Introduction

In 1997, the Office of National Drug Control Policy (ONDCP) proposed and received dedicated funding for a historic initiative: a large-scale paid media campaign to educate and enable America's youth to reject illegal drugs. This campaign, developed from a solid scientific base, will be implemented in collaboration with the Partnership for a Drug-Free America and a wide array of non-profit, public, and private-sector organizations, including America's major corporations and media companies. Although the campaign is likely to be the most visible element of our Nation's response to the youth drug use epidemic, it is but one of many drug-prevention activities offered by schools, civic organizations, and government agencies in communities across America. Developing synergy among these myriad drug-prevention activities is our Nation's best chance to significantly reduce drug use rates. This campaign is a catalyst to create that synergy.

Drug abuse is harmful at any age, but reducing adolescent drug use is crucial for controlling overall drug use and abuse (Sloboda & David, 1997). People are most susceptible to the allure of illicit drugs during their adolescent years (Kandel & Logan, 1984). Young people who refrain from using psychoactive substances until age 21 rarely become users later in life. Moreover, the earlier in life drug use is initiated, the more likely users are to consume progressively more dangerous substances (Newcomb & Bentler, 1989). Thus, preventing or delaying use of psychoactive drugs among adolescents is a critical public health goal for the Nation.

ONDCP programs address a range of goals that include demand reduction, reduction of drug-related crime and violence, and reduction of drug-related health and social costs. The goal of the National Youth Anti-Drug Media Campaign is to educate and enable America's youth to reject illicit drugs. This goal includes preventing drug use and encouraging occasional users to discontinue use.

This document outlines the strategic basis for the National Youth Anti-Drug Media Campaign, a multi-faceted primary prevention media campaign. This communication strategy will be used by ONDCP to chart the overall direction of the campaign, as well as guide the development of specific campaign messages, materials, and activities. Although the communication strategy will evolve over time as a result of campaign monitoring and evaluation, this document represents a solid framework and starting point based on ONDCP's extensive campaign planning process.The communication strategy represents a distillation and integration of information from many sources. These sources include a review of published studies on the etiology and prevention of adolescent drug use, drug-prevention campaigns, other public health communication campaigns, and general consumer marketing communication campaigns targeting youth and their parents. Also included are the results of unpublished audience research conducted by various organizations, and the results of an original focus group study commissioned by ONDCP to support the development of the campaign strategy.

This research evidence was supplemented with an extensive expert consultation process that included input from over 200 experts in academia, civic and community organizations, government agencies, and the private sector, and through the establishment of a campaign design expert panel. The panel included experts in the fields of drug use and prevention, public health communication, advertising, market research, consumer marketing, and public policy. Panel members met over the course of four days during the fall of 1997 and played a pivotal role in integrating diverse sources of information and guiding the development of the communication strategy for this campaign. (See the Appendix for a list of panel members.)

While the strategy was designed primarily to provide direction for the National Youth Anti-Drug Media Campaign, it can also be used to shape the activities of other national, regional, and local anti-drug programs, and thereby create synergy across youth drug prevention programs. Care was taken to formulate a broad-based and flexible communication strategy that could be applied in a variety of contexts to develop or refine media-, school- and community-based drug prevention initiatives.

The reality of youth drug use defies all stereotypes. Youth drug use rates are more or less consistently high across all gender, racial and ethnic, income, and geographic boundaries. It is critically important that primary prevention efforts address all young people as well as the adults who influence them. Using newly emerging terminology in the field of drug abuse prevention, this is termed a universal approach.

Although preventing and treating drug abuse are both critically important in ensuring the health and well-being of our Nation and its people, a media campaign that attempts to accomplish both is unlikely to accomplish either. To succeed, a communication campaign must have a highly defined purpose. The purpose of the National Youth Anti-Drug Media Campaign is to promote the primary prevention of drug abuse, which means preventing drug abuse before it starts.

The campaign focuses on primary prevention for three key reasons. First, primary prevention targets the underlying causes of drug use, and, therefore, has the greatest potential to reduce the scope of the problem over the long term. Second, over time a primary prevention campaign will lessen the need for drug treatment services, which are in critically short supply. And third, a media campaign has greater potential to affirm and reinforce the anti-drug attitudes of youth who are not involved in drug use than to persuade experienced drug users to change their behavior.

Youth drug use rates are influenced more by young people's attitudes and beliefs about drugs, and by prevailing social norms, than by the availability of drugs (Johnston, 1997; Johnston, O'Malley, & Bachman, 1996). Thus, the National Youth Anti-Drug Media Campaign seeks to alter these demand-related factors.

The goal of the National Youth Anti-Drug Media Campaign is to prevent drug use before it starts and encourage occasional users to discontinue use. In both instances, the drugs to focus on are drugs of first use. Most commonly, the illicit drug of first use is marijuana (Kandel, Yamaguchi, & Chen, 1992). Many adolescents who start using marijuana at an early age progress to use of other drugs (Newcomb & Bentler, 1989). Conversely, people who have never tried marijuana and inhalants are unlikely to try other drugs (Newcomb & Bentler, 1989). Thus, preventing use of marijuana appears to be a powerful means for preventing other drug use.

Inhalants are another class of illicit substances of first use for many adolescents. Unlike marijuana, inhalants can have very immediate and serious physical consequences for users (NCADI, 1997). Both the variety of inhalants used and the proportion of young people who have used them have risen dramatically in the past few years (Monitoring the Future Study, 1997). Thus, this campaign will also focus on preventing the trial and use of inhalants.

Tobacco and alcohol are two other important substances of first use for many adolescents (Grant & Dawson, 1997; Kandel, 1975; Kandel, Yamaguchi & Chen, 1992). Although underage use of alcohol and tobacco is not legal, the campaign will not use paid media resources to address these issues. However, ONDCP will use its media-buying negotiations with media companies to secure support for public service advertising on these and other important issues.*

As necessary, the campaign will also address other illicit drugs that represent an immediate threat to occasional users. New drugs are intermittently developed and introduced into the drug use scene, and new ways of using existing drugs can rapidly become popular among young people. In these cases, adolescents (and adults) often have little or no factual information about the risks involved, and they make decisions based on incorrect assumptions and perceptions. For example, certain communities are experiencing an epidemic of heroin inhalation even among very young adolescents, in part because of the incorrect assumption that inhaled heroin is less dangerous than injected heroin. The campaign will address such emerging trends in efforts to prevent their spread.

Although adolescent drug use rates are at epidemic proportions nationwide, there is considerable variation from community to community in the drugs that are used. Anti-drug efforts and community resources also vary by community. Therefore, to maximize overall campaign effectiveness, appropriate community groups should be involved in making decisions about how to tailor campaign efforts to best address local conditions.The campaign should promote effective parenting strategies.

There is a growing and robust body of research that indicates that parenting practices are central to preventing adolescent substance abuse and other problem behaviors (Baumrind, Moselle, & Martin, 1985; Bry, 1988; Newcomb & Felix-Ortiz, 1992; Resnick et al., 1997; Spoth, Yoo, Kahn, & Redmond, 1996). However, many parents and other caregivers do not know what specific actions they should take. The National Youth Anti-Drug Media Campaign will convey parenting practices that are known to be effective not only in helping to prevent use of illicit substances, but also in helping to prevent tobacco and alcohol use, academic failure, and involvement in other high-risk behaviors (Ary, et al., in press; Barrera, Ary, & Biglan, under review; Biglan, Ary, & Smolkowski, 1995; Biglan et al.,1995, 1997; Dishion & McMahon, under review; Dishion, Reid, & Patterson, 1988).

Campaign Design Principle:

Because family-focused prevention efforts have a greater impact than efforts focused only on youth or only on parents and primary caregivers, the campaign should target both audiences. Moreover, the communication objectives for youth audiences and parent/caregiver audiences should be complementary and synergistic.

The campaign should encourage action on the part of other people who influence the lives of youth.

Teachers, mentors, coaches, older siblings, and a wide variety of other people can and do have a critical impact on adolescents' behavior. They help to guide the development of young people, not only through their actions as role models but also through the recommendations, instruction, and encouragement they provide. The campaign can cultivate a key drug-prevention resource by motivating and assisting youth-influential adults to encourage positive youth development and discourage drug use in a variety of ways.

While media can be used to influence important beliefs and behavior, consistent messages from a variety of sources are necessary to produce an effect.

Media have come to play an increasingly important role in public health campaigns due to their wide reach and ability to influence behavior in a variety of ways (Flora, Maibach, & Maccoby, 1989; Maibach & Holtgrave, 1995). There is convincing evidence that carefully planned mass media campaigns can reduce substance abuse by countering false perceptions that drug use is normative and by influencing personal beliefs that motivate drug use. Several recent media campaigns have successfully prevented or reduced consumption of illicit drugs and cigarettes, and risky behaviors such as driving under the influence of alcohol (Flay, 1987; Flynn, et al., 1995; Montgomery, 1995; Popham, et al., 1994; Worden, et al., 1996).

For all their power to inform and persuade, the media alone are not likely to bring about large, sustained changes in drug use behavior. This campaign will be truly successful only if media efforts can be coordinated with other initiatives in homes, schools, and communities. Research has repeatedly shown that media programs work best in conjunction with other community- and school-based anti-drug programs, when consistent messages are conveyed through a variety of channels and in several different contexts (Flay & Sobel, 1983; Maccoby, 1990; Schilling & McAllister, 1990; Sloboda & David, 1997).

Campaign Design Principle:

The campaign messages must reinforce prevention messages delivered in other settings including schools, community organizations, and homes, and be linked to existing prevention resources in communities. This can be accomplished, in part, by developing a communication strategy based on approaches that have been proven effective and are accepted in these settings. It can be further accomplished by encouraging community organizations, professional groups, and government agencies to incorporate the communication strategy into their new and on-going programs.

The media influence most people in a variety of ways. The news media inform and alert us to important developments in our communities and beyond, shaping our subsequent actions in the process. The entertainment media are often used to satisfy our leisure-time needs, and, in the process, they influence our beliefs about the world around us (Brown, Childers, & Waszak, 1990; Gerbner, Gross, Morgan, & Signiorelli, 1986; Marc, 1984). Advertising is used to stimulate our interest in commercial goods and services, and to influence how and where we shop.

Health information, including information about drug use issues, is provided through all forms of media including news, entertainment programming, and advertising. This information is so pervasive that most people report the media as their primary source of information about health issues (Freimuth, Stein, & Kean, 1989). Unfortunately, this does not mean that placing drug prevention and health information in the media necessarily influences people to behave in more healthful ways.

Understanding the potential and limitations of the media is the key to designing successful campaigns. It is also the key to establishing appropriate expectations about what can be accomplished through the media, and over what period of time.

Media campaigns, in some situations, can be a powerful force for social change. In general terms, media campaigns have great potential to raise awareness of an issue, enhance knowledge and beliefs, and reinforce existing attitudes (Alcalay, 1983; Gandy, 1982; Klapper, 1960; McCombs & Shaw,1972; Wallack, 1990). In situations where the recommended behavior change is relatively simple and of obvious benefit to members of the target audience, media campaigns can effect large-scale changes in behavior. Relatively recent campaigns to prevent Reyes Syndrome and Sudden Infant Death Syndrome offer two excellent examples of such situations (Soumerai, Ross-Degnan & Kahn, 1992; Engelberts, de Jonge, & Kostense, 1991). In both cases, modestly scaled media campaigns produced large-scale behavior changes among the parents of young children.

Many behaviors, however, are not so easily changed. Behavior results from complex interactions among people's beliefs and motivations, and their social, cultural and physical environment (Bandura, 1986). In many situations, people are not motivated to change because the perceived benefits of the recommended behavior fail to outweigh the perceived social, cultural, or economic costs. In other situations, people are motivated to change their behavior but are unable to do so because they lack the necessary skills or other resources. Overcoming such social, environmental, and psychological barriers to behavior change is a complex and formidable task, and one not easily achieved by a media campaign alone.

The potential for using media to influence adolescent drug use is directly related to the age of the adolescent. Virtually all children begin early adolescence with strongly held anti-drug attitudes, beliefs, and intentions (PATS, 1997). These anti-drug attitudes and beliefs typically begin to erode during the middle-school years. Because media campaigns have tremendous potential to reinforce existing anti-drug attitudes, perceptions, and intentions, the National Youth Anti-Drug Media Campaign should focus its efforts on early adolescents. The objectives of these efforts should be to "inoculate" early adolescents against increasing pressures to use drugs and to enable them to maintain their anti-drug attitudes and intentions (Pfau, 1995).

Campaign efforts targeting older adolescents are likely to be less successful than those targeting younger adolescents because the drug-related attitudes, beliefs and intentions of older adolescents are, on the whole, more pro-drug than those of younger adolescents (PATS, 1997). Media messages simply have less potential to alter rather than reinforce existing attitudes and behavior (DeJong & Winsten, 1998). Moreover, the challenge of reaching older adolescents with effective media messages is aggravated by the facts that they tend to view less media and are more skeptical of media messages than are younger adolescents (Ritchie, 1995; MRI 12+ Study, 1997). These challenges notwithstanding, it is imperative for the campaign to effectively communicate with older adolescents because their rates of drug use are startlingly high.

Parents and other primary caregivers are highly motivated audiences for drug prevention messages. Most firmly disapprove of adolescent drug use and are willing to take action to prevent it (PATS, 1997; National Survey of American Attitudes on Substance Abuse II, 1996; PDFA, 1994b). Although highly motivated to act, parents and caregivers often lack both certainty about what actions to take and confidence that their actions will make a difference (National Survey of American Attitudes on Substance Abuse II, 1996). A media campaign that successfully convinces parents and caregivers that their actions can make a difference, and provides them with effective instruction regarding what actions to take, has tremendous potential to change parenting practices and thereby effect the goal of reducing drug use among youth.

Universal messages can be tailored through media and interpersonal channels.

The wide reach of the mass media is both their most attractive feature and their biggest drawback. While the mass media provide efficient means to communicate with large audiences, they do so at the expense of selectivity and precision. The mass media make it difficult to deliver messages that are tailored to the unique concerns and perspectives of subgroups within the target audience.The communication objectives presented in this document are "universal" in that they are intended for virtually all adolescents and their parents or other primary caregivers. The specific messages developed to realize those objectives, and the channels through which these messages are delivered, will vary for different subgroups within the target audience. For example, although the communication objectives for Hispanic and Anglo-American parents are the same, the specific messages and channels of message delivery are likely to differ.

Tailoring the campaign's universal messages to respond to regional, ethnic and cultural, gender, and age differences among members of the target audiences will require use of a variety of messages and channels. The National Youth Anti-Drug Media Campaign will harness a diverse media mix including television, video, radio, print, and Internet and other forms of new media to deliver both general and tailored messages. Within the media mix, messages will be delivered through the full range of media content including paid and public service advertising, news, public affairs programming, and entertainment programming. The campaign will further extend its reach and opportunity to tailor messages by developing partnerships with a broad range of community and civic groups, professional associations, government agencies, and corporations.

Campaign Design Principle:

To achieve the maximum effect, the campaign should use a full range of media mechanisms and formats in an integrated fashion and in a manner consistent with the communication strategy.

The commitment to use a variety of media and tailored messages to reach diverse target audience members is a critical component of effective media campaigns, regardless of their goal. Effective message tailoring involves soliciting input from target audience members, working with communication professionals who specialize in creating content for particular audiences, and testing the effectiveness of messages to ensure that they evoke the desired response among members of each target audience. The National Youth Anti-Drug Media Campaign will employ each of these methods to ensure the effectiveness of its messages for diverse audiences.

Campaign Design Principle:

To ensure effectiveness, all message executions should be pre-tested with diverse members of the target audience before final distribution. Moreover, where there is cause to think that messages targeted to a particular audience group can produce unintended negative consequences among other audiences, messages should also be tested with non-target audience members.

There is no way to know with certainty how much time it will take for the campaign to have an appreciable impact on drug use behavior. Targeting young adolescents, however, requires commitment to a relatively long time frame. Drug use prevalence begins to increase dramatically during the middle-school years. The campaign effort targeting elementary and middle school-aged youth should be sustained, at a minimum, throughout the audience's middle-school years to allow an assessment of its preventive impact.

Analysis of drug use data over the past two decades further supports the need for a sustained commitment. Trend data from large surveys such as the Monitoring the Future Study show that changes in key drug-related beliefs (such as perceived risks of use or personal disapproval of use) usually precede corresponding changes in drug use prevalence by about a year. Media campaign messages typically work gradually by influencing perceptions and fostering interpersonal communications (with friends, family members, and others), a process that is characterized as one of "erosion and accretion" rather than one of "upheaval and conversion" (Roberts & Maccoby, 1985). Given the nature of the campaign goal, and the social and psychological conditions that must be influenced to achieve the goal, the campaign must be sustained over a period of time before it can reasonably be expected to have an effect.

Campaign Design Principle:

The campaign must be sustained for a period of time sufficient to bring about a measurable change in the beliefs and behaviors of the target audiences.

Another issue relevant to the campaign's impact is exposure. Even if campaign messages are extremely effective, they cannot be expected to drive a national change in drug-use prevalence unless they are seen repeatedly by a sizable proportion of the target audience. To ensure that the campaign messages reach the target audience, they must be aired frequently. To make sure that a consistently high exposure rate can be maintained without having the message seem repetitive, boring, or annoying, a sizable number of different message executions will have to be developed and aired during the course of the campaign.

Campaign Design Principle:

The central messages of the campaign should be repeated often and in a variety of ways. Repetition is important to enhance exposure and availability; variety is important to capture the range of perspectives among audience members, and so that the message will not be perceived as annoying or "stale."

* To ensure that these public service advertisements are consistent with and supportive of the overall campaign goal, ONDCP will provide media companies with a variety of pre-approved public service advertisements on a range of topics including underage tobacco and alcohol use prevention.