____________________________________________________________________________

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Resource Page 6.1

The processes involved in evaluating a media intervention involve

Assessing needs;
Assessing program design/logic;
Assessing implementation; and
Assessing outcomes.
Assessing needs requires that we first establish that a problem exists. In a substance use
context, this determination can be based on data from:
Police/arrest reports;
Hospitals;
Coroner’s reports; and
School truancy reports.
Also need to know for whom the problem exists (that is, which groups are affected), and
why
Are particular groups of people using (e.g., school drop-outs, street people, etc.)
Is substance use normative?
Is there pressure put on non-users?
Is it dangerous to refuse to use substances?
Why is the problem not being addressed?
Do community members lack knowledge about the dangers/effects of a particular
substance?
Does the population hold improper Attitudes or Beliefs about substance use?
Do the schools avoid substance prevention discussions?
Assessing Program Design: The logic model
The assessment of program design, or the logic model, is the explicit proposal about
how the media intervention is supposed to affect substance use.
A logic model may be viewed as a series of ‘if-then’ statements
• If this kind of message is presented,

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• Then this outcome will occur
{ For example, , if we think that use of a substance is the result of people no
knowing its dangers, then to lower substance use, we will design a program to
provide this knowledge to our audience
• The logic model should be decided upon well before the media intervention is
designed.
• It is the theory on which the intervention is based.
• It is informed by the needs assessment, and in turn helps guide all subsequent
aspects of the intervention and its evaluation.
Process Assessment (Implementation) involves
Process analysis evaluates how the program is being implemented.
It is designed to learn if the target group is being reached, and if people are receiving
the intended media intervention.
Provides an indication of the number of people who have made contact with the
intervention.
Measuring implementation allows us to obtain important information.
Poor results may be a function of poor implementation.
Outcome Assessment involves
An examination of the extent to which the media intervention affected planned
responses, as defined in the logic model.
Often repeat the measures used in the needs assessment to illustrate change in
knowledge or attitudes or intentions from pre- to post-intervention.
Outcome assessment often involves measures of:
• Current usage;
• Attitudes toward substances and substance use; and
• Usage intentions.
Community level assessments often are made when the media intervention is guided by
the two step flow model of communication
In community level assessments, rather than measuring individual attitudes, intentions,
and behaviors, community level assessments are concerned with
• Measures such as: police reports of substance use;
• Hospital admittances for substance problems;

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• News stories related to substance use; and
• Deaths due to overdose.
Given its stress on opinion leaders, two step flow assessments usually focus on
• Parents;
• Teachers;
• Community leaders; and
• Popular students in schools.

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Summary of Module 6: Working with Evaluation
Research Consultants Effectively
Introduction
This module was designed to help you lay the groundwork for a successful media campaign
using monitoring and evaluation procedures. It describes how to measure various factors
to see if the media intervention worked as planned. Much of the information you need to
gauge success or failure is not immediately available, but it evolves over time. The type
of media campaign you decide to run will determine the measures that you might want
to use to measure effects.

Processes Involved in Evaluation of a Media-based Program

Evaluating a social intervention, including a media-based substance use prevention
intervention, requires a series of activities. The evaluation requires:
Baseline measures—e.g., surveys of the problem; archival data
An assessment of the logic upon which the intervention program is based
A process assessment, which measures the program’s implementation (number and
characteristics of the target audience reached, etc.)
An outcome assessment, which is designed to determine the extent to which the
intervention achieved its planned objectives

Baseline Measures
Before a campaign is begun, existing data can be collected and/or a survey can be
conducted to identify the behaviors and attitudes of the target audience. A review of
existing information from police or arrest reports, hospital reports of emergency room
visits that occur as a result of substance use, coroners’ reports of substance-induced
deaths, toxicology and pathology reports, and school truancy reports, which sometimes
are indicative of school children’s substance use is useful to inform this process. Also,
schools may have conducted a survey of students that served to identify the specific
problem being addressed—e.g., marijuana use among high school students.
It is also important to know for whom the problem exists. Are boys, or girls, or men, or
women, primarily at risk for the substance whose use we wish to prevent? Is substance
use normative or not normative? Are youth pressured by peers or older individuals to
initiate substance use? Is it safe to say “no” to offers to use psychoactive substances?
This information is valuable in determining the target group and tracking them pre- and
post-campaign implementation. These pre- and post- measures will indicate if there are
changes in behavior, attitudes, and even norms if those are the questions included in the
evaluation.

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Defining the Problem
Defining the problem within any community for prevention programming includes both
descriptive and analytic information. Descriptive information addresses the questions:
What substances are being used?
By whom were these substances used and when was use initiated (e.g., age)?
During what period of time were substances used -- within the last year, or last month,
and how frequently were they used?
How are these substances administered—are they smoked, injected, snorted?
What are the health and social consequences of such use?
What are the perceptions of substance use held not only by substance users but also
by the non-using community?
Analytic information describes the origins and progress of substance use and identifies
the determinants and the interaction of factors that are associated with the initiation of
substance use…the WHY questions.
The task of defining the problem is designed to answer the questions: Does a problem
exist? In the substance use context, such an analysis is designed to determine if a problem
of substance use actually exists in the community or group under study, and if so, who is
most at risk for substance use, and why they are using substances. As was noted, preliminary
information to answer this question can be gained from police or arrest reports, hospital
reports of emergency room visits that occur as a result of substance use, coroner’s reports
of substance-induced deaths, and school truancy reports, which sometimes are indicative
of school children’s substance use.
These societal level indicators provide a broad and general picture of the scope and
severity of the problem. In addition, consultation with the individuals whom we feel might
be involved in the problem can also shed light on the issue. Focus groups consisting of
individuals from the “community” or the “sub-groups” that the society-level variables
indicate are most at risk can be formed. Or, a key informant approach can be implemented,
in which people who know about the group in question are interviewed about the features
that motivate substance use, what types of individuals (men, women, boys, etc.) use or
refrain from the use of substances, and where usage occurs. Yet again, a survey of the
community of interest could be employed to assess knowledge, attitudes, or extent of
drug use in the community.
Again, people in a small group, or a one-on-one interview can be asked: Who uses? Why?
What substances are used? What does the substance do? How does it work?
In addition, it is important to make some assessments of the cause of the problems.
Are community members misinformed about the dangers of the substance you wish
to prevent being used?

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Do community members hold incorrect attitudes or beliefs about psychoactive
substances? For example, do some think that illicit drugs might help solve difficult
problems?
Are their intentions leading them to usage?

Assessment of Program Design: The Logic Model

The assessment of program design, or the logic model, is the explicit proposal about how
the media-based intervention is supposed to affect substance use. A logic model makes
explicit what constitutes the content, structure and delivery strategy for an intervention.
A logic model may be viewed as a series of ‘IF-THEN’ statements. It is informed by
an underlying theory of prevention. The logic model is essentially the roadmap of the
intervention. It is an explicit statement of the problem, what will be done to solve the
problem, and the expectations of the effects we expect to observe as a result of the
intervention.
The logic model phase of the evaluation should be decided upon well before the media-
based intervention is designed. It is the theory on which the intervention is based. It is
informed by the problem assessment, and in turn helps guide all subsequent aspects of
the intervention design, development and implementation, and its evaluation.

Process Assessment of Implementation

In an evaluation of a media-based intervention, a process assessment is used to determine
if the intervention is being implemented properly. In this case, it means that the media are
being delivered properly to the community members who are the designated principal
recipients of the media-based intervention, and the frequency with which the intended
recipients were actually exposed to the media messages.
Process assessment relates to the questions: “WHO says WHAT to WHOM, and with
WHAT EFFECT.” The process assessment focuses fundamentally on the reach of the
intervention. This means that it is concerned with whether or not the intended targets of
the intervention actually were exposed to the media intervention. If the intended audience
is not exposed to the persuasive anti-substance use communications, the quality of the
communications doesn’t matter, because they will not have an effect.

WHY and HOW the Campaign Succeeds

When initiating planning for a campaign, it is important that formative evaluation techniques
be used—e.g., focus groups and key informant interviews, principally--to identify
audience issues, concerns about substance use, respected sources of information, media
preferences, etc. This will help develop effective campaign messages and understand
how best to reach an audience before investing in the expense of producing an ineffective
campaign and incurring potential broadcasting costs. In the campaign design, it is useful
to conduct substance use surveys or use existing information to establish the need for the
campaign that will later serve as baseline measures to assess the impact of the campaign
on substance use over time.

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So, if the success of the campaign is to be assessed, it is important to re-examine the
elements of the campaign that were designed. The WHO, WHAT, TO WHOM, HOW
questions form what is termed the monitoring or process evaluation.
Was the SOURCE selected for the messages effective in reaching the target audience…
was the source likeable? Credible?
What about the CONTENT of the communication? Did the words and images we
selected convey the message we were trying to deliver? Did the audience understand
the communication that the use of substances can impact their everyday activities
such as school work, employment, and family stability?
In addition, was the intended audience reached by the intervention? And within that
audience, were some subgroups more attentive than others. Did the communications
resonate more with girls than boys? Younger or older adolescents?
And, was the best MEDIUM—radio, newspaper, TV ads, social networking—used to
reach the target population with the right combination of messages?

Outcome Evaluation
Finally, the OUTCOME evaluation will address – Did the campaign achieve the desired
short-, intermediate-, and long-term outcomes? Were perceptions of the normative nature
of substance use changed? Were perceptions of the negative aspects of substance use
reinforced or altered? Was there an effect on intentions to use substances in the future?
And, ultimately, was there an impact on actual substance use among those exposed to
the campaign?
It is important to consider all of these factors when designing a planned substance
use prevention media campaign. And the same features are useful when judging why
a campaign succeeded, or why it failed. For example, if a substance use prevention
campaign did not have the desired effect, it may be determined that the “WHO” in the
communication formula was not a source that the audience respected. Or, it may be found
that the particular medium used to convey the persuasive information was not a medium
that was regularly used by the intended audience (the WHOM). These considerations
alert the campaign developers to factors that matter, and that might provide insight into
program success or failure (Baran & Davis, 1995).
The outcome assessment, which considers why an intervention had an effect, involves
examination of the extent to which the media-based intervention affected planned
responses, as defined in the logic model—that is, the “WITH WHAT EFFECT”. So if it is
determined that knowledge is lacking in the target group, and it is thought that if people
knew more, they would avoid using a particular substance, then the outcome assessment
would measure both knowledge and rates of substance use.
Suppose it is found that the media campaign increased knowledge about the dangers
associated with the use of a substance. The next step would be to measure the association
between knowledge gain and its effect on substance use. In the best-case scenario, those
who learned the most from the media-based intervention would be the least likely to

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initiate substance use. This result would suggest that the intervention operated as planned
(in other words, as hypothesized in the logic model). Negative outcomes sometimes can
be informative as well. For example, an analysis of data from the audience may show that
the intervention did not affect their behaviors. Even so, this information provides some
valuable lessons.
For example, suppose the intervention did increase the audience’s knowledge about the
targeted substance, but people still initiated or continued using the substance. These
results would not suggest that the media plan was faulty (it did what it was designed
to do, which was to increase knowledge). However, perhaps it was the assumption that
usage was based on a lack of knowledge that was faulty. The logic model on which the
intervention was based was incorrect. This information, derived from an intervention that
did not produce the anticipated outcome, is nevertheless valuable.
The measures used in outcome assessments often repeat those used in defining the
problem to illustrate change in knowledge or attitudes or intentions from pre- to post-
intervention.
So, suppose an assessment of the audience’s knowledge of a particular substance was
made prior to the development of the media campaign. For the outcome assessment, the
same knowledge measure can be repeated after the campaign, to see if the campaign
had the desired effect on increasing knowledge about the substance. The logic model has
specified the potential cause of the problem, which the media intervention is designed to
change. These potential causes of substance use are measured in the analysis.
In addition, usage of the targeted substance, and others as well, are assessed. So, for
example, as the intent of the media-based intervention was on decreasing marijuana
use in a targeted audience through the media-based intervention, an assessment of
marijuana use before and after the campaign would demonstrate the effectiveness of the
intervention. However, the use of tobacco and alcohol use, nonmedical use of prescription
drugs, and other drug use may be assessed in addition to marijuana, to see if the media
intervention program had a positive effect on use of related illicit or illegal substances.
The outcome assessment is the ultimate test of the effectiveness of the program.
It is designed to answer the question: Did the intervention succeed in affecting
substance use?

Simple Measure of Usage Status

One way to categorize user types in a population involves a simple 3-item measure allows
determination if a person is a user, an experimenter, a resolute nonuser, or a vulnerable
nonuser – that is, a person at high risk for substance use. Measuring people’s behaviors,
intentions or attitudes is not difficult. The rules are simple:
1. Use short, direct sentences or questions
2. Use a simple response format throughout the scale

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Categorizing Respondents by Response
The scoring for questions for substance use or developing a substance use measure from
these questions is straightforward. Substance use prevention researchers have found it
useful to categorize their audience in terms of their usage patterns. A typical question of
this type is:
Have you ever, even once, used {SUBSTANCE}? Yes/No
If “Yes”, then, “Have you quit using this substance? Yes/No
If “No”, then, “Do you intend to use {SUBSTANCE} in the coming 12 months?
Response choices:
1. Definitely Not
2. Probably Not
3. Uncertain
4. Probably Will
5. Definitely Will
The categories of usage patterns derived from these questions would be:
People who have used a particular substance that we are interested in preventing are
called Users.
Those who have used the substance but have ceased doing so and have no intentions
to re-initiate use are called Experimenters.
Those who have never used the substance and are definite about never doing so are
called Resolute Nonusers.
Those who have never initiated use but will not definitely say they will not do so in the
next 12 months are defined as Vulnerable Non-Users or At-Risk Nonusers (Crano et
al., 2008).

Theory of Planned Behavior

Since the Theory of Planned Behavior (TPB) underlies our campaign and what media
messages are trying to achieve, the TPB components should be addressed in any
monitoring and evaluation efforts made to determine the implementation, reach, and
outcomes of the media intervention. The intervention messages should involve attitudes,
normative beliefs, and perception of control. While the outcomes of interest should be
intentions to use within a specified time period, say, in one year (‘intention’ is a proxy
measure of use) and actual substance use behaviors. How far out that can be measured
of course depends greatly on the age of the target population and the age of initiation
of substances in the target group’s community. There are many existing surveys and
questionnaires for a variety of age groups that are available (http://www.scribd.com/
doc/86164585/Question-Are-Theory-of-Planned-Behavior).

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Common Research Designs Used in Media Evaluations
Common designs used in evaluations of media-based prevention interventions include
the Randomized Control Trial (RCT), that is, the classic pre-test–post-test control group
design with participants randomly assigned to intervention and treatment conditions; the
One Group Pre-test–Post-test Design without control group; a Quasi-Experimental
Pre-test–Post-test Control Group Design without random assignment; and an
Interrupted Time-Series Design.
The reality of conducting research in the real world has prompted a number of acceptable
research designs that are particularly useful for evaluation research. Sometimes the pre-
test in these designs is not used, and participants are assigned to intervention or control
conditions randomly. This, too, is a true experimental design and is more efficient than
the classic pre-test–post-test control group design, and less likely to sensitize participants
to the treatment by the administration of the pre-test.
The One-Group Pre-test–Post-test Design without control group is one of the weakest
designs for analyzing the effects of a media intervention. It considers the effect of an
intervention on a group, but has no other group against which to compare effects, and so
many factors that might influence an audience over and above the media communication
might be responsible for an audience’s reaction. Sometimes, these designs are used to
compare results against established findings from earlier studies. However, results from
this design are always subject to explanations that do not involve the intervention
The Quasi-Experimental Pre-test–Post-test Design looks very much like the classic RCT
design, but it differs from the RCT because it does not make use of random assignment
of participants to intervention or control conditions. Lacking random assignment, causal
inferences are not strongly supported with the quasi-experimental designs. However,
they can provide useful information, and with appropriate controls, may provide strong
evidence of the possible effectiveness of a media intervention.
Another interesting quasi-experimental design is the Interrupted Time Series Design.
With these designs, we have a series of data on a particular issue (e.g., death attributed
to driving under the influence of alcohol) across a number of weeks, months, or years.
At a particular point, a media intervention campaign (the “interruption”) is introduced,
which discusses the dangers of drinking and driving. After the campaign, another series
of data are collected in the following weeks, months or years. Generally, it is advisable to
have data on at least 50 time-points on each side of the intervention. If we see a strong
change in the death rate attributed to drunk driving after the implementation of the
intervention, the result could suggest that the intervention had the intended effect. As
with all quasi-experimental designs, these conclusions are tentative, but they can suggest
the likelihood of success of an intervention, and that further implementations of media
campaigns are useful.

Post-test Assessments
The post-test assessment generally consists of assessing the implementation and
assessing the outcomes. One other aspect that needs to be considered is whether the
assessment is at the individual-level unit or community-level unit.

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Campaign Implementation Assessment. An implementation assessment provides an
indication of the number of people who have made contact with the intervention. If a
media-based intervention is developed for TV, but it is played at 4 in the morning, it
probably won’t have much impact, because its audience will be asleep. If an intervention
focuses on schoolchildren, but it is played during the school day, it is unlikely to affect the
intended audience.
Measuring implementation – how many people saw the media prevention ads, how often
were they exposed to them, etc., provides important information about the media-based
prevention campaign. Poor results may be a function of poor implementation. If the
campaign fails, there is a chance the failure has to do with the process of dissemination,
not with the information that is being disseminated. Thus, we need to design measures
that assess the extent to which people were exposed to our media.
These measures can take many forms, but generally involve asking potential audience
members if they have been exposed to the campaign material, and the frequency
with which they were exposed. “Have you seen this ad?” is a good starting question.
Sometimes recall is cued: that is, the ad is presented to the individual, and the question
is posed.
Sometimes ads are presented that were not broadcast, to get a measure of incorrect
reporting. This measure indicates the extent to which the respondents’ reports are reliable.
Individual Level Assessment. Outcome assessment measures are focused on the effects
of the media intervention. Assuming the process evaluation indicates good exposure, it
is important to know if the ads worked as planned. Did the intervention actually cause
people to quit using a substance, or to refrain from starting?
These effects can be measured at the community level and at the individual level. The
process is the same, but the items or measures used might be quite different.
To assess the impact of the intervention on individuals, their attitudes, intentions,
perception of usage norms, behavioral resistance skills, and knowledge can be measured.
Attitudes have to do with the individual’s evaluations of the principal focus of the media
campaign – a specific substance or behavior that is the target of the media. Usually,
this has to do with participants’ evaluative feelings or knowledge about substances
and substance use
Norms are concerned with respondents’ perceptions of what is considered standard
behavior in the group under study. For some groups, substance use in highly non-
normative; for other groups, it is expected. Members of these groups respond
differently to preventive persuasive appeals.
Intentions have to do with the participant’s plans to use or to avoid substance use in
the future
Behavioral resistance skills are concerned with the participant’s reported capability of
resisting offers to use the indicated substance

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Knowledge measures are concerned with the participant’s understanding of the
substance and its potentially detrimental effects
In addition, during the post-test assessment, the credibility of the message and messenger
may be addressed. These questions would assess participants’ reactions to the message
they received. Standard attitude items can be used to determine their evaluation of the
message.
The evaluation of the messenger (or message source) can be accomplished with the
standard measures used in assessing participants’ attitudes, which were discussed earlier
in this module.
Community-Level Assessment: What Happened? For community-level evaluations,
measurements differ from individual level measures. Rather than measuring individual
attitudes, intentions, and behaviors, community level assessments are concerned with
measures such as: Police reports of substance use, hospital admittances for substance
problems, news stories related to substance use, deaths due to overdose, and measures
of this type are the focus of a community-level evaluations.
If the intervention is thought to have had a positive effect, its success should be evident
in these community-level assessments. These are firm, observable measures of effects.
They do not depend on participants’ statements that they plan to avoid substance use
– they indicate whether the media campaign had an effect on important substance use
behaviors. If the media campaign succeeded, lower police reports of use (vs. those before
the intervention), fewer hospital admittances for substance problems, more news stories
about the dangers of substance use, and fewer deaths attributable to overdoses would
be found. These kinds of effects usually do not occur instantaneously. It may take time for
a media campaign’s effects to become evident, so measures should be spread over time
to determine the immediate and continuing effects of the intervention.
Two-Step Flow of Communication Model. For media interventions based on the two-step
flow of communication model, assessments involve opinion leaders. These might include
parents, teachers, community leaders, popular students in schools, and other individuals
identified as opinion leaders. These individuals differ from site to site, depending upon
the particular substance being studied, the community, etc. If the media substance use
prevention intervention had its desired effects, they should be evident in the responses
of opinion leaders, whose evaluation of the media campaign will have a considerable
influence on the likelihood that they will disseminate its message or messages to their
followers (Alvaro et al., 2013; Huansuriya et al., 2014).

Postscript on Evaluation
This module was intended to convey information about the ways in which the effect of the
media-based prevention intervention can be assessed. The importance of evaluating the
effectiveness of the media-based interventions cannot be overestimated. The evaluation
should establish the effectiveness (or ineffectiveness) of the work, and show where
improvements are needed.

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So, for example, if it is found that the intervention did not affect the targeted audience,
and it is learned from the post-test that the audience strongly resisted or disbelieved
the persuasion message, then there is evidence that the intervention failed because the
participants successfully resisted the message. This would indicate that more work was
needed to craft more persuasive communications.
Or, it might be that the participants did not find the messenger credible. Perhaps the
messenger’s credentials were not sufficient to cause the participants to listen carefully to
the message. In this case, the credentials would need to be adjusted. Or, conceivably,
the participants simply did not comprehend the message. This would be indicated by a
lack of difference in knowledge between the intervention group and the control group.
This result would suggest that the media developer learn why the message did not
come across. Perhaps it was too difficult. Perhaps it was too far removed from the lives
of the participants. This type of information is extremely valuable in helping intervention
developers design better and more effective persuasive media communications.
If the evaluation provides this kind of information, it will prove highly useful for future
prevention. Of course, interventions rarely work perfectly, but their developers can
gradually improve their prevention work with proper evaluations.
The media can be used for good, for persuading people not to begin substance use, or
for convincing them to quit if they have begun. The media can provide an efficient and
effective means of fostering substance use prevention, if they are used properly, and
evaluated sensibly.

References
Alvaro, E.M., Crano, W. D., Siegel, J.T., Hohman, Z., Johnson, I., & Nakawaki, B. (2013).
Adolescents’ attitudes toward anti-marijuana ads, usage intentions, and actual marijuana
usage. Psychology of Addictive Behaviors, 27(4), 1027-1035.
Baran, S. & Davis, D. (1995). Mass Communication Theory: Foundations, Ferment, and
Future. Belmont: Wadsworth.
Crano, W.D., Brewer, M.B., & Lac, A. (2015). Principles and methods of social research.
New York, NY: Routledge.
Crano, W. D., Siegel, J. T., Alvaro, E. M., Lac, A., & Hemovich, V. (2008). The at-risk
adolescent marijuana nonuser: Expanding the standard distinction. Prevention Science,
9, 129-137.
Huansuriya, T., Siegel, J. T., & Crano, W. D. (2014). Parent–child drug communication:
Pathway from parents’ ad exposure to youth’s marijuana use intention. Journal of Health
Communication, 19(2), 244-259.

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MODULE 7
REVIEW OF MEDIA-BASED PREVENTION INTERVENTIONS:
APPLICATION TO PRACTICE

Content and timeline......................................................................................247

Training goals and learning objectives..........................................................247
PowerPoint slides............................................................................................248

245
Content and Timeline
Person
Activity Time
Responsible
Introduction to Module 7 and review of exercise 15 minutes
Small-group exercise: Development of a media-based
prevention campaign to integrate learning from this 60 minutes
introductory curriculum
Large-group discussion: Review of plans, approaches
30 minutes
to overcoming barriers, and general Q & A session
Overall training evaluations 15 minutes
Program completion ceremony and socializing 30 minutes
End of Day 3

Module 7 Objectives
Learning objectives
Participants who complete Module 7 will be able to:
Complete a draft media prevention plan that will describe the steps needed to
implement evidence-based media prevention to address substance use problems in
their area; and
Network with other participants when they leave training through email and other
communication mechanisms.

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Participant Manual: Module 7—Review of Media-Based Prevention Interventions:
Application to Practice
The Colombo Plan Drug Advisory Programme (DAP) Training Series
Universal Prevention Curriculum for Substance Use (UPC) Managers and Supervisors Series

Managers and
Managers and Supervisors
Supervisors
Course 08
Course 07
Media-Based
Prevention Interventions

MODULE 7—REVIEW OF MEDIA-BASED

PREVENTION INTERVENTIONS:
APPLICATION TO PRACTICE

7.1

Learning Objectives

 Complete a draft media prevention plan that will

describe the steps needed to implement
evidence-based media prevention to address
substance use problems in their area
 Network with other participants when they leave
training through email and other communication
mechanisms

7.2

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Small-group Exercise

 Media-based Prevention Campaign

 Describe the problem
 What is the substance-use problem you will attack?
 Who is your audience?
 What will be included in the messages you develop?
 Why? Which theory or theories guide your message
development?
 How will the message overcome resistance?

 Describe types of media you might use to reach

your audience
 Identify facilitators of your prevention campaign
7.3

_____________________________________________________________________________

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Participant Manual: Module 7—Review of Media-Based Prevention Interventions:
Application to Practice
Large-group Discussion

Review of Media-Based
Prevention Plans

7.4

Networking Opportunities

 Exchange email addresses, telephone numbers,

and regular addresses to keep in touch;
 Training staff will be happy to answer questions
as well

7.5

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
Overall Evaluation

7.6

_____________________________________________________________________________

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Participant Manual: Module 7—Review of Media-Based Prevention Interventions:
Application to Practice
APPENDIX A—GLOSSARY
ambiguous Unclear, vague, having more than one meaning,
causing uncertainty.
audience The target of a communication; to whom a message
is directed
campaign, media A series of planned activities or a combination of
activities designed to persuade individuals and
groups
cognitive contest Counterargumentation; a mental resistant reaction
to a persuasive message that is contrary to the
individual’s established beliefs
communication The message that is broadcast by the media; can
involve only words, only pictures, or a combination of
both words and pictures. If developed properly, the
communication that is delivered, and the message
the audience receives, are the same.
community level evaluation Measurements that reflect the general or average
beliefs, attitudes, or values across a large group (e.g.,
a community, school, nation), in contrast to individual
level evaluations
compliance Conformity, falling in line, agreement, obedience
cost-effective Economically worthwhile
counter-argue A mental resistant reaction to a persuasive message
that is contrary to the individual’s established beliefs
empirical Based on observation and experiment, experimental
and observed
empirically validated research Research based on observation and experiment that
has been systematically confirmed and corroborated
epidemiological Based on the study of disease origin and spread and
the pattern of disease development
expertise Skills, knowledge, and abilities of an individual or
entity
exposure Refers to the reach of the media – the extent to which
the communication reaches the intended audience.
fear-arousing The ability to frighten or make another person or
group worry or anxious
formative research Research looking at the development of a process
individual level measures Measurements that are taken on individual
respondents, rather than across entire groups
intervention A manipulation or action that will affect another’s
situation or affairs

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Participant Manual: Appendices—Appendix A
mass media The general category of communications including
television, radio, broadcasting, newpapers, etc. that
reach a broad group of people
media Any form of mass communication; can involve
television, radio, magazines, newspapers, posters,
billboards, facebook, twitter, emagazines, and so on.
media-based prevention Use of the mass media, usually through coordinated
campaigns, to prevent the initiation of substance use,
or to encourage individuals to cease use of a targeted
substance
messaging Process by which persuasive communication is
developed; is concerned with the persuasive
components built into communications, to influence
people’s beliefs and actions
multiple-source effects In persuasion, the effects of communications
attributed to many (vs. one) message source
normative Based on a set of accepted standards
persuader The individual or entity trying to change the opinions,
attitudes, beliefs, or behaviors of others
persuasion The act of influencing others to adopt a belief, set of
beliefs, or position, or to change behavior(s)
reach (in media) the number of viewers exposed to a
communication
receiver Person or group to whom communications are
directed
reinforcement In persuasion, an inducement to accept the
information being delivered
resolute non-users Individuals who are certain they will never use
substances and to date have never done so
scale A system of measurement or classification
source The person or entity delivering the persuasive
message
target The object of persuasive communication
target group The group of people whom a persuader hopes to
influence or to whom the persuasive attempts are
directed
theoretical Based on theory or tested hypotheses
trustworthiness Reliability and positive quality of the source of a
communication who typically has nothing to gain by
one’s acceptance of his or her message

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Managers and Supervisors Course 08: Media-Based Prevention Interventions
APPENDIX B—RESOURCES
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Participant Manual: Appendices—Appendix B
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Participant Manual: Appendices—Appendix B
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Yzer, M. C., Cappella, J. N., Fishbein, M., Hornik, R., Sayeed, S., & Ahern, R. K. (2004). The
role of distal variables in behavior change: Effects of adolescents’ risk for marijuana use
on intention to use marijuana. Journal of Applied Social Psychology, 34(6), 1229-1250.

261
Participant Manual: Appendices—Appendix B
APPENDIX C—CURRICULUM
DEVELOPERS
Zili Sloboda, Sc.D. Rebekah Hersch, Ph.D.
President Senior Research Scientist and Senior Vice
APSI, Ontario, Ohio President
ISA Associates
Susan B. David, M.P.H. Alexandria, Virginia
APSI
Bethesda, Maryland Richard Spoth, Ph.D.
F. Wendell Miller Senior Prevention
Chris Ringwalt, Ph.D. Scientist
Senior Evaluator Director of the Partnerships
University of North Carolina’s Injury Prevention Science Institute, Iowa State
Prevention Research Center University
Adjunct Professor Ames, Iowa
University of North Carolina School of
Public Health William Crano, Ph.D.
Chapel Hill, North Carolina Professor of Psychology
Claremont Graduate University
J. Douglas Coatsworth, Ph.D. Claremont, California
Professor of Human Development and
Family Studies
Colorado State University
Fort Collins, Colorado

263
Participant Manual: Appendices—Appendix C
APPENDIX D—EXPERT ADVISORY
GROUP (2015 EDITION)
Thomas Browne Harry Sumnall, Ph.D.
CEO Colombo Plan Liverpool John Moore’s University
Liverpool, England, United Kingdom
Brian Morales
Branch Chief, Jeff Lee, M.Ed.
Office of Global Programs and Policies, ISSUP
Bureau of International Narcotics and Law Leicestershire, England, United Kingdom
Enforcement Affairs,
US Department of State Maria Paula Luna, M.A.
APSI
Felipe Castro, Ph.D. New York, New York, U.S.A
University of Texas at El Paso
El Paso, Texas, U.S.A Sue Thau, M.C.R.P.
Community Anti-Drug Coalitions of
Fernando Salazar, Ph.D. America
Universidad Peruana Cayetano Heredia Alexandria, Virginia, U.S.A.
Lima, Peru
Teresa Salvador
Giovanna Campello COPOLAD
Prevention, Treatment and Rehabilitation Madrid, Spain
Section, United Nations Office on Drugs
and Crime Tracy Tlumac, Ed.D.
Vienna, Austria The National Association of State Alcohol
and Drug Abuse Directors
Gregor Burkhart, M.D., M.P.H. Washington, D.C., U.S.A.
European Monitoring Centre on Drugs
and Drug Addiction Zachary Patterson, Ph.D.
Lisbon, Portugal Canadian Centre on Substance Abuse,
Ottawa, Ontario, Canada

265
Participant Manual: Appendices—Appendix D
APPENDIX E—SPECIAL
ACKNOWLEDGMENTS
A special thank you to the following individuals who participated in pilot-testing the first
edition of this course in 2014 and created client case studies for the curriculum series.
Their input was invaluable.

Anthony Coetzer–Liversage Rogers Kasirye

South Africa Uganda

Dorji Tshering Susan Atieno Maua

Bhutan Kenya

Grace Duka-Pante Teresita Pineda

Philippines Philippines

Haji Yusof William Sinkele

Singapore USA

Little Jones Espeleta Susmita Banerjee

Philippines India

Maria Corazon Dumlao Josephine Choong Lean Keow

Philippines Project Manager - Curriculum
Development (Prevention), DAP
Naina Kala Gurung Sri Lanka
Bhutan
George Murimi Kariuki
Project Manager - Training , DAP
Rehana Kader
Sri Lanka
South Africa

Richard Gukunju
Kenya

267
Participant Manual: Appendices—Appendix E

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UPC1 CUR8 2020 Participant

Uploaded by

UPC1 CUR8 2020 Participant

Uploaded by

The Colombo Plan Drug Advisory Programme (DAP) Training Series

Managers and Supervisors Series

April 2020 Edition

Published April 2020

Part I—Participant Orientation

Part II—Training Modules

April 2020 Edition

Goals and Objectives for Course 8

Getting the Most from Your Training Experience

“ As a participant in this training, you are part of a rapidly

How is this global community of substance use

Individuals working worldwide in the substance

Organizations that act as portals or

ISSUP stands for the International Society of Substance Use

 There are more than 10,000

Learn about specialized addiction programs at universities

GCCC stands for the Global Centre for Credentialing and

Learn about how to apply the latest in research-based

Where does this global community of substance use

The Colombo Plan Drug Advisory Program (DAP)

The African Union Commission (AUC)

The United Nations Office on Drugs and Crime

The World Health Organization (WHO)

How can I participate in this global community of substance use

Content and timeline........................................................................................21

MODULE 1—TRAINING INTRODUCTION

 Make a persuasive case of why it is important to

 What is your name?

Substance Use World-Wide

 The United Nations Office on Drugs and Crime

Country Tobacco Alcohol T&A Cannabis Other drugs Other Drugs

Mexico 64.4 91.5 92.1 11.5 9.6 58.3

USA 74.4 96.2 96.0 57.6 27.3 12.6

Belgium − 88.4 88.4 31.0 10.2 8.7

France − 94.5 94.5 52.9 11.0 21.7

Italy − 79.6 79.6 17.4 1.1 27.0

Netherlands − 92.6 92.6 38.9 15.5 40.7

Ukraine 81.1 99.7 99.4 15.2 2.6 32.1

Nigeria 9.0 62.1 63.1 3.1 0.4 93.1

South Africa 33.1 45.5 52.0 12.7 3.0 51.1

China 49.3 78.7 84.0 1.4 0.6 −

Japan − 97.2 97.2 4.5 4.8 77.3

New Zealand − 95.4 95.4 63.0 23.6 7.0

Degenhardt et al., 2010

 Health is linked to:

Why is Substance Use Prevention

 The primary objective of substance use prevention

Managers and Supervisors:

 Toreduce the significant health, social, and

Overarching Themes (1/2)

 Substance use inclusion: Tobacco & alcohol,

 Developmental nature of substance use

 Course 01: Introduction to Prevention Science

Curricula in the Series

 Course 02: Physiology and Pharmacology for

 Course 03: Monitoring and Evaluation of

 Managers and Supervisors Course 04 : Family-

Curricula in the Series

 Managers and Supervisors Course 05 : School-

 Managers and Supervisors Course 06 :

 Managers and Supervisors Course 07 :

Curricula in the Series

 Managers and Supervisors Course 08 : Media-

 Managers and Supervisors Course 09 :

 Demonstrate understanding of the ways media function in prevention

Large-group Exercise: Training

 Write two training expectations on your

Examples of persuasion media

Small-group exercise: Substance use

 Type of substance involved

Course 1: Introduction to Prevention Science (5 days)

 Developmental focus, which means that, as prevention professionals, we need to

Why is prevention important?

The training series

Content and timeline........................................................................................55

MODULE 2—INTRODUCTION TO MEDIA AND

Developmental focus, which means that, as prevention professionals, we need to