Phase I Evaluation: Site Visit Findings

Following is a summary of results obtained during the baseline and intermediate site visits.

Youth Findings: Baseline Key youth findings at baseline include the following:

• Youth participating in the focus groups indicated opportunities for drug use are enhanced by the easy availability of drugs from peers, siblings, and adult family members.
• Organized activities, in addition to free-time activities, can serve as both risk and protective factors. Organized activities such as sports may protect some youth by keeping them constructively engaged, yet they also may provide other youth with opportunities for drug use.
• Peer group attitudes, norms, and behaviors regarding drug use varied by age and ethnicity, but across all groups youth gave the impression that illegal drug use is common, starting as early as the fifth grade.
• Although high school students reported many sources of stress (school pressures, family conflicts, and peer relationships ranked highest), they disagreed on whether stress leads to drug use. Those who think it does named cigarettes, alcohol, and marijuana as the coping drugs of choice.
• The chief sources of information on the risks of drug use were the school, the home and family, the neighborhood, and the media; there were no discernible differences between target and comparison sites in the source of information.
• Although youth considered school and parents to be their primary sources for anti-drug messages, youth also viewed them as the sources of mixed messages and exposure to drug use.
• The neighborhood as a source varies by urban and non-urban locations, with the former having more visible, public drug use.
• The major media influences for youth were TV and movies, followed by radio, music tapes/compact discs, and videos. Most youth regarded the media as conveying mixed messages on drugs, noting back-to-back anti-drug ads and beer commercials; they asserted that in general TV programming promotes drug use and violence.
• Awareness at baseline of drug use prevention ads cut across grade levels and communities, with marginal differences between target and comparison sites; youth in target sites recalled a wider range of ads. Awareness of ads among many youth in comparison sites was found because of existing PSAs that were run in those sites.
• Comprehension of ad messages and reaction to them varied by age group, with 4th-6th grade students finding them troubling and hard to understand. Middle school and high school youth were very knowledgeable about the messages of the ads but high school students also were more cynical about the ads' ability to change their peers' attitudes and behavior.

Youth Findings: 12 Weeks Into the Media Campaign In target sites awareness of anti-drug ads -- both their increasing frequency and variety -- was significantly greater than that of comparison sites; older youth remembered more ads and understood them better than did younger children. The impact of anti-drug ads varied by age group in both target and comparison sites as follows:

• Elementary school students found some of the ads scary but worried they could lead some children to experiment with drugs;
• Middle school students had mixed responses -- from scary to funny to ineffective; and
• High school-age youth were most influenced by graphic depictions of real situations and the negative consequences of drug use.

To obtain information about reactions to anti-drug ads, focus group participants were asked to describe any anti-drug advertisements they had seen or heard recently. Then they were asked to discuss any impact these ads had on them, whether the ads changed their thinking, and whether they believed the ads were effective. Findings include the following:

• Only a few of the younger youth (grades 4 through 6) reported they had discussed with parents, teachers, or peers any anti-drug ads they had seen or heard.
• High school-age youth in comparison sites had slightly more negative responses to anti-drug ads in general (i.e., their responses were related to viewing existing ads aired as PSAs) than did target site youth.
• Giving their perceptions of the effectiveness of anti-drug ads, youth in target and comparison sites and across all age groups had mixed views and qualified responses. They viewed anti-drug ads as useful for specific categories of persons (i.e., those who have not started using) but not for others.

The most frequently mentioned ideas for new ads and improvements for the Media Campaign concern the content of ads, as follows:

• Students of all ages recommended the use of "realistic" and "graphic" ads and those showing drugs' effects on mind and body, friends and family.
• Youth suggested placing more ads at locations they frequent and at times when the ads are most likely to be seen; using more local people and scenery in the ads; and showing a wider variety of youth in terms of ethnicity, dress, and activity.
• Students' perceptions of the cultural relevance and credibility of ads suggested that there should be mixed-race situations and/or ethnic minority actors to foster youth identification with ads. Media ownership (i.e., whether the media outlet was minority-owned) was deemed less relevant than program content.

Parent Findings: Baseline

Parent findings at baseline include the following:

• Parents' perceptions of youth's knowledge of drugs closely paralleled those of youth themselves. Parents in general agreed that youth know more about drugs and their availability than adults do, but parents added that youth are not adequately informed about the risks of drug use.
• Parents generally perceived organized activities only as desirable protective factors and were unaware of how those activities can provide opportunities for drug use.
• Parents in all sites agreed on the importance of their role in talking with youth about drugs; most parents believed they take this role seriously but recognized that it is difficult for some to do -- especially single working parents -- and becomes more difficult as children grow older.
• In all sites, parents' perceptions of stress among high school students closely paralleled those of youth. Ethnic minority parents also mentioned the stress of being marginalized; many parents expressed empathy with the many and extreme sources of stress on youth, which they believe exceed those of their own generation.
• Parents' views on the influence of media ads were mixed. Some felt the ads are useful tools for teaching their children to stay away from drugs, but some parents "channel-switch" when anti-drug ads appear on TV. Parents reported that TV ads for beer and billboard ads for tobacco overwhelm the anti-drug messages. Parents offered many constructive suggestions for messages that would more effectively reach their children.

Parent Findings: 12 Weeks Into the Media Campaign

Parents in most of the target sites reported a high level of awareness of anti-drug ads on television, including Spanish-language ads. Parents rarely remembered channel or sponsor identifications, but most had good recall and understanding of the ads' messages. Many expressed appreciation of the ads' frequency and regularity.

Parents in four target and four comparison sites reported that the anti-drug ads had not changed their ideas about drugs or who uses drugs, but had stimulated discussion between them and their children. The parents appreciated these opportunities for better family communication.

Many target site parents said the ads could be helpful, especially those focusing on parent-child communication. Others were skeptical that ads could change people's thinking or compete with the plethora of messages that glamorize drug use.

Comparison site parents remembered fewer anti-drug ads (again, pertaining to ads run as PSAs). Comparison site parents also were more pessimistic about the effectiveness of the anti-drug ads they had seen, and felt the ads could not counter media promotion of drug use. They stressed the importance of parental involvement, communication, and responsibility in relaying anti-drug messages.

Parents in almost all focus groups had ideas for new ads and Media Campaign improvements; the ideas centered on being "realistic" and "graphic" and showing the consequences of drug use. The following were additional suggestions:

• Feature local youth and prevention programs in ads;
• Educate parents about the warning signs and specific effects of drug use;
• Highlight local anti-drug programs and youth successes; and
• Help parents and youth to communicate better.

Some parents were wary of using famous personalities, perceiving that many have drug problems themselves.

Parents' perceptions of the cultural relevance and credibility of anti-drug ads, much like youth's perceptions, focused more on program content and presentation than on media outlet ownership. All parents commenting on the issue advocated using ethnic minority role models and producing more ads in Spanish.

Community Findings: Baseline

Community members at almost every site reported a serious youth drug problem. The following trends were reported by key informants:

• Alcohol, tobacco, and marijuana were the most frequently used drugs and were considered readily available;
• Youth drug use was broadly perceived to be increasing, with sites having distinctive patterns of favored drugs;
• Type of drug used also varied by age group and socioeconomic level, and some sites had distinctive urban/nonurban patterns of use; ethnic group differences in use and attitudes emerged at a number of sites;
• Overall, it appeared that youth were using drugs at increasingly early ages;
• Drug cartels and international syndicates were in evidence at several sites; and
• Drug dealing was widespread in the sites.

In nearly one-half of the sites, community informants reported that there were adults who minimized the youth drug problem, in some cases viewing marijuana or alcohol as a rite of passage or a fad. Parents ranged from being aware of the seriousness of the drug problem to being naive or permissive, in part related to parents' own current or previous drug use.

Among anti-drug activities, every site had local coalition efforts underway. Drug Abuse Resistance Education (D.A.R.E.) was the most commonly cited outreach program at all sites and the Gang Resistance, Education, and Awareness Training (GREAT) program was mentioned in several sites. The Safe and Drug Free Schools Program also was collaborating with local agencies in drug prevention.

Almost all sites had a range of support groups, counseling services, and other outpatient treatment modalities; inpatient treatment, however, was not easy to obtain. Many sites operated local programs such as job readiness and leadership development; a number of sites had related "youth protective" programs, one of whose implicit goals was drug use prevention.

Recent local events varied widely by site, from local and State policy efforts to "high sensation" events such as reported drug-related crimes and deaths.

Several sites were running their own local anti-drug media activities prior to the Media Campaign; television, radio, billboards, and newspapers were the major outlets for disseminating anti-drug information to the public.

Community Findings: 12 Weeks Into the Media Campaign

Several positive aspects of the Media Campaign have emerged through discussions with youth, parents, and community informants. Findings include the following:

• Almost all sites reported changes in community contextual conditions that kept the local drug problem in the news such as arrests, stings, and drug-related deaths -- including child abuse deaths and drive -- by shootings. There was a growing recognition that drugs were not confined to inner-city neighborhoods and that all youth were vulnerable. Several cities targeted their education and drug prevention efforts on the increasing incidence of methamphetamine and heroin use in their local communities.
• Community rollout or other activities to support the Media Campaign were reported in all target sites. The characteristics of the activities and the response to them varied by site; some were tied to other national programs (e.g., the Bill Moyers series on drug addiction, which aired on the Public Broadcasting Service), and others were generated locally. A number of sites, both target and comparison, planned public education activities around the broadcast of the Bill Moyers series.
• In general, more new anti-drug activity was found in target sites than in comparison sites. Community involvement in new anti-drug initiatives had recently begun in several target sites such as Milwaukee, Denver, Houston, and San Diego, as well as a few comparison sites. The initiatives included prevention and treatment modalities and media campaigns; some of them were school-based, and others worked through local churches and community organizations. The Milton Creagh campaign, a Christian-focused drug-prevention campaign was the main concurrent anti-drug activity in a number of sites.
• In relating community evidence on the cultural relevance and credibility of anti-drug ads, informants were divided on the minority-owned outlet issue; most said that the message mattered more than the outlet. There was broad consensus in favor of portraying local drug issues and using local or locally appropriate actors. Some minority informants felt that certain Media Campaign ads were culturally insensitive, such as the Cannabis Stupida billboards.
• In reporting their community response to the Media Campaign and ideas for new ads, key informants stressed that ads should unsparingly portray drugs' destructive effects, feature local (not national) celebrities, be more realistic, have shock value, and portray positive parent-child interaction. Many ideas for improved placement of ads also were generated.
• Media Campaign ads were widely seen as a step in the right direction, helping to focus drug use prevention efforts; people often said the ads did make them think about the dangers of drug use.

Findings from media informants were as follows:

• Most station managers and newspaper editors make decisions to air or print PSAs based on the sponsoring organization's commitment to local priorities, values, and current issues (in many cases, children and health);
• Every community had a sizable list of public service priorities including education, literacy, violence, teen pregnancy, sexually transmitted disease (STD) and HIV (human immunodeficiency virus) awareness, and infant mortality;
• Media representatives in several target sites pointed out that the ONDCP paid ads had not negatively influenced stations' ability and willingness to continue to air PSAs for other causes; and
• Reported responses to the Campaign ads were virtually all positive; the few negative responses reflected the worry that the ads might encourage youth to try drugs.

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