4. CASE STUDIES

Baltimore, Maryland

Two site visits have been made to Baltimore. The first baseline visits occurred at various times between November 2, 1997, and January 28, 1998. The intermediate visit took place during the week of March 16, 1998.

Richmond, Virginia, was selected as a comparison site for Baltimore, Maryland, because both sites have similar demographic and community characteristics. The quantitative data collected from in-school surveys completed by students in both Baltimore and Richmond also showed similar patterns at baseline. These patterns, displayed in Exhibit 4-1 at the end of Section 4, further demonstrate that Richmond constitutes a reasonable comparison site for Baltimore. Exhibit 4-3 summarizes youth, parent, and community findings for both sites.

The remainder of this site visit report will describe (a) key baseline data collected in Baltimore at baseline and some 3 months later at intermediate, and (b) some key results collected in Richmond during the intermediate visit.

Baseline Picture

Ongoing Anti-Drug Activities in the Community

Numerous drug prevention programs operate in the Baltimore Metropolitan Statistical Area (MSA). Some programs, such as the Safe and Sound Campaign, are coordinated among multidisciplinary federal, state, and local programs. Other programs are local and smaller in scale. The Baltimore MSA has received numerous federal, state, and local grants as well as private donations from philanthropists and foundations to address drug use and trafficking. For example, the Maryland Alcohol and Drug Abuse Administration (ADAA) funds research-based drug prevention programs that are tailored to the local needs of every Maryland county. All programs are based within communities instead of schools. To receive funding, each county must have a prevention coordinator who serves as a program administrator and liaison between the county and ADAA staff in Baltimore City. Baltimore's FOX 45-TV channel airs Straight Talk and Steering Clear, television programs hosted by Baltimore County's Bureau of Substance Abuse Director, Mike Gimbel. Each program addresses drug and violence issues, and features guest interviews. These programs are aired free of charge by the station. The programs will soon be added by Comcast Cable to six cable systems across Maryland.

Trends in the Baltimore Community

Baltimore has a well-documented youth drug problem. Though the drugs of choice differ among urban and non-urban environments, the drugs most commonly used by youth include marijuana, alcohol, and tobacco. It is commonly cited that non-urban residents purchase drugs in Baltimore City. As the legitimate job pool shrinks and the requirement for advanced educational attainment becomes the norm, urban youth see drugs as an economic opportunity.

The 1996 Maryland Adolescent Survey (MAS), a biennial drug prevalence survey conducted in Maryland's public schools and administered by the Maryland State Department of Education, indicates that current marijuana use in Baltimore City is down for 12th graders from 1994. However, the 1996 statistics are still 6.9 percentage points higher than those from 1992 (Maryland State Department of Education, 1996). Baltimore City's 8th graders reported the highest percentage of past-month use of any drug (23.2%) and marijuana (21.5%) in 1996 in Maryland (Maryland State Department of Education, 1996). Sixth graders in the City reported the third highest past month marijuana use at 4.1 percent (Maryland State Department of Education).

The 1996 MAS also shows that approximately 55 percent of Baltimore County 12th graders report lifetime marijuana use, while 26 percent of 8th graders and 3.8 percent of 6th graders in the County recorded similar marijuana use (Maryland State Department of Education, 1996). Six percent of Baltimore County seniors reported lifetime use of crack-cocaine, while 10 percent reported lifetime use of other cocaine (Maryland State Department of Education, 1996). Baltimore County seniors indicated that 6.1 percent of their population had ever used heroin (Maryland State Department of Education, 1996).

Drug Awareness and Behavior Reported by Youth and Parents

Non-urban 4th-6th graders had very limited knowledge about illegal drugs. They were well educated about the dangers of tobacco, which was stressed in their school's curriculum. In contrast, the urban 4th-6th graders said that they are aware of drugs, not from parents or school, but from seeing them being used in their neighborhoods, especially by teenagers. They also said that people can learn to use drugs from movies in which people use drugs and smoke. This year, the non-urban 7th-9th grade boys are learning about drugs in their health class. They appeared to be learning a lot about the science of drugs but disagreed over whether they were being given a strong anti-drug message in class. The urban 7th-9th graders brought more firsthand knowledge to the discussion. The urban 10th-12th-grade age group said that they learned about drugs primarily from "just being around, watching people on the street." The non-urban 10th-12th graders said that youth their age know a lot about drugs, primarily through talking with their friends.

Parents do not necessarily know what to say to their youngsters about drugs. Urban parents tend to have a better understanding of the scope of the youth drug problem, but they possess fewer resources. Both urban and non-urban parents were concerned about what their children did in their free time and wanted them to participate more in organized activities. They were concerned about media influences such as television and rap music. Their reviews of anti-drug ads varied.

Community Drug Problems as Perceived by Community Key Informants

Every key informant agreed that the Baltimore area has a significant drug problem. Most informants stated that marijuana was the drug of choice for youth, but added that alcohol and cigarettes were common. One service provider stated that "marijuana is not perceived as a substance, but as a cigarette. Kids (in Baltimore City) see their parents and don't want to be addicts like them, but smoke marijuana because it is not perceived as a risk." Youth seem to begin smoking marijuana either as a cigarette (i.e., "joint") or a "blunt" (i.e., a Phillies Blunt type cigar filled with marijuana) and then move to cocaine powder and/or crack-cocaine. A non-urban law enforcement official reported that methamphetamine use is "very random and spotty."

All informants agreed that there is no difference in drug use among ethnic or racial groups. There are also no reported geographic boundaries or areas of availability for specific drugs. One service provider stated that "there are no clean distinctions. You find the same drugs on different corners." According to urban and non-urban law enforcement officials, polydrug dealing is now common, instead of having one drug dealt on one corner or in a specific neighborhood.

Awareness of Anti-Drug Advertising Prior to the ONDCP Media Campaign

The Maryland Governor's Office is conducting an anti-drug media campaign which began in the fall of 1997. It relies on donated air time and resources for PSAs, and the Lieutenant Governor is involved in a series of meetings and appearances with local agencies.

Only one key informant remembered seeing any Media Campaign television ads prior to the Media Campaign. She said that she believed the ads had been run frequently enough to capture the attention of parents, teenagers, and children, but would not make them more aware of the risks and dangers of drug use. She stated that her sons, ages 14 and 17, are "pretty jaded with the same old stuff." Another key informant recalled seeing the casts of Friends and Suddenly Susan on NBC's The More You Know series. The remaining persons could not recall seeing any ads on TV, radio, or in print. Consequently, they stated that they did not think PSAs were aired often enough to be noticed.

Intermediate Findings Reported After Initiation of the ONDCP Media Campaign

Recent Local Events Affecting Awareness/Attitudes Toward Drugs

Baltimore City, according to one key informant, is moving money out of programs such as housing and putting those funds, as well as the savings from reduced welfare payments, into drug treatment. This person said that funding for treatment increased from $15 million to $31 million in 2 years, and will increase to $33 million in another year. A reporter for the Baltimore Sun stated that the expansion of city funding for drug treatment is "close to a national experiment of offering treatment on demand." He stated that a foundation has pledged $25 million over the next 5 years to fund drug treatment activities.

An informant from a civic group stated that the most significant trend is a growing awareness that the heroin problem has spread to the suburbs. He stated that an elementary school teacher overdosed on heroin in a Baltimore suburb in January. The Baltimore Sun has published a series of articles on the spread of heroin to the suburbs and the effect it has had on non-urban youth. A newspaper reporter said that within the past 6 months, a small number of heroin overdose deaths in non-urban and rural areas sparked interest in heroin because the deaths occurred "where you wouldn't expect overdose deaths." He also said there were several articles on the Bill Moyers television special on addiction.

Youths' and Parents' Reactions to the ONDCP Media Campaign

Non-urban focus groups in all grades were much more aware of the Media Campaign than their urban counterparts. The urban 7th-9th graders did not report seeing many ads, though most of them felt that all the ads basically talk about is marijuana. They were much less positive about the Media Campaign than the other youth focus groups in Baltimore. A few participants said they saw the Cannabis Stupida billboard and stated that it was "real stupid" and "had no purpose." One girl said that "they should not have spent money on it." The group liked the Frying Pan ad because it caught everyone's attention, and they were able to connect it to the fried egg ad. Some participants agreed that "some commercials seem like they are just making them to say `we put an ad out to make people aware.' "

None of the participants recalled ONDCP as the sponsor of the Media Campaign. The urban 7th-9th graders guessed "The American Drug Association." The non-urban 7th-9th graders seemed certain that the American Heart Association and the American Cancer Society sponsored the ads; their confusion stemmed from seeing a plethora of anti-smoking ads and posters sponsored by these organizations. The non-urban 10th-12th graders were able to remember PDFA as the sponsor of the ads.

The urban parents agreed that they did not remember seeing that many anti-drug ads. Most participants stated that there were not as many as there used to be. Non-urban parents were very aware that anti-drug commercials were playing on TV between the evening news and prime time shows. They also reported hearing them on the radio, and seeing the Cannabis Stupida billboard. They were also able to describe the ad and correctly state the message. The parents reported seeing the following ads: Frying Pan, one depicting a teacher, one describing another missed opportunity, and Burbs. None had seen any ads on the Internet or in the newspaper. Most of the parents were aware that ONDCP was the sponsor of the ads.

Urban parents made the following suggestions to increase the effectiveness of the ads: make them stand out and boldly show the effects and consequences of drug use; tell children what it feels like to be on drugs; start with younger children before they become teenagers; and show the unglamorous side of drug use. The parents stated that "kids need to see what you lose" when you use drugs. Many urban parents also maintained that personal face-to-face contact with youth is required to influence their decisionmaking about drugs.

The non-urban parents recommended the following to make the ads more effective: aim parent-targeted ads at parents with young children; have "kids" like them promote the avoidance of drug use; modernize the ad that shows all of the entertainers who have died because of drugs; use black and white film to catch the eye; use silence to bring attention to the ad; and maintain the frequency of the ads so that the messages can get through to their audience. Most parents recognized ONDCP or PDFA as the sponsor of the ads.

Parents who had seen the ads agreed that anti-drug ads were needed because "the ads help you realize how bad the problem is."

Key Informants' Responses to the ONDCP Media Campaign

Most key informants recognized the commercials as Partnership for a Drug-Free America (PDFA) ads or said that they could not really recall but that they thought it was PDFA. Two people said that ONDCP sponsored the ads. Most of the key informants agreed that the ads were shown frequently enough and at the appropriate times to catch the attention of their intended audience. A city youth influencer said she thought that since youth talked a lot about the Frying Pan ad, it probably was appropriately aired. She also said that the billboard she saw was located in a "heavily trafficked area, so it was probably noticed." Another interviewee stated that "if they are sticking out in my mind, they must be aired enough."

The informants had mixed perceptions of the community's response to the Media Campaign. Some of the informants said that they have talked about the ads with people, while others stated that they have not heard anything. A youth influencer said that youth are talking a lot about the fried egg ad, but that she has not noticed any other response. Another informant related that he thinks that people look at them as "just commercials and that's what the mute button is for." An urban service provider asserted that people do not generally talk about commercials and billboards. He said that "other prevention and treatment providers are more likely to talk about it, however, most providers don't believe that a media Campaign is the appropriate way to get the message across."

Media Representatives' Reactions to the ONDCP Media Campaign

Site visitors were able to coordinate interviews with representatives from The Baltimore Sun, The Afro-American, and FOX 45-TV. According to one media representative, the community is offended and dismayed by alcohol advertising directed at youth. Older community members are afraid that young people and children are using drugs, and that youth drug use may be connected to violence. This person also said that she feels that "[t]he problem is not being ignored or dismissed, but perhaps it is being underestimated to keep people from being overwhelmed."

The TV representative reported that public service campaigns have been increasingly sponsored by businesses, which allows the messages to be aired more often and at better times. The local FOX TV station still donates airtime, and the ratio of unpaid to paid advertising is estimated at 60:40. The station also produces PSAs for nonprofits. The station's representative said that "[t]he [ONDCP] ads are excellent." She asserted that they are of great quality, address recognized problems, are localized, and come in different lengths. She stated that "they are exactly what I like in ads. PDFA does an excellent job producing parent-targeted ads."

Followup Findings at Comparison Site of Richmond, Virginia

The Richmond community appeared very uninformed about the Media Campaign or about any anti-drug commercials. The Richmond MSA is large and includes rural areas on the outskirts of the city. The non-urban areas appear to be rather separated from the poorer urban areas, yet common themes emerged. Throughout the site visit it became apparent that the community has the impression that drugs are only in the east end of the city. Yet the individuals we spoke with in both urban and non-urban areas have realized the severity of the drug problem in the suburbs, as well. They feel this is something the community needs to be enlightened on because they fear this misconception stigmatizes the urban areas and leaves residents of the non-urban areas ignorant of the problems facing their children. This might be the reason that the Burbs ad was continually mentioned as positive and effective by those who had seen it.

Probably due to the fact that Richmond is a comparison site, none of the informants appeared aware of the Media Campaign, although one informant had seen a number of the PDFA ads (most likely as PSAs). As a result, none of the informants were involved in Media Campaign-related activities. The majority of informants felt that ads had the potential to be effective, usually in conjunction with other prevention efforts. One informant said a commercial could make no difference, asserting that all change is going to come from a role model or mentor. Others felt that anti-drug ads would be particularly effective for young children.

Summary of Intermediate Findings

In general, non-urban youth and parents seemed to be much more aware of the Media Campaign ads than urban youth and parents. Furthermore, there was little recognition by any focus group participants (youth or parent) that ONDCP had sponsored Media Campaign ads.

The comparison site, Richmond, was generally found to be very uninformed about the Media Campaign or about any anti-drug ads.