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SB Final
Social Studies

Additional Social Studies Flashcards




Needs Assessment Purpose
understand the character of the community and its strengths
Needs Assessment- Steps
1. Establish a planning group, potential program participants to plan the needs assessment
2. Conduct needs assessment with PRECEDE Model
a. Analyze health and quality of life problems
b. Analyze their causes
c. Decide on priorities to focus the intervention
3. Balance the problem assessment with the assessment of the community capacity
4. Use the needs assessment to establish desired program outcomes
1. Identify data sources
a. Primary- survey, key informant interviews, ethnographic interviews, community forms, focus groups
b. Secondary – census data, birth and death records, surveys
c. Caution- opinion of stakeholders/ community vs factual description of problem causes
2. Describe the at risk populations
a. Group definable boundary and hared characteristics eg geographic and demographic boundaries
b. Share a sense of community, common values, culture, norms, language
c. Have or are at risk for certain health and quality of life problems
d. Have health problems and re at risk for the sequelae- consequence of disease or illness
3. Describe the problem
a. Outline the pop health and quality of life problems, plus their behavior and environmental causes ex: health: CV disease, physiological risk factor: high BCL, behavioral, eating high fat food, environmental, poor access to healthier foods
b. Problem assessment
i. What is the problem? Incidence, prevalence, distribution? Demographic characteristics of pop, segments of pop have excess from the health problem?
c. Community Assessment
i. Is there a community, characteristics, resources, strengths?
1. Cultural traditions and community values
2. Personal skills- group process, conflict resolution, community assessment, program planning, intervention design and implementation, evaluation, resource mobilization, advocacy
3. Leadership, social an inter-organizational networks
4. Social capita (citizen’s participation and connected ness)
5. Community institutions and services
ii. Where can groups at risk be reached by the program?
4. Explore the Underlying causes
a. Association between exposure to risk factor and development of a health problem
i. Behavioral risk factors and environmental risk factors
b. Relative risk- exposed/unexposed
John Snow-
problem-cholera epidemic of 1954, assessment-plot residences of fatalities, solution-shut off Broad street water pump, lesson- change public health by changing the environment, impact- inspired public health focuses on community infrastructure an sanitation.
• “Lifestyle” Health problems – substance use, violence, sexual behavior, exercise and diet
o Diagnosis: poor decision-making due to lack of knowledge and unhealthly beliefs and attitudes
• Traditional Focus: Health Education- Wrong way
o Strategy: increase knowledge of risks and change beliefs and attitudes
o Expectations: A rational consideration of what is in their best interests lead people to make better decisions and change their behavior
o Result: Knowledge alone seldom alters behavior, especially for those at greatest risk

• Shift in focus
o Move back to paradigm that returns to a focus to a focus on the environment
 Alter the environment in which people make decisions about their health behavior
 Do this by creating changes in organizations, communities and society
• Environmental Risk Factors
o Increase disease-causing exposures
o Influence health related behaviors
 Enabling factors- factors in the environment that either facilitate or hinder health promoting behavior
 Reinforcing factors- events that occur after behavior that make it more or less likely to reoccur
• Social ecological Framework
o Heuristic/method device
 Analyzing determinants, of a health outcome or behavior at multiple levels
 Brainstorming interventions that can address the health problem at multiple levels
• Individual
• Interpersonal
• Organization
• Community
• Culture/society
• Agent
• Cultural/societal level
o Demographic, political system, economic system and trends, legal codes and policy, cultural norms, ideologies, media influences, inequalities
• Community level
o Built environment
 Land use, transportation systems, services
o Community investment
 Economic development, maintenance, police services, education
o Legal codes, policies
o Community capacity
o Civic participation
• Interpersonal level
o Family influences-expectation, modeling, reinforcement
o Peer influences- expectation, modeling, reinforcement
o Intimate Relationships- mutual exchange, negotiation
o Social Support Network- Contact, guidance, assistance
• Individual Level
o Knowledge, attitudes and beliefs, perceived outcomes, social norms, personal norms, behavioral skills, perceived behavioral control behavioral intentions cues to action behavior
• Logic Model Template for Needs Assessment
o Quality of life health problems behavioral factors or environmental factors personal or external determinants
Personal Determinants of Behavior Change Theory
• Knowledge- modes of transmission, attitudes associated with behavior, protective behaviors
• Attitudes and beliefs- Personally at risk, personal responsibility, social beliefs
• Perceived outcomes- personal health benefits, psychological benefits
• Social Norms- what society and peers deems as acceptable, how peers are taking steps
• Personal Norms- safe health practices to benefit one self, connect with self image, self values
• Behavior skills- behavior to stay prepared, obtaining alternative by purchase or free
• Perceived Behavioral Control- routine to ensure prepared, money, time, deal with barriers, self efficacy
• Cues to action- reminders to act, calendar, or sign
• Environmental factors
o Interpersonal factors- support from peers and family
o Organizational Factors- health care organization encouragement, schools/ facilities- subsidize, availability in stores, access
o Community Factors- PSA campaign to encourage, public policy,
o Cultural/Societal Factors- Advertisement policy, Price subsidy programs
Web of Causation
- a diagram depicting the causal relationships among multiple types of determinants and a single health outcome aka theory of the problem, explanatory or causal model
o Levels of influence-
 Individual factors- personal desire
 Interpersonal factors- relationships
 Environmental factors
• Organization (health clinic), community (vending), culture/society (TV)
Health Belief Model
- Perceived Susceptibility- chances of getting the condition
- Perceived Severity- how serious a condition and its consequences are
- Perceived Benefits- efficacy of the advised action to reduce risk of seriousness of impact
- Perceived Barriers- tangible and psychological cost of the advised action
- Cues action- Strategies to active “readiness” to engage in the behavior
- Self- Efficacy- Confidence in one’s ability to take action in at a particular time and place
Limitations- the model assumes that health beliefs are primary, when that may not be the case, other categories that are important, subjective norms and personal norms.
Theory of planned behavior aka Theory of Reasoned action
- Behavior beliefs- beliefs about the likely outcomes of behavior and the evaluations of these outcomes– expectancy x value, behavioral beliefs produce a favorable or unfavorable attitude towards behavior
- Normative beliefs–beliefs about the normative expatiations of other, and motivation to comply with those expectations, normative beliefs result in perceived social pressure of a subjective norm
- Control beliefs– beliefs about the presence of factors that may facilitate or impede performance based on behvir, and the perceived power of those factors, control beliefs result in Perceived behavior control
 Intentionbehavior
Social Norms-
correct negative misperceptions (usually overestimates of use) and to identify, model, and promote the healthy, protective behaviors that are the actual norm in a given population.
Social ecological model
, interpersonal, institutional, community, public policy/society  environmental systems change
Types of Social Norms
- Descriptive Norms- What others are doing- actions (behavioral norms)
o Consumption
o Protective behavior
- Injunctive Norms- What others are think- beliefs (attitudinal)
- Global and Celebratory
steps for implementing social norms
1. Baseline- identify actual misperceived norms
2. Intervention- intensive exposure to actual norm messages
3. Predicted results- less exaggerated misperceptions of norms  reduction in harmful behavior and increase in healthy behavior
Adding social media- easily spread info but not easily change how people behave, need quality connection
Social Cognitive - define
Theory- explains how people acquire and maintain certain behavioral patterns, while also providing the basis for intervention strategies. Human behaviors personal environmental
Social Cognitive- constructs
1. Acquisition of behavior
a. Vicarious learning
i. Observe credible models( based on similarity, status, and likeability)
ii. Develop a cognitive representation of the behavior ( “script”)
iii. Vicarious reinforcement- working hard for rewards
b. Skill development-show how to do it
i. Rehearsal and guided feedback
ii. Leading to mastery
2. Building Self-efficacy
a. Observing successful role models
i. Struggle, followed by success and reward- cannot be too easy for role models
b. Encouragement from others
c. Successful performance
i. Managing emotional responses from gradual exposure to stimuli
ii. Gradually approximations of the desired behavior, leading to mastery – rewards along the way
d. Explaining the failure
i. Attribution to temp and situational factors versus permanent and internal factors- easier to blame failures on temporary circumstances then toblame self “ bad luck” help build self efficacy
3. Execution of behavior
a. Expected outcomes, which are valued personally
b. Self efficacy
i. Have the confidence in performing a behavior at particular times and places, particular self confidence
ii. Can overcome any barriers to performing the behavior
1. Unless people believe they can execute the behavior and produce the desired results they have little inclination to act to persevere in the face of difficulty. “whats in it for me?”
4. Maintenance of Behavior
a. Reinforcement
i. Direct reinforcement – catch them doing something good
ii. Self reinforcement– intrinsically motivated
b. Self control
i. Personal regulation of goal directed behavior
c. Self-motivation
i. Analysis and problem solving
ii. Self-correction
5. Punishment- doesn’t work well
a. Less effective than reinforcement for teaching and modifying behavior
b. Punishment is more effective when it is
i. Immediate – BAC over .08 police can take the license away immeditely
ii. Certain- in order for punishment to work you have to believe you can get caught
c. Severity of the punishment is far less important determinant of effectiveness if you don’t get caught
Family independence initiative- beautiful babies – intervention- info and coupon book
Individual Determinants of Behavior
1. Knowledge- the person knows basic facts about the health problem and the behavioral alternative
a. Seriousness, susceptibility of heath problem
b. Features of the behavior benefit
c. Other key facts e.g. who is at risk, warning signs, genetic factors, location of services
2. Attitudes and beliefs- the person has more positive than negative attitudes towards the behavioral alternative, beliefs related to the outcomes not just the health benefits
a. Positive or negative beliefs, reactions and feelings
3. Perceived outcomes- the person believes that the advantages of the behavioral alternative outweigh the disadvantages
a. Health benefits and other positive outcomes- expectancy x value
b. Punishments and other negative consequences
4. Social norms- the person perceives more social pressure to perform the behavioral alternative than not to do so- motivation to comply
a. Normative beliefs
i. Perceptions of other behavior (descriptive norms)
ii. Expectations of significant other (injective norms)
b. Motivation to comply
5. Personal Norms- the person perceives that performing the behavioral alternative is more consistent than inconsistent with his or her own values .
6. Behavioral skills- the person has the skills necessary to perform the behavioral alternative at specific times and places
a. Self-assessment, self management conflict resolution, negotiation, refusal skills, relapse prevention
7. Perceived Behavioral control- the person believes that he or she can perform the behavioral alternative at specific times and places
a. Perceived power (self efficacy)
b. Perceived capacity to overcome barriers ( control beliefs)
8. Cues to action-there are environmental stimuli that trigger the new behavior or remind the person of his or her behavior change objective
a. External cues, personal cues ( internal)
Transtheoretical Model – stages of change theory
1. Precontemplation- people do not recognize the problem or see a need to change their behavior
a. Move to contemplation
i. Raise awareness of the problem
ii. Prompt reevaluation of personal risk by increasing:
1. Perceived seriousness of the problem
2. Perceived susceptibility
iii. Explain change is possible
iv. Stimulate information seeking
2. Contemplation- people are seriously thinking about the problem and the possibility of behavior change
a. Moving to preparation
i. Reinforce a reevaluation of personal risk
ii. Increase familiarly with the alternative behavior- suggestion
iii. Introduce the potential benefits to be gained versus the potential costs
iv. Encourage confidence in abilities
v. Stimulate a commitment to change ( behavioral intention)
3. Preparation- People are committed to try the alternative behavior and are taking steps to prepare
a. Moving to action:
i. Promote developing personal goals and a list of motivating statements
ii. Show how to engage in the new behavior – skill development
iii. Show how to create social and environmental supports for the behavior change
iv. Promote self efficacy
v. Show how to confront and overcome barriers
vi. Prepare a plan of action
4. Action- people are attempting the new behavior change
a. Moving to maintenance:
i. Show how to maintain social and environmental supports for behavior change
ii. Show how to monitor behavior and provide self-reinforcement- charts/records
iii. Show how to avoid negative cues to action
iv. Develop strategies to resist temptation- avoid stimulis
v. Show how to cope with lapses
5. Maintenance- people are sustaining the new behavior and coping successfully with lapses if there are full relapse, help people move to the approporate stage and reengage in the behavior change process
Using the Stages of the change model
- Establish where in the behavior change process the target audience can be found
- Try to move the audience sequentially through the remaining steps
- Address the appropriate determinants at each step
- Reminder- people do not always go thought the sequence of steps in order and may cycle through the sequence multiple times, you can sometimes move people through multiple steps at the same time
- May have a narrow focus moving from one stage to the next
- Relapse
– resumption of frequent, uncontrolled, substance use after a period of abstinence
o Unfolding process, with resumption of substance use as the last event in a long sequence of response to stressors or conditioned stimuli
- Unavoidable part of the recovery process
o High relapse rates found in misused substances
o Majority of clients relapse within 1 year
o First 90 days are volunerable
- Can maintain sobriety after repeated treatments
a single incidence of substance use, vs a full blown relapse
- May not result in a relapse
o If see lapse as inevitable => full relapse can result
o Better to view lapse as a mistake and an opportunity for further intervention
Causes of relapse
- Occur long after drug use has ceased and physical dependence has ended
- Clients acknowledge their chemical dependence and are strongly motivated to change
- Predictors
o Criminal record
o Weak employment record
o History of severe addiction
o Coexisting psychiatric disorder
Antecedents of Relapse (preceeders of relapse)
- Stress, due to negative life events or everyday “hassles”
- Negative emotions, including anger, anxiety, depression, and frustration
- Interpersonal conflict, with family members and friends or at work
- Social pressure, due to being enmeshed in a social network in which others misuse substances
- Positive emotions, when socializing or to celebrate
- Use of other substances, which can trigger a craving, undermine self-control, or impair the person’s ability to respond effectively to a relapse crisis
- Presence of people or places associated with substance, which can trigger cravings
Process of Relapse
Likely to occur if
- Effective coping responses to deal with situation are unavailable or not executes
- Individual has expectation regarding positive effects of substance use in the situation
Abstinence violation effect of relapse
- Lapse is at odds with the client self image as a recovering addict who has vowed to remain abstinent
- Creates a stage of cognitive dissonance, guilt, shame or upset
- Desire to seek emotional relief can stimulate further substance use
- Relapse is more likely when the client attributes a lapse to a cause that uncontrollable, such as lack of will power
- Results in self blame and reduced sel-efficacy
Keys to relapse prevention
- Commitment to total abstinence not just controlled use
- Warn clients that temporary lapse is likely
o Avoid appearing to give permission for occasional use
o Explain how classical conditioning works
- Develop skills for anticipating, avoiding, and coping with high risk situations
- Counter positive expectation
o Reminders about “lows” that follows the “high” and the long term consequences
- Develop self management skills to cope with cravings and social pressures to use
- Become integrated into new social networks
- Learn to find pleasure in drug free activities
- Find new ways of responding to emotional stress and emotional pain
Cognitive approaches to relapse
- Identify cues that trigger relapse- be alert to earning signs: emotions, thoughts, and behaviors
- Avoid high risk situations- don’t set up test of ability to resist temptation
- Cope with unavoidable high risk situations- rehearse strategies for coming with stress, anger, disappointment and interpersonal conflict
- Develop strategies for coping with cravings-
o Behavioral- leaving the situation, using relaxation skills, repeating motivational statements aloud, writing in a journal, calling someone for support
o Cognitive- reviewing reasons for quitting, reflecting on process made to date, creative positive mental imagery
- Manage lapses-
o take slips seriously,
o immediate action is necessary, stop drug use after the initial lapse, remove one self from the situation, call someone for support, employ other behavior and cognitive strategies
o Analyze what happened and what can be learned
o Avoid self defeating attribution and instead see it as an isolated failure to use effective coping strategies on a specific occasion
o Recommit to abstinence and recovery
Social Support approaches to relapse
- Take an active role in structuring beneficial social support
o Announce intention, break off ties with drug-using friends, learn refusal skills
- Family oriented therapy, family support groups, and family education are important
- Establish new relationships through a buddy system or self help group

Social support
- Model desired behavior
- Create a supportive interpersonal environment
- Help client avoid or cope with sources of stress or with specific temptations to lapse
- Praise and encourage self-reward for continued progress
- Monitor client behavior and help identify signs of an impending relapse
Lifestyle change approaches-Move away from a drug using subculture, create new interest new social networks, new social identities.
Motivation- define
force that initiates and maintains goal directed behaviors
Motivation- theory
– Instinct Theory—act due to inborn pattern of behavior
– Positive reinforcement- receipt of a positive stimulus following the behavior
– Negative reinforcement- removal of an aversive stimulus following the behavior
– Greater impact if the consequences is immediate
– Drive Reduction Theory—act in order to reduce internal tensions caused by unmet needs
– Arousal Theory—act to decrease or increase levels of arousal to maintain an optimal level
– Incentive Theory—act in response to expected and valued rewards
– Goal-Setting Theory—act to reach a defined end-state or goal
Maslow’s Hierarchy of Needs
- Unsatisfied needs influence behavior, people advance to the next highest level only after lower level is satisfied.

Self-Actualization-Fulfillment of potential
Esteem -Self-esteem, confidence, achievement, recognition, respect
Love/Belonging -Family, friendship, interpersonal intimacy
Safety -Personal safety, shelter, access to resources
Physiological -Food, water, sleep, sex
Mcguire’s Typology on keying in on perceived benefits- - Consistency theory
o A person’s beliefs, feelings and actions are highly interconnected
o The person strives to maintain internal coherence among them
o Method: sensitize to internal inconsistencies, shame
Mcguire’s Typology on keying in on perceived benefits- - Autonomy theory
- a person has a need for freedom and control over his/her identity
o Method: build resentment against control by others, portray behavior change as an expansion of ones freedom, show how being controlled and build resentment
Mcguire’s Typology on keying in on perceived benefits- - Stimulation Theory
person seeks novelty, play and excitement
o Method: be the first one on your block to… , alternatives, tied to arousal theory
-Mcguire’s Typology on keying in on perceived benefits- Tension-reduction theory
a person strives to reduce arousal and maintain an emotional equilibrium
o Method: fear approaches- flip side of arousal theory, people are going to find ways to distance themselves
--Mcguire’s Typology on keying in on perceived benefits- Ego- defensive theory
- a person seeks to maintain self-esteem
o Method: self image, worry about what others think, shouldn’t feel shame something bigger is going on and should access resources available
---Mcguire’s Typology on keying in on perceived benefits- Expressive Theory
a person derives gratification from physical exertion, risk taking and fantasy play
o Method: alternative activities, be the action hero
-Mcguire’s Typology on keying in on perceived benefits-- Assertion Theory-
- a person is achievement oriented, longs for success and is eager to leave mark on the world
o Method: power or status theme, start something amazing big brother big sister
-Mcguire’s Typology on keying in on perceived benefits-- Identification theory-
a person has a need to create and expand a distinctive identity
o Method: identify formation though positive action- fitting in
-Mcguire’s Typology on keying in on perceived benefits-- Empathy Theory-
a person has a need for physical closeness and to be lied
o Method: altruistic appeals, concerns for others fatherhood
-Mcguire’s Typology on keying in on perceived benefits-- Contagion theory-
a person matches his/her thoughts, feelings and behaviors to those of others
o Method: get on the bandwagon, got milk
-Mcguire’s Typology on keying in on perceived benefits-Theories of human motivation, benefit, some are contradictory
autonomy v contagion, stimulation v tension reduction.
Diffusion of Innovations
Possibility of innovation – new ideas
Resistance to change – I don’t need it
Fundamental attribution error- point lack of change to external factors v. see others resistant to change explained in terms of their personal traits or characteristics, “ She is set in her ways” we “ I don’t understand why they think this will be easier”
Reflection- need to understand people’s perspectives
Key tasks for implementing an innovation
1. Communicating the characteristics of the innovation
2. Understanding the perspective of the decision makers
3. Creating a sense of urgency
Characteristics of innovations- framework cost and benefit
- Relative advantage- superior to replacement? Save time or money? Result in benefit or convince? Whats in it for me?
- Cost- requirements? Money, personnel, equipment? How much training time? Monitor and sustain
- Compatibility- consistent with past experiences and values? Can organizational goals still be met?
- Social impact- effect on relationships among individuals in the implementation setting and outside
- Complexity- how difficult to understand? How difficult maintaining the fidelity of innovation over time
- Communicability- how easily can the innovation be communicated to others
- Obervability- can use of the innovation and its effects be observed by others
- Divisibility- innovation tried on a limited basis without long term commitment of personnel or resources, can it be sold
- Reversibility- innovation be discontinued without permanent consequences resulting from the trial, undone without permanent damage
- Adaptability- innovation be updated or modified to be consistent with new knowledge or needs
Types of adopters
Innovators Visionary, creative, and well-educated. Willing to take risks. First to develop an idea, and often the first to try it. How can we things differently?
Early Adopters Highly respected. Often seen as opinion leaders. Willing to try new ideas developed by the innovators. Is there something new we can try? Do we have reason to believe it might work?
Early Majority Thoughtful and deliberate. Want to see evidence. Willing to adopt new ideas before most people. Has someone else tried this? Is there evidence that it works?
Late Majority Cautious. Often skeptical of new ideas. Willing to adopt new ideas after a majority has done so. What are our competitors doing? What are most people doing?
Laggards Traditional. Highly critical of new ideas. Willing to adopt a new idea after it has become main¬stream or they are forced to do so. Is this conventional practice? Are we being forced to do this?
Creating institutional change- Kotter’s framework
1. Create a sense of urgency
a. Identify potential threats
b. Mix statistics an personal stories
c. Identify opportunities for leverage
d. Start honest, dynamic discussions about the need for change
e. Request support from others
2. Build a team
a. Identify true leaders and recruit them
b. Check your time for weak areas(roles, skills, experience, political, connections) and expand if needed- diverse team
c. Organize into working groups to accomplish specific tasks
d. Agree on procedures that will maximize the team’s effectiveness
e. Work on team building with your change coalition/task force
3. Create a vision for the team
a. Determine the central values
b. learn what key decision makers identify as their priority objectives
c. describe the future in positive and compelling terms linking the institution’s central values and decisions makers top priorities
d. ensure that your change task force can describe the vision in five minutes or less
e. develop a strategic plan, being mindful of how to link specific proposals to a larger vision
4. Communicate the vision
a. Talk often about your change vision
b. Communicate how your vision applies to all aspects of campus operations
c. Openly and honestly address people’s concerns and anxieties
d. Encourage others in the campus community to endorse and communicate your vision
5. Remove obstacles
a. Engage people who are resistant until you understand their perspective
b. Explain why the benefits of the change exceed the potential costs
c. Identify incentives that can motivate resisters to get on board
d. Identify key influencers or constituency groups who can persuade others to support the team’s proposal
e. Consider modifications to accommodate people’s objections
f. Recognize and reward people who are supportive
6. Create short term wins
a. Identify projects that offer far more benefits that costs and that will be widely supported
b. Concentrate initially on projects that can be implemented without help from critics
c. Make a strong, committed effort to succeed
d. Reward people who help you accomplish the targeted projects
7. Build on the change
a. Use each victory to create a sense of momentum for additional change
b. Examine how to improve the team’s work procedures and external communications
c. Focus on new projects that build on momentum that’s been created and now seem feasible
d. Bring in new members as the teams work evolves
8. Anchor the changes in culture
a. Publicize the progress being made and projects that have made it possible
b. Develop supportive job descriptions and performance review criteria
c. Hire and train new staff who will support the changes that have been made
d. Monitor ongoing projects t prevent backsliding
e. Publicly recognize members of your change coalition/task force
f. Create procedures for replacing key leaders as they move on.
Harvard Alcohol Project
• Introduced the designated driver to the American public
• Method: Entertainment programming and network public service announcements to convey public health messages
o Hollywood lobbying
• Used persuasion to the major television networks and Hollywood television producers to contribute to the campaign.
• Why?
o Attract attention to the issue
o Provide role models for desired attitudes and behaviors
o Attract commercial support
o Generate news coverage

• Challenge-Keeping the issue and the project in front of the producers, Harvard invitations
• Designated Driver- define
one person from a group or couple agrees to abstain from alcohol and to take responsibility for driving, The drinking companions are free to drink or not
Harvard alcohol project • Good Focus for media campaign
o Positive step to avoid driving-after-drinking
o Interpersonal communication: when implemented, the idea becomes known to more people
o Easily communicated concept- dialogue, short PSA
o Novel and memorable idea
o Gallup poll: strong public support- public thought it would be a good idea

• Maintaining a high profile
Approached studios

o Journals, news papers ads, traffic reports.
Guidelines for Harvard Alcohol Project
• Public Service Announcements
o Themes
 Males teens and young adults previously thought designated driver as a “babysitter” or “mom”
• Do not stress that being the driver is “socially responsible” or the right thing to do “ = babysitter
 Portray being the designated driver as a rewarding role.
• Cool, in control
• A leader, but also an accepted member of the group
• Sexually attractive
• Meaningful role
o Guidelines
 Stress the importance of planning ahead
 Don’t tell the audience what to do: show them
• How can the subject be brought up
• How can friends’ resistance be overcome
 Show the benefits of following through
 Show that the designated driver has a good time
 Depict the designated driver as a full member of the group- especially later, when others have been drinking- show rewards
 Do not suggest that the designated driver’s friends are free to drink heavily
o PSAs on ABC, CBS and NBC did not follow guidelines and promote starts
 Talking heads
Impact of Harvard Alcohol Project
o Gallup poll: use of DD all or most of the time increased from 62% to 72 % in one year
o Widespread public awareness and support
o Entry in Random House Webster’s College Dictionary
• Principle Concern of Harvard Alcohol Project
o Having a designated driver encourages excessive drinking by the passengers
o 1993 college alcohol survey
 1908 students who normally drink heavily did not do so the last time they served as a DD (47% abstained and 23% had one drink)
 1031 students who normally do not drink heavily did so the last time they rode with a DD
o Wanted to have roadside BAC test for drivers and passengers to get good data
Conclusion for Harvard Alcohol Project
use of DD should be promoted, but in the context of a strict policy enforcement
• Reasons for Campaign’s success
o Based at Harvard (“prestige by association”)
o Frank Stanton connection NBC
o Low key approach
o Easily incorporated on a routine basis
o Problem of personal relevance to Hollywood
o Groundwork laid by MADD
o Des not challenge the status quo on alcohol advertising or sales or focuses on policy
Strategic use of Communication
• Start with figuring out what to say to reach the target audience to change behavior vs
• Better approach:
o Developing strategic objectives for a comprehensive intervention plan (broad)
o Determining how the campaign can best support that effort
• Potential communication objectives
o Individual Level
 Increase awareness of the public health problems and establish it as a priority concern
 Increase factual knowledge
 Change beliefs and attitudes
 Stimulate information seeking (hotlines/ websites)
 Describe personal/social benefits of the behavior
 Correct misperceptions of behavioral norms
 Show the conflict between personal value and current behavior
 Teach new behavioral skills
 Show how to overcome barriers to change
 Build self-efficacy
o Group level
 Publicize shifts in behavioral norms
 Reinforce injunctive norms
 Stimulate interpersonal communication
 Stimulate social support
 Encourage social reinforcement
o Institutional, community, society/culture
 Generate demands for changes in public policy or new programs
 Publicize changes in public policy and enforcement
 Promote school- or community-based programs
• Recruit volunteers
• Recruit program participants
• Announce availability of self-help materials and program activities
• Reinforce information presented on the programs
Media Planning Guide 1. Problem Analysis
a. What is the problem?
b. What causes or contributes to it?
c. What has been done in the past to address it and to what effect?

a. Few alcohol dependent teens are going into treatment
b. Parents need to get their teen into treatment
Media Planning Guide 2. Overall Strategy
a. What is the best way to leverage change?
i. What level of social ecological level are you focused on?
ii. What is the best way to produce the most change
b. How can the mass media be used to advance that overall strategy

a. Increase knowledge
b. Increase self-efficacy beliefs
c. Communicate positive behavioral outcomes
Media Planning Guide 3. Target Audience
a. Who do you want to reach with your mass media message? Be specific. What is your rationale?
i. Not necessarily people telling its people who need the message (ex: to tackle the topic of sexually active teenagers the message is directed towards the parents)

a. Parents
Media Planning Guide 4. Objectives
a. What do you want your audience to do after they hear or watch your message?
i. “truth goggles” implicit message but not asked to do anything
b. Obstacles
i. What stands in the way of your audience doing what you asking of them?
1. What are key barriers to change

a. Call a toll-free 1800 number to get information and a referral to local treatment and AL-Anon resources
Media Planning Guide 5. Key Promise
a. Identify one promise or benefit that the audience will get if they do what you are asking of them.

a. There is hope for a teen alcoholic and we can help you help him/her
Media Planning Guide 6. Support statements
a. What else does your audience need to know. Think. Or believe. In order for the message to motivate their taking action
b. Support key promise by getting them motivated
c. Rational (TPB, HBM) vs emotional (smoking rates truth campaign)

a. Powerful instinct to deny alcoholism
b. Significant others often provoking an alcoholic’s drinking by “enabling”
c. Parents have tried everything they can and nothing seems to work
d. Family members my handle problems in conflicting way
Media Planning Guide 7. Net Impression
a. Summarize what you want your audience to say to themselves after seeing or hearing your message.
i. Compares what you want people to say after you get their message

7. Values
a. Parents will do anything to help a child in need
8. Support statements
a. Parents do not need to feel alone, hopelessness and powerless over their ability to have a positive effect on their teen’s drinking
b. Parents should know that there are tools that will help the problem drinker overcome denial and take the first step towards recovery
9. Net impression
a. While there is no miracles, there is a hope for a teen who has a drinking problem im not really alone, and I can do something to help.
Media Planning Guide 8. Tone
a. What feeling should your message have? Authoritative? Light? Emotional? Other?
i. Doesn’t need to be consistent to drive home the message (sync with collaborators)

a. Emotional, moving to authoritative
b. Rely on empathy and hope, not guilt or scare tactics
i. Depict the problem and lives of people who live it
ii. Provide a solid basis for hope, leading to action
Media Planning Guide 9. Media
a. What channels of communication will you use TV, radio, newspaper, ad, poster, news coverage, or what? (sync with other things in the community)

a. Television PSA
b. Radio PSA
c. Print advertisements
Media Planning Guide 10. Collaborators
a. What other sponsors or collaborators do you need? What level of media cooperation do you need?

a. National Council on Alcoholism and Drug Dependence
b. Broadcast and print media outlets
Media Planning Guide 11. Continuing activities
a. What other program activities could you tie into or build off the media activity?
i. Other programs in the community that you could create
Media Planning Guide Overview
1. Problem Analysis
a. What is the problem?
b. What causes or contributes to it?
c. What has been done in the past to address it and to what effect?
2. Overall Strategy
a. What is the best way to leverage change?
i. What level of social ecological level are you focused on?
ii. What is the best way to produce the most change
b. How can the mass media be used to advance that overall strategy
3. Target Audience
a. Who do you want to reach with your mass media message? Be specific. What is your rationale?
i. Not necessarily people telling its people who need the message (ex: to tackle the topic of sexually active teenagers the message is directed towards the parents)
4. Objectives
a. What do you want your audience to do after they hear or watch your message?
i. “truth goggles” implicit message but not asked to do anything
b. Obstacles
i. What stands in the way of your audience doing what you asking of them?
1. What are key barriers to change
5. Key Promise
a. Identify one promise or benefit that the audience will get if they do what you are asking of them.
6. Support statements
a. What else does your audience need to know. Think. Or believe. In order for the message to motivate their taking action
b. Support key promise by getting them motivated
c. Rational (TPB, HBM) vs emotional (smoking rates truth campaign)
7. Net Impression
a. Summarize what you want your audience to say to themselves after seeing or hearing your message.
i. Compares what you want people to say after you get their message
8. Tone
a. What feeling should your message have? Authoritative? Light? Emotional? Other?
i. Doesn’t need to be consistent to drive home the message (sync with collaborators)
9. Media
a. What channels of communication will you use TV, radio, newspaper, ad, poster, news coverage, or what? (sync with other things in the community)
10. Collaborators
a. What other sponsors or collaborators do you need? What level of media cooperation do you need?
11. Continuing activities
a. What other program activities could you tie into or build off the media activity?
i. Other programs in the community that you could create

a. Toll free number
i. Brochure
ii. Referral to local treatment center
• Issue- lower the per se limit from .10% BAC to 0.08% BAC
• Chief Opponent- Senator Ed Burke
• MADD’s public image
o Primary work
 Victim services
 Awareness education
 Public policy advocacy
• MADD’s political capital
o MADD’s image-and its credibility with the public- is a resource that can be used to MADD’s advantage. Image: victim services/ education don’t know that MADD can fight politically.
 A resource that can be spent
 If MADD takes actions that are inconsistent with its public image, then MADD itself can become the story
 Such actions can also create internal dissension within MADD
• Senator Ed Burke- block several bulls that were important to MADD
o Used parliamentary maneuvers to prevent action by a majority of State senators
o Apparent acquiescence of senate president Bulger
o Result: no new drunk driving legislation since 1986 state roads act
MADD Reflection, Lessons, conclusion
• Reflection
o The focus on the admissibility bill distracted MADD from its main legislative objective
 Bill was a symbolic importance to MADD
 Forms a prevention standpoint, it was not as important as the 0.08% per se law
o Created ill will within MADD Mass
o Used up enormous political capital
o Media advocacy strategies did work, but at a cost
• Lessons
o Plans can be made, but you also have to be opportunistic
o The radio commercial played a key role but in the context of the broader media strategy
o The news media love controversy, and will always try to present both sides of an issue
• Conclusion
o Media advocacy seeks to encourage a fully informed and energized citizenry to demand of government that if protect the public good
o This approach was inherently controversial
 Does not win many friends, especially among financial interest and political leadership within vested interest in the status quo.
• Performance objective • Behavior change- condom use
• Performance objective- use condoms correctly during every act of social intercourse
o Components
 Make a decision to use condoms to prevent from future infections
 Purchase condoms or obtain them from free sources
 Carry condoms regularly
 Store condoms properly
 Communicate about the negotiate condom use (initiate conversation and overcome objections)
 Refuse sex when condoms are not available
 Use condoms correctly
 Use condoms consistently
• Short v long term relationships
• New v well known partners
• During pregnancy
• Learning objectives-
- actionable and therefore measureable
o Knowledge
 Explain (cannot measure “understand”) the seriousness of HIV infection
 Describe where to find the expiration date
o Attitudes and Beliefs
 Express belief in personal risk of getting HIV
 Explain need to care for partners’ well being
o Personal norms
 Explain why condoms use show that a person cares about a partner’s health
 States that condom use is consistent with a masculine self image
o Social Norms
 Reports that friends use and enjoy condoms
 Express belief that partners have been thinking of condom use.
o Skills
 Purchase or obtain free condoms
 Carry condoms regularly
o Perceived Outcomes
 Reduced personal risk for HIV, STDs, Pregnancy, sterility
 Better communication in relationship
o Cues to action
 Calendar notes to check supply
 Reminder by door (until carrying them is habitual)
o Perceived behavioral control
 Barriers
• Condoms not available if sex is spontaneous
• Unable to stop sexual activity once initiated
 Strategies
• Express confidence in ability to engage in safer sex activities without intercourse when condoms are not available
• Develop list of safe places and an exit strategy for leaving an abusive partner
• Choosing the intervention Venue
o Key questions
 Can the target audience be reached directly through an effective way?
 Is there an overarching change objective that needs to be addressed first? If so what decision makers who can bring about the change?
 Should the intervention population be differentiated into subgroups, in terms of demographics, developmental stages, personal determinants ( related to stages of change)?
o Considerations
 Characteristics of target audience
• Sit, ease of access, special needs or considerations, secondary audience that can reach primary audience
 Potential strength of the intervention (efficiency)
• Size triumphs efficiency ex: on air smoking cessation clinic, higher % of people
o Available resources
 Funding
 In kind contributions
 Allies, angels, partners
o Coordination
 Number of people/agencies who have to give approval
 Number of people/agencies who have to work collaboratively
o Personal and infrastructure
 Space
 Patient flow
 Staff
• Availability
• Investment. Inclusion
• Qualifications
 Political considerations
• Upper level organizational support
• Public support
o Intervention options- condom use
 Options
• Media campaign
• School-based intervention
• Clinic intervention
• Retailer intervention
 Focus on patients at STD clinic
• High risk group by definition
• Teachable moment
o Role models
 Parameters of use?
• The audience identifies with the model
• The model must be credible and likeable
• The model demonstrates feasible skills
• The model receives reinforcement
• The audience perceives a coping model, not a mastery model
Web Based intervention
• Problems with college drinking- target- 1st year college students
• Highlights from literature
• Competitive Analysis- 4 websites showing strengths and weaknesses
o Lessons learned
 Appropriate scope and depth of content
 Need for interactive features
 Smart organization and navigation techniques
 Tailor resources, data on drinking norms, and school policies to students, unique experiences at their college or university
• Health Behavior Change theories
• Formative research
o Interviews with 1st year students
o Interviews with manager of wellness and prevention services at BU
• Performance Objectives
o Practice refusal techniques
o Communicate to peers actual drinking norms
• Learning Objectives
o Identify stress-relieving activities other than drinking
o List specific warning signs of alcohol poisoning
• Fictional persona that gives life to the person youre trying to reach
• Empower yourself and students to find other things to do
• Web diagram- visual presentation of the site’s webpages and organization
o Shows categories of proposed content and relationships between pages
• User testing protocol
o Does the website work as intended?
o “get it” testing- initial impressions
• User testing results-
o images of people they can relate to
o Peer based perspective its not authoritative
o Liked student videos
Alcohol EDU
• Teaches basic facts about alcohol
o Impact on brain development and learning
o Factors that affect BAC
o State alcohol and DUI laws min drinking age, zero tolerance law 0.08% BAC per se law
• Motivates behavior change
o Resets unrealistic positive expectation about the effects of alcohol
o Outlines the negative consequences of elevated BAC
o Links choices about drinking to academic and personal success
o Dispels misperceptions of student drinking norms
o Part 2 : healthy ways to deal with stress
• Promotes developing a personal plan
o Strategies to encourage safe decision making
o For drinkers, strategies to reduce alcohol consumption and drinking related harm
• Promotes bystander intervention
o Respond to possible alcohol poisoning
o Prevent drinking and driving
• Creates and engaging learning experience
o Customized pathways
 Men and women
 Frequent heavy drinkers
 Abstainers (committed/situational)
o Student “investigators” introduce and reinforce key concepts
o Multimedia format
 Dramatic vingettes
 Scenario driven exercises
 Interactive tools
 Pop quizzes
 Flash video animation
 Simulated blogs and IMs
o Authoritative, but non-judgmental tone( with occasional humor)
• Provides college specific data reports
o Knowledge pretest and exam
o Baseline, interim and follow-up surveys
 Attitudes and beliefs
 Alcohol use
 Protective behaviors to reduce alcohol consumption
 Harm reduction strategies
 College specific customized question
o Creates multi campus database
 World’s largest database on college students and alcohol
 Provide insights into the etiology and prevention of high risk drinking
Alcohol EDU conclusion
• Summary-Villanova university version 8.0 RTC
o Students who took alcohol EDU drank significantly less than control groups students
o Students who took alcohol EDU, compared to control group students,
 Suffered significantly fewer drinking related behavioral consequences
 Showed significantly less acceptance of others alcohol use
 Had significantly lower positive expectancies of alcohol use
 Engaged in significantly fewer responsible drinking behaviors
• Summary- University of west Florida – pilot study version 9.0 ETC
o Fall courses/ Intent to treat analysis indicated significant reductions in
 Frequency of past 30 day alcohol use
 Heavy episodic drinking
 Frequency of past 30 day alcohol problems
o Effects did not persist when assessed in the spring
o Ancillary analyses suggested stronger Alcohol EDu effects on these outcomes at colleges with higher rates of student course completion
The learning and Environmental Change objectives
• The planning process
• The planning process
o Establish planning group that includes potential program participants and plan the needs assessment
o Conduct needs assessment and decide on priorities
 Health problems
 Impact quality of life
 Behavioral and environmental causes
 Determinants of behavior and environmental causes
o Assess community and group capacity
o Choose the health behavior to be changed
o Define the target audience
o Define the performance objectives for the target group of concern
o List both the individual and environmental determinants of behavior
o Develop learning objectives (tied to individual determinants)
o Develop environmental change objective (tied to environmental determinants)
 Identify key actor /agency
 Determine whether a deeper analysis is needed
o Identify the most important objectives, and which are possible to change
 Learning objectives
 Environmental change objectives
o Select methods for achieving each of the learning and environmental change objectives
 Ex: modeling
o Select or design practical strategies for delivering the methods to the target audience
 Ex life demonstration, video, photo novella, script
o Review the final set of strategies to make sure they match up with the objectives
o Translate the strategies into an organized program
o Develop a logic model of the intervention
• Performance objectives- observable and measurable
o What are the fundamental changes in behavior that need to occur?
 Subgroups of the target group that may need different objectives?
 Think in terms of what the target group should do
 Use precise wording
• Reduce the number of drink consumed per drinking occasion
 Do not need to express objective in terms of percentage change expected
• Objectives expressed this way are usually a guess, unless there is an existing intervention as a guide
 Develop a comprehensive list
 Use language that highlights important points of information
• College students screened and identified as problem drinkers will enter a comprehensive campus based treatment program
• Learning objectives - define
behavior self efficacy is key
o Written for individual determinants
 Use behavior change theory to round out your thinking
• What does the target audience need to learn, related to eac individual determinant, in order to do the performance objective?
 Some learning objectives will apply to multiple performance objectives that are conceptually related
• Example: reduce drinking occasions and reduce amount consumed per occasion
o Learning objectives should also be an action- use strong verbs (argue, demonstrate, describe)
o If appropriate, state the contextor conditions under which the behavior should occur
o Note any behavioral standards require to perform the behavior correctly
Example • Performance Objectives: Sexually active high school students will use condoms correctly during every act of intercourse, what are the learning objectives?
o Knowledge: argue against misconceptions about HIV transmission
o Attitudes: agree: using condoms in a creative way can be fun
o Perceived outcomes: outline personal benefits of condom use (e.g. personal safety, peace of mind, improve relationship)
o Social norms: express belief that partners have been thinking about condom use
o Personal norms: describe how condom use is consistent with a personal value of caring about others
o Behavioral skills: outline how to use condoms correctly
o Perceived behavioral control: demonstrate how a condom can be purchased without embarrassment
o Cue to action: describe how to use a monthly calendar note as a reminder to check the condom supply
Example • Performance objectives: College students who drink will reduce the number of drinks consumed per drinking occasion, what are the learning objectives?
o Knowledge: explain alcohol’s biphasic properties
o Attitudes: agree: I don’t need to drink heavily to have fun
o Perceived outcomes: outline personal benefits of reduced drinking (e.g. fewer hangovers: blackouts, injuries, fights)
o Social norms: agree: most college students don’t drink heavily
o Personal norms: agree: high risk drinking is not consistent with my academic goals
o Behavioral skills: by each Thursday, plan weekend activities around alcohol free events
o Perceived behavioral control : agree: I know how to use non-confrontational responses to decline alcoholic drinks
o Cues to action: create an automatic reminder text message to have one rink per hour or less
• Environmental Change objectives - Define
• Environmental Change objectives- written for environmental determinants
o key question: what needs to be changed related to external determinants in order for the target group to do the performance objective
o analyze in terms of
 social ecological framework
 conceptual framework based on the research based understanding of this problem
o which actor /agency can bring about this change?
o Is a detailed analysis of change objective needed?
 Yes
• Essential change that needs to be made
• Making the change will require real effort
• Achievable given available resources and the politics
 No
• At risk group can be taught to make the change
• Simple change, easily put in place during program implementation
• Change objective is beyond the actor/agency’s purview or control
 If yes, organize a program of activity to bring about the change objective
• Develop performance objectives for the actor/agency who can bring about that change
• Analyze individual and environmental determinants of the required behaviors
o Based in part on the adopter category
• Identify learning and environmental change objectives for the actor/agency
• Develop an intervention plan to address the change objective as part of the overall program plan
Example o Performance objectives : sexually active high school students will use condoms correctly during every act of intercourse what are the Environmental Change objectives?
 Interpersonal: other youth will express support for the consistent condom use
 Institutional: local health clinics will make free condoms available at patient check in counters
 Community: health educators will work with local retail outlets to improve product placement and clerk training
 Culture/society: television entertainment programming will depict negative consequences of unprotected sex
Example o Performance objectives: College students who drink will reduce the number of drinks consumed per drinking occasion, what are the Environmental Change objectives?
 Interpersonal: peers will support a person’s decision not to drink excessively
 Institutional: local bars, taverns, restaurants will eliminate advertising that encourages excessive alcohol consumption
 Community: local law enforcement will state law/municipal ordinances that prohibit over-service
 Culture/society: legislation will increase federal alcohol excise tax and index future increases to inflation
• Choosing Key objectives
- important and changeable
o Judgment call based on
 Behavior change theory
• Elements needed based on a target audience’s stage of change
 Literature review
 Expert opinion
 Existing program experience
 Personal experience
 General knowledge
 Available resources
 Political considerations
• Logic model
o Change of events that will lead to the implementation of each program or policy to a specific (and measurable objective
o There are several reasons to build a logic model:
 Resolve uncertainty, confusion, disagreement among the planning team
 Guarantee that all programs and policies are logically linked to objectives
 Reveal any false assumptions that have to be addressed
 Help inform the evaluation (examine interviewing steps)
 Serve as an educational and communications tool
• Evaluation - Define
- formal process for collecting analyzing and interpreting information about a program’s implementation and effectiveness
o Answers two basic questions
 What are we doing?- process evaluation
 What effect are we having?- outcome, impact or summative evaluation
Process Evaluation - Define
o Process evaluation
 Focus:
• How the program is actually operating
• What resources (time, money) are going into the program
 Essential question
• Do the actual resource expenditures, administrative activities and delivered services match what was originally planned?
 If a program fails, was it flawed idea, or was it inadequately implemented?
 Almost impossible to interpret findings unless it’s known whether the program is being carried out as planned
 Use process evaluation to detect an implementation failure and the reasons for it.
o Outcome, impact or summative evaluation - define
 Is the program accomplishing its stated objectives?
 Focus
• Comparison across time
• Comparison across program
o Program planning and evaluation
 The idea is for the program planning and evaluation to be integrated
• Thinking about the evaluation sharpens thinking about the intervention
 Planning should result in clearly articulated goals, objectives and activities all guided by a logic model of how the intervention will work
 This sets the stage for the evaluation
o Research design
 A set of instructions about when and from whom to collect specified data
• Purpose
o Demonstrate whether any changes have occurred
o Access whether the program can be credited for causing that change
• Good research design increases our confidence that the program is producing results
• Social norms marketing research project
o Social norms- people’s beliefs about the behavior that is typical or is expected of them in a particular social context
o People’s perceptions of the norms are often a good predictor of what they will say and do

• Survey of college alcohol norms and behavior
o Students have exaggerated views of how much other students drink  students perceive greater normative expectations to drink students increase alcohol consumption
• Social norms marketing
o Use campus based media to report accurate drinking norms decrease in perceived normative expectations to drink decrease in alcohol consumption
Summary of Social norms marketing research project
 Study implementation
• Can any one respondent describe prevention activities accurately? Not necessarily
o University of Michigan- over report
• Do the respondents know what the term “social norms campaign” means? Not necessarily
• What level of activity qualifies as a “campaign”? not defined
• where the norms campaigns implemented properly? Not investigated
o SDSU- campaign failed small social norms
 Analysis
• Did the analysis control for the other programs and policies being implemented at the same time? No
• Was there sufficient statistical power to detect differences over time at individual schools? No sample size too small
• Social norms marketing research project NIAAA and US dept of education
o True experimental design
 Treatment Random Assignment RO X O
 Comparison Random Assignment RO X O
o Random assignment
 If people(or groups or institutions or communities) are randomly assigned to the treatment or comparison groups and
 If all other conditions are held constant
 Then we can conclude that the treatment accounts for an observed differences between the groups
o Almost perfect
 The design controls for almost all threats to validity
 Absence of selection effects should be verified
• Did the randomization work?
o Remaining threats to internal validity
 Attrition
 Treatment groups exposure to other programs
 Hawthorne effect
 Interactions between groups assignment and threats to validity
• Example: protest helps the treatment group focus on how to make a program work for them
o In practice
 Random assignment may be viewed as unethical e.g withholding potentially effective treatment
 Potential participants may refuse to participate if denied the treatment
 It may be prohibitively expensive
 Evaluators may be unable to hold other conditions constant
o Selection of participating institutions
 Sent open invitation
 Applicants completed questionnaires
• Never had a social media campaign
• Willing to be control group if assigned
• Demonstrated commitment to the program
 Secured IRB approval (1 study 18 sites)
 Matched schools (region, size, governance, student demographics)
 Randomly assigned schools to treatment group or control group
Summary of Both Social norms marketing research projects
• Social norms marketing research project- finding for study 1- cohort A= 18 colleges and universities- “just the facts”
• Social norms marketing guidelines
o Campaign messages must
 Be targeted to the entire undergraduate population
 Convey information about the behavior typical of a majority of students
 Correct an identified student misperceptions
 Be simple statements of fact( i.e. should not have a judgemental or moralistic tone)
 Normative message
 Campaign logo
 Identification of the source of information (survey, date)
 Drink equivalency line (i.e. 1 drink = 12 oz beer= 40z wine= 1oz liquor)
o Print advertisements should include an eye catching photograph
• Study 1 summary
o Relative risk of alcohol consumption was lower at schools with JTF campaign
o Pattern:
 Minor changes at treatment group schools
 Heavier alcohol consumption at control schools
o Core institute data suggest a national treat for increased heavy drinking between 2000 and 2003
• Social norms marketing research project – findings for study 2 cohort B = 14 colleges and universities- no statistically significant evidence, replication failed
• Overall summary
o Study 1
 Students attending an institution with an SNM campaign have a lower relative risk of heavy alcohol consumption
o Study 2
 Replication failure
• Rejected hypotheses
o Replication study sites had less active campaigns: no, they were more active
o Student body characteristics differed across the two studies: no, there were only minor differences
o School characteristics (region, size) differed across the two studies yes, but there is no theoretical basis for the thinking this would create a null finding in study 2
• Alcohol outlet density
o Density- number of on-premise alcohol outlet (bars, restaurants) within 3 miles of campus boundary, per 1000 total student enrolled
 Off campus liquor stores are not as frequently cited by students as a source of alcohol
• Summary- alcohol outlet density confounder
o Significant interaction between on-premise alcohol outlet density and the intervention effect (experimental group x time x outlet density)
 Number of drinks when partying
 Recent maximum consumption
 Composite drinking scale
o High density- no intervention effect
o Low density intervention effect
 Number of drinks when partying
 Recent maximum consumption
 Composite drinking scale
• Alcohol outlet density
o Study 1
 18 sites, 5 at or above median
o Study 2
 14 experimental sites, 1 at or above the median
• Potential explanatory mechanism
o High density of alcohol outlets
 Increases alcohol access, which drives up consumption
 Counters the social norms campaign’s normative message
• Implications
o Social norms marketing an work to reduce student alcohol use
o But it does not work as well in alcohol rich environments
 Need an even more intensive social norms marketing campaign
 Need to work to change the campus community’s alcohol environment
1. What is the most critical challenge that public health practitioners will face when soliciting stakeholders’ opinions about a community’s needs? (2 points)
There may be a discrepancy between actual and perceived needs in the community, which needs to be resolved.Other answers: It may be difficult to identify the key stakeholders; they may not want to cooperate; they may not be completely open and honest; the stakeholders may disagree with one another.
2. A key step when conducting a community needs assessment is to describe a target group with a “definable boundary” and shared characteristics. Other than geographic and demographic characteristics, name two dimensions by which a potential target group can be defined. (2 points)
They share a sense of community, with common values, culture, norms, and language. They have or are at risk for certain health or quality-of-life problems or their sequelae.
3. When describing a community’s health problems, practitioners will report both its incidence and prevalence. Explain the difference between these two terms. (2 points)
Incidence refers to the number of new cases, expressed as a rate over a period of time per 1,000 or 100,000 population. Incidence refers to the number of all cases, similarly expressed.
4. How do practitioners most commonly use the social ecological framework when working on a public health problem? (2 points)
The framework is used to organize an analysis of a health outcome or health behavior, and to organize thinking about alternative interventions
5. Define the concept of self-efficacy. (1 point)
Self-efficacy is the confidence a person has to engage in a specific behavior at a particular time and place.
6. According to the Health Belief Model, what two factors determine whether a person sees a particular disease or health problem to be a personal threat? (2 point)
Perceived susceptibility, or the likelihood of contracting or suffering from a disease or other health problem; and perceived severity, or the perceived seriousness of a disease or other health problem and its consequences
7. What is the theoretical basis for using a social norms marketing approach to reduce heavy drinking among college students? (2 points)
Students have exaggerated misperceptions of drinking norms and therefore feel greater normative pressure to drinking heavily. SNM campaigns provide factual information to correct those misperceptions, which in turn will change students’ normative beliefs and reduce the pressure they feel to drink heavily.
8. Examine the poster on the final page of the exam. What is the target group asked to do? Which motivational theory does this poster utilize? Explain. (2 points)
There is no action step specified. Implicitly, the target group should resolve to avoid marijuana use before using heavy equipment. The poster utilizes tension-reduction theory: the message is designed to increase emotional arousal, which can be reduced when the viewer resolves not to use marijuana
9. Name two strategies for enhancing a target audience’s self-efficacy. (2 points)
Present successful role models; offer encouragement; provide guided feedback; reinforce gradual approximations of the desired behavior; and help them explain failure in terms of temporary and/or external factors rather than permanent and/or internal factors.
10. Name and define three of the five levels of Maslow’s “hierarchy of needs.” (3 points)
Physiological, safety, love/belonging, esteem, self-actualization
11. Describe the type of information to which each of the following groups is most likely to respond when considering adopting an innovation. (3 points)
Early majority:
Late majority:
Early majority:
Evidence that the innovation works

Late majority:
Evidence that most people (or competitors) are using the innovation

Information that the innovation is conventional practice or mandatory
13. What is the primary objective that must be met when creating a vision for institutional change? (1 point)
Describe the institution’s future in positive and compelling terms, linking it to the institution’s central values and the decision-makers’ top priorities.
14. When promoting an innovation, what are two strategies for dealing with resistance to change? (2 points)
Explain why the benefits of the change exceed the potential costs; identify incentives that can motivate resisters to get on board; identify key influencers or constituency groups who can persuade others to support the team’s proposals; and consider modifications to accommodate people’s objections.
15. Explain why working first for small, short-term wins can help promote institutional change. (1 point)
Each victory can be used to create a sense of momentum for additional change. This also provides an opportunity to examine how to improve the team’s work procedures and external communications.
16. Explain the difference between positive and negative reinforcement. (2 points)
Positive reinforcement involves a positive stimulus following the behavior, whereas negative reinforcement involves the removal of an aversive stimulus following the behavior.
17. Name three steps that can be taken to move people from the “preparation stage” to the “action stage” of the behavior change process. (3 points)
Promote developing personal goals and a list of motivating statements; show how to engage in the new behavior (skill development); show how to create social and environmental supports for the behavior change; promote self-efficacy; show how to confront and overcome barriers; and prepare a plan of action
18. Name three steps that can be taken to move people from the “action stage” to the “maintenance stage” of the behavior change process. (3 points)
Show how to maintain social and environmental supports for behavior change; show how to monitor behavior and provide self-reinforcement; show how to avoid negative “cues to action”; develop strategies to resist temptation; and show how to cope with lapses
19. What is the primary way to prevent a lapse from segueing into a full-scale relapse? (1 point)
They should remove themselves from the situation. It is better to view a lapse as a “mistake” and an opportunity for further intervention and learning.
20. Define the concept of vicarious learning. (1 point)
Learning that occurs when observing a credible model, from which the person develops a cognitive representation of the behavior (“script”).
21. List two major shortcomings shared by the Health Belief Model and the Theory of Planned Behavior. (2 points)
The models assume that all behavior is the product of conscious, rational thought; they do not take into account motivating factors such as emotion and habit; and they do not take into account social and environmental factors.
22. What are cues to action? Name a possible cue to action related to texting and driving prevention. (2 points)
Cues to action are external or internal stimuli that activate an individual’s readiness to change. Possible answers: buzzer; sign on the dashboard; comment from other passengers.
23. Identify a motivational theory that could be applied in a public communications campaign to reduce texting and driving by adolescents. Based on that theory, what would be the primary message of the campaign? (2 points)
24. Name two factors that led to the success of Florida’s “Truth” campaign. (2 points)
The campaign was youth-focused and used youth-driven campaign ideas; the campaign branded the word “Truth”; the campaign directed adolescents’ need for autonomy against the tobacco industry; the campaign worked to change policy
12. A public health practitioner is establishing a program to encourage small manufacturing plants to become tobacco-free worksites. Analyze that innovation in terms of the listed characteristics, viewed from the perspective of the business owner. (4 points)

Relative advantage:



25. The _____ for a particular factor is defined as incidence of a public health problem among those who have been exposed to a risk factor, divided by the incidence of that problem among those not exposed to the risk factor. ( 1 point)
a. Prevalence
b. Relative risk
c. Problem definition
d. Expected outcome
Relative risk
26. Environmental factors that increase the likelihood that a person will repeat a particular health behavior are _____. (1 point)
a. Enabling factors
b. Risk factors
c. Systemic factors
d. Reinforcing factors
d. Reinforcing factors
27. A diagram that shows the causal relationship among multiple determinants of a public health problem is a _____. (1 point)
a. Logic model
b. Social ecological framework
c. Web of causation
d. Venn diagram
. Web of causation
28. According to the Theory of Planned Behavior, _____ lead to perceived social pressure to perform a certain behavior. (1 point)
a. Normative beliefs
b. Control beliefs
c. Behavioral beliefs
d. Motivational beliefs
Normative beliefs
29. Which motivational theory does the Florida “Truth” campaign best illustrate? (1 point)
a. Consistency theory
b. Contagion theory
c. Ego-defensive theory
d. Autonomy theory
. Autonomy theory
30. Which motivational theory often involves power or status themes? (1 point)
a. Expressive theory
b. Assertion theory
c. Identification theory
d. Autonomy theory
Assertion theory
31. From which adopter group would it be best to recruit role models who could successfully encourage others to adopt an innovation? ( 1 point)
a. Innovators
b. Early adopters
c. Early majority
d. Late majority
. Early adopters
32. Which statement would be endorsed by an alcoholic who was in the “contemplation stage”? (1 point)
a. I stopped drinking more than 6 months ago.
b. I stopped drinking 3 months ago.
c. I intend to stop drinking in the next month and have already started to cut back.
d. I intend to stop drinking in the next six months.
e. None of the above
. I intend to stop drinking in the next six months.
33. Which of the following statements is false? ( 1 point)
a. For modifying behavior, punishment is less effective than reinforcement.
b. Punishment is more effective when it is immediate and certain.
c. The severity of a punishment is the most important factor determining its effectiveness.
d. Using punishment to control behavior interferes with the development of self-management skills.
c. The severity of a punishment is the most important factor determining its effectiveness.
34. Which of the following factors is not a social determinant of health? (1 point)
a. Income disparity
b. Gender
c. Perceived control
d. Race/ethnicity
c. Perceived control
35. An illusion of control can lead to which of the following? (1 point)
a. Reduced anxiety
b. Improved luck
c. Conduct disorder
d. Learned helplessness
a. Reduced anxiety
36. What does Malcolm Gladwell call the moment when an innovation or health behavior reaches “critical mass”? (1 point)
a. Jumping the chasm
b. Massive adoption
c. Tipping point
d. Cataclysmic change
c. Tipping point
37. Which of the following models take into account the process of behavior change over time. (Circle all that apply) (1 point)
a. Transtheoretical Model
b. Health Belief Model
c. Theory of Reasoned Action
d. Precaution Adoption Process Model
e. Theory of Planned Behavior
a. Transtheoretical Model
d. Precaution Adoption Process Model
38. Which behavioral health problems contributed to half of all deaths occurring in the U.S. in 1990?(1 point)
a. Alcohol, tobacco, and illicit use of drugs
b. Diet and activity patterns
c. Firearms and motor vehicles
d. Sexual behavior
e. a& b (combined)
f. a, b, c, & d (combined)
f. a, b, c, & d (combined)
39. Which of the following statement is true? (1 point)
a. Relapse prevention requires a commitment to total abstinence.
b. Warning clients that a temporary lapse is likely would be counterproductive.
c. An addict’s recovery will be delayed if she abandons old friends.
d. Cognitive approaches to relapse prevention are superior to social support approaches.
a. Relapse prevention requires a commitment to total abstinence.
40. You have been asked to develop an alcohol prevention program that integrates social norms marketing with stricter policy enforcement. Outline how you would integrate these two program components so that they could work synergistically. Briefly explain your rationale. (7 points)
Use a social norms campaign to correct misperceptions of student drinking norms, to demonstrate that the majority of students make good decisions most of the time.

Use that campaign to introduce data showing that the majority of students support tougher policies and stricter enforcement against alcohol-related offenses.

Campus administrators will be emboldened to move forward with environmental prevention strategies.

Introduce new policies and apply stricter enforcement measures, and position these as being consistent with student preferences.

A minority of students who might oppose those measures will not be influential in deterring administrators from taking this course.

Publicize the enforcement actions being taken, reminding students that this effort is a response to their concerns.
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