CenterforSubstanceAbusePrevention PreventionWORKS/ Technical Assistance Bulletin s Offic Minority Health irce Center Box 37337 Washington DC 20013-7337 You Can Avoid Common Errors As You Develop Prevention Materials An organization may spend thousands ofdollars in developing a campaign tofight theproblems caused by alcohol, tobacco, and otherdrugs. But that moneygoes to waste ifthe messagespromoted in the campaign are unclear, outdated, or irrelevant. Prevention materials can play a key role in the on solid scientific findings, and relevant to fight against alcohol, tobacco, and other drug the intended audience. problems. A well-executed campaign can The Center for Substance Abuse Prevention foster an environment where dangerous (CSAP) in the Substance Abuse and Mental drug-related behavior is widely recognized as Health Services Administration (SAMHSA) unacceptable. And a young person who might has reviewed thousands of products otherwise have been inclined to begin using intended to prevent alcohol, tobacco, alcohol, tobacco, or other drugs might lose and other drug abuse and found several — that inclination if he unacceptable messages messages that or she is fully in- are open to misinterpretation, messages that Even though formed about the are not adequately supported by scientific yourmaterials dangers of alcohol, research, and messages that fail to address tobacco, and other aredesigned the real concerns of, or appeal to, the drug use and addic- intended audience. toprevent tion. But sometimes alcohol, prevention materials In order to eliminate the chance for misinter- tobacco, and fail to achieve the pretation of prevention messages, and to desired response ensure that messages actually reach their otherdrug use, because the intended intended audiences, CSAP has developed yourreader audience either public health principles, and scientific and mayperceive misinterprets or communications guidelines. These principles ignores the preven- and guidelines form the basis of CSAP's thatyou are tion message. Poorly evaluation of all prevention materials. These condoning executed campaigns principles and guidelines are first and fore- ' drug use. may even stimulate most based on the major tenet of "Do no dangerous drug- harm." Prevention workers are urged to related behavior or use these principles and guidelines when offend the target audience, thus ensuring that screening or developing materials for use in no prevention message will be heard. In Federal, State, or local prevention programs. order to achieve their goals, developers of The purpose of this bulletin is to help prevention materials must do all that they can developers of prevention materials avoid to ensure that their products are clear, based those messages that may do more harm than September 1994 good. The bulletin focuses on the principles The use of any legal drug, including alcohol andguidelineswithwhichpreventionprogrammers or tobacco, by individuals legally underage most often fail to comply. for its use The illegal or unwise use of a legal drug. Mixed Messages Make the Message Clear "While some people may be able to use a 'soft,' mood-altering drug like marijuana for Prevention materials sometimes contain subtle occasional recreational purposes without any messages that run counter to the intent of the apparent ill effects, no individual can be sure prevention program. An individual who is inclined that he or she will not have a negative to smoke, abuse alcohol, or use other drugs is response to such a drug." likely to look for any justification for his or her behavior. That individual may misinterpret a "Any substance, in and of itself, is neither prevention message in order to find that justifica- good nor bad. It is only the improper use, tion. This section provides examples both of misuse, or abuse of substances that is bad." mixed messages and of clear messages. T—he Note that these mixed messages imply that some examples of mixed messages—are derived illegal drug use may be "safe" even though they although not directly quoted from materials are intended to discourage drug use. reviewed by CSAP. Some of these messages may be interpreted to condone what is actually unwise ClearMessages or unsafe behavior. Some of the examples of clear "It is unlawful to produce, distribute, or messages may have a familiar ring. These are purchase cocaine under any circumstances." adapted from national campaigns that have received CSAP approval. Others are also taken "Even substances that are not prohibited by from materials submitted by CSAP grantees. law can harm your health if they are used improperly." These examples are provided to illustrate the clear, positive communication that CSAP is seeking to "It is not only unhealthy to allow your promote as well as the mixed communication teenager to smoke cigarettes, but it's also CSAP is seeking to avoid. against the law." Public Health Principle: Make it clear that illegal and unwise drug Public Health Principle: use is unhealthy and harmful for all Give a clear message that "risk" is associ- In an attempt to be "even handed" or "realistic," ated with using any form or amount of many prevention materials acknowledge (either alcohol, tobacco, or other drugs. directly or indirectly) illegal drug use as a "fact of life." Even though the ultimate intention may be Even though alcohol consumption and tobacco to prevent this kind of behavior, this acknowledg- use are legal for individuals who are 21 or older, ment will be read by some to mean that such drug this does not mean that these practices have no adverse consequences. Even small amounts of use is "normal." All prevention materials should alcohol, tobacco, and other drugs increase injury take a clear stand against: or health risks. The use of any legally prohibited drug Mixed Messages The use of a drug for a purpose other than its prescribed use "The alcoholic content of beer and wine is not as high as that of hard liquors like The use of any product or substance that can whiskey or vodka." produce a drug-like effect Arf^hDZ^^ "Many people use alcohol in social settings These mixed messages do not contain any to relax and to celebrate special occasions. incorrect information. But they fail to give the There is nothing wrong with social drinking clear "no use" message that should be sent to as long as one stays within moderation and all underage individuals, pregnant women, does not drive after drinking." recovering alcoholics and drug addicts, and individuals using prescription or nonprescription Clear Messages medications. "The alcohol content of one bottle ofbeer is Furthermore, materials should clearly state that the same as that of a martini or a shot of pregnant women should consult their physician whiskey." before buying any new medication, refilling a "Alcohol is a drug. And like any drug, it prescription, or taking medication on hand for will affect your judgment and your physical common ailments, such as headaches and colds. coordination, even when taken in small Common over-the-counter drugs that should amounts. Another danger of alcohol is be avoided by pregnant women without first that it can be addicting." consulting their physicians include antacids, Note that euphemistic terms like "mood-altering nasal sprays, nose drops, aspirin, laxatives, drug" or "recreational use" should be replaced and vitamins. with more accurate terms like "mind-altering." Likewise, commonly prescribed drugs that can be dangerous to the fetus include antibiotics, antihistamines, vaccinations, antimigraines, PublicHealth Principle: tranquilizers, antinauseants, sedatives, diuretics, When targeting persons under 21 years or hormones (e.g., oral contraceptives). ofage, pregnant women, recovering Materials must state clearly that these and other alcoholics, or persons taking prescription drugs should only be used by pregnant women or nonprescription drugs, give a clear on the advice of their physicians or other medical message ofno alcohol use. practitioners. Many prevention materials aimed at youth stress Clear Messages the importance of learning to make wise deci- "Part of growing up is learning how to make salilontsh.e iBnuftortmhaetsieonmattheartiawlosusltdopheshloprtthoeftgeievniangger wcihsoeosdeectiosidornisn.k Ybeofuorsehoyuoludakrneo2w1,tyhoatuifaryeou make the wise decision of abstinence from breaking the law." alcohol or other drug use. Materials often fail to mention that alcohol consumption by anyone "The U.S. Surgeon General says that 'the under 21 years of age is illegal. Materials that safest choice is not to drink at all during urge moderation in alcohol use for pregnant pregnancy or ifyou are planning women fail to take into account recent pregnancy.' " research that reveals that even small amounts of alcohol will increase the risks of birth defects. Public Health Principle: Mixed Messages Materials targeting youth should not use "Part of growing up is learning how to make recovering addicts or alcoholics as role wise decisions. Ifyou choose to drink, drink models. responsibly. Don't overdo it. And don't A number of celebrities who have had problems drink and drive." with alcohol or other drugs are eager to use their "You owe it to yourself and your unborn celebrity status to help others. But the message child to be informed about drinking during the celebrity intends to convey may not be pregnancy and to avoid excessive or abusive the message that teenagers and preteens receive. drinking." While the celebrity may be saying, "Don't do it," " the youth are hearing, "I did it, and I'm okay ClearMessages now. Taking drugs is part of being famous." "Alcohol impairs the drinker's speech, coordination, and judgment." Mixed Message "I was stupid to do drugs. I almost threw "Even more cancer-causing agents are found away my whole career. But now that I'm off in marijuana smoke than in tobacco smoke." drugs, I've been able to turn out hit records "People who snort cocaine frequently just like I used to." develop nasal problems, including holes in the cartilage separating the nostrils." ClearMessage "Taking drugs lessens your chance of succeeding at whatever career you would PublicHealth Principle: choose to pursue. Drugs close the doors Do not include illustrations or dramati- The basis of of opportunity." zations that could teach people ways to all CSAP An exception may prepare, obtain, or ingest illegal drugs. principlesand be made for role Many prevention materials use photographs or guidelines is models who clearly illustrations of illegal drugs or drug paraphernalia one major show they have been as graphic fillers. Illustrations of drugs or drug tenet: "Do negatively affected by paraphernalia should be used only when they no harm. the use of alcohol, serve a specific purpose (e.g., helping parents to tobacco, and other recognize signs of drug use by children). Materi- drugs, such as als intended to warn against drugs may inadvert- someone now ently teach someone how to use drugs. Further- visibly disabled or injured as a result of alcohol, more, scenes of people injecting drugs, sniffing tobacco, and other drug use. cocaine, or drinking alcohol may stimulate the behavior. These are best portrayed as implied actions. For example, someone representing a Public Health Principle: drug user might be shown with his or her back Do not unintentionally glamorize or toward the camera so that only a general sugges- glorify the use ofalcohol, tobacco, and tion of drug use is presented. Prevention materi- als should avoid representing any details of the other drugs. procedures of drug use. A powerful craving for In the effort to be informative about drugs, many cocaine has been found to be very common for prevention materials detail the effects all cocaine addicts and can be easily triggered by the drug has on the user. Even though most the sight of this drug and by objects, people, prevention materials focus on the negative paraphernalia, places, and emotions associated effects, even a brief description of a drug's in the addict's mind with this drug. positive or euphoric effects might attract a potential user. PublicHealth Principle: Mixed Messages "Alcohol helps many people relax or be Do not "blame the victim.» more sociable at parties." Addiction is an illness. Therefore, materials "Jeremy giggled a lot when he smoked should focus on preventing and treating the marijuana because the drug made him think disease and not on berating the individual. When that everything was funny." you use negative terms to describe an addict, you may be sending the message that the individual is "Several crack addicts have compared the not worth helping. Do not use insulting terms sensation they derive from the drug to about the victims of alcohol, tobacco, or other sexual orgasm." drug abuse. Likewise, do not focus on an 4 individual's shortcomings as a reason for use "It's fine to relax with a beer at the end of a or addiction. This does not imply that a person hard day. But know your limit." should not take responsibility for his or her "In most cases, curing insomnia requires alcohol, tobacco, and other drug problems, nothing stronger than the sleeping pills you whether related to addiction, dependence, can buy at your local grocery store." or unwise use. Encourage the person to take responsibility for seeking help if alcohol, Clear Messages tobacco, and other drug problems continue "Ifyou want to teach your children to be or if dependence is suspected. responsible with alcohol, show them that you Mixed Messages can abstain from alcohol and still have a good time." "Only losers take drugs." "It's fine to relax with a beer at the end of a "Stay away from pot heads and dope hard day. But you don't need a beer to relax." fiends." "If you have trouble getting to sleep, do not "Some people start taking drugs as a form of assume that finding the right pill to take is the escape because they do not have the solution. A change in your nighttime routine courage to face their problems." might be just as effective." ClearMessages This last message in no way implies that valid "Be smart. Don't start." medical attention, including appropriate drugs, should be withheld from anyone for any reason. "Ifyou have a problem with alcohol, tobacco, or other drugs, you can get help. But YOU have to take the first step." Materials that encourage individuals to seek help Make the Message Accurate should include information about organizations or agencies where help is available. In addition to being clear, prevention messages must be accurate and based on solid evidence derived from the latest scientific research. Public Health Principle: Unjustified claims can undermine the credibility of a prevention message. Furthermore, outdated State that abstinence is a viable choice. information may fail to contain important findings. In a culture that is conditioned to treat any For example, as more is learned about Fetal ailment with a drug, it may not occur to some Alcohol Syndrome (FAS), the clearer it becomes individuals that they have the option of not that abstinence from alcohol is the wisest course taking a drug at all. Be careful to avoid implying for pregnant women. But in the 1970's, it was that the only solution for a headache is an over- common for medical officials to recommend only the-counter analgesic or that the only way to that women limit their consumption of alcohol. celebrate a special event is with an alcohol It was even suggested in some materials that as beverage toast. In fact, prevention materials much as two drinks a day was a safe level of should strongly recommend alternatives to drug- alcohol consumption for pregnant women. reliant behaviors. Materials that focus on reduc- ing or limiting the amount of alcohol, tobacco, or other drug taken send a mixed message if Scientific Guideline: they do not include total abstinence as another viable choice. Be sure your message is scientifically significant, based on valid assumptions, MixedMessages accurately referenced, and appropriately "Ifyou want to teach your children to be used. responsible with alcohol, be a responsible Ifyou are working from hypotheses, theories, drinker yourself." or models but not from statistically significant, conclusive, and replicated research, be especially careful that your assumptions will not increase Make the Message Relevant drug use and that application will not result in misperception or other harm. Even though your message is clear and accu- rate, it will serve no purpose ifyour intended For example, ifyou are reporting that research has audience ignores the message. In order to not yet conclusively proven a link between a drug reach their targets, prevention messages must and a suspected health hazard, be very careful not be relevant. That is, they must appeal to the to imply that the drug has been proven harmless. values and interests of the audience. Promoters of some substances (e.g., the tobacco industry) have used a "lack of conclusive scientific Prevention messages must be cast in a language evidence" as an argument against restrictions and at a level of diction that is understood by the audience. However, prevention workers imposed on their products. As the FAS example demonstrates, prevention materials should make should be careful when attempting to use the it clear that a lack of conclusive evidence is dialect or slang that is associated with the target audience. Such attempts may be perceived as grounds for greater caution rather than for lighter inauthentic and condescending. Furthermore, restrictions. imitations of a group's dialect may reinforce Occasionally, CSAP reviewers find statements that negative stereotypes. have no apparent scientific base. An example is a course purporting that men required 10 to 12 years to develop the disease of alcoholism while Public Heath Principle: women required half that long and teenagers "only 6 months." These statements may be a Check for cultural and ethnic biases and misapplication of a sound scientific study, but the sensitivity. reader has no way of discovering the mistake Many of the negative stereotypes associated because no source is cited in the course materials. with minority groups involve perceptions of These statements are dangerous not only because their alcohol- or other drug-related behavior. oftheir inaccuracy and their lack of referencing, Prevention materials that address alcohol, but also because they may encourage irrespon- tobacco, and other drug abuse problems within sible use of alcohol. While the statements are clearly intended to demonstrate how easily a a specific minority should avoid reinforcing those negative stereotypes. Information about teenager may be trapped by alcohol, the state- any group's pattern of alcohol, tobacco, or ments inappropriately suggest that adults, espe- cially adult men, are relatively immune to the other—drug use should be presented objec- tively and based only on scientific and disease for a long period of time. Such a state- demographic research findings. ment clearly violates the tenet of "Do no harm." Presenting role models from a targeted minority If you are presenting information derived from can be an effective means of appealing to that scientific research, be certain that the information audience. But program developers should avoid is adequately referenced and appropriately applied limiting their chosen spokespersons to minority to the issue at hand. Many prevention materials athletes and entertainers. Community leaders, give relevant information but fail to identify the teachers, doctors, lawyers, educators, military source of that information. While some readers personnel, writers, parents, and many others may be convinced that a statement is true simply can help to demonstrate the variety of opportu- bdeescearuvseetiot akpnpoeawrsthiensporuinrtc,eootfhetrhsedfeinmdainngds athnadt nities open to minority youth. are being presented. If evidence is derived from Prevention messages must reflect the cultural sound scientific experiments conducted by re- norms ofthe audience. It is not enough simply spected individuals at reputable institutions, citing to include images of an ethnic or economic the source of the evidence can only help to make group in the prevention materials. Be sure to the prevention message more convincing. reflect the social, economic, and familial norms and symbols ofyour audience as well as their physical appearance. For example, groups are more important than individuals among some populations; spiritual symbols are important The No-Harm Checklist among others. You may also want to reflect such cultural factors as the importance of the extended family, the key role of grandparents, and religion. Give a clear no-use message for: Always be extremely careful that you do not inject ^ Any illegal drug use any of your own biases that could perpetuate a ^ myth or stereotype about a group of people. For Anyone under 21 years of age example, do not portray everything good with \/ Pregnant women white symbols and everything bad with dark symbols. And don't show only males being %/ Recovering alcoholics or drug arrested for alcohol-impaired driving. addicts. A campaign aimed at any group should communi- cate that the message sender cares about the well- Ensure that scientific findings: being ofthe audience. If a campaign aimed at a •" Will not encourage drug use specific ethnic group contains negative stereotypes of that group or fails to include any positive •" Are up to date symbols of the audience's culture, the audience ^ Are adequately referenced. will receive the mixed message that you are insensitive to their needs. The intention may be to say "We want to help you." But what is being Make your materials: said is "We don't care enough about you to learn ^ Relevant to the targeted audience anything about your culture." ^ Free of negative stereotypes The best way to ensure that prevention materials ^ Appealing. will appeal to their intended audience is to involve members of the targeted cultural or ethnic group in the planning and development processes. Pretest your materials. Ifyour organization does not already include members of the targeted group, people with knowledge of the intended audience should be sought out to provide input at an early stage. Furthermore, all materials should be pretested before they are widely distributed. Pretesting Communication Guideline: may include the use of focus groups or individual interviews with representatives of the targeted Prevention messages should include cultural or ethnic group. Questions asked during appeals that the target audience will pretesting should be designed to reveal whether perceive as personally relevant. the audience understands the central message of your product, whether the audience believes the The producers of prevention messages may strive message and the message giver, and whether the to keep teens from becoming addicted to drugs audience finds the message personally relevant. or facing other risks, including injuries or health problems. Yet teens who perceive themselves to Pretesting may not guarantee the success of a be immortal may turn off messages that empha- campaign. But it should identify any mistakes that size effects they don't believe they are at risk for. could guarantee its failure. Pretesting can identify Rather, appeals should be based on something the barriers to communication that often keep that teens value or consider important, such as prevention messages from reaching those who peer pressure or looking good and feeling good. need them most. Communication Guideline: When developing publications or other products relying on the written word, use white space 4 Prevention messages should inform the generously to keep the text from becoming reader ofthe seriousness ofthe problem, dense, and use headings and photo captions to persuade the reader ofthe need for impart essential information. In addition, use a change, and engage the reader with a call large typeface for materials that will be read by for action. young children, people with a low literacy level, or the elderly. Messages should make the reader aware of the need for change, the need for further informa- Audiovisual materials should offer clear and tion, or the seriousness of alcohol, tobacco, and understandable sound and visual quality. other drug problems. Materials must not preach Finally, the style ofthe product should be but rather find positive appeals that engage and appropriate to the audience. For example, motivate the target audience. And finally, materi- teens may find some cartoons "babyish." als must present a desired behavior so the Some Hispanics may be attracted to fotonovellas. message is not merely negative. Positive actions MTV-style videos may appeal to teens and be called for in prevention materials might include incomprehensible to their parents. seeking treatment, calling a referral number, confronting a drug-using spouse or friend, or joining a parent group. Communication Guideline: Do all you can to make your product professional and attractive in appearance. Gear the format (type, size, layout, style) 4 to your target audience. You do not have to use high-cost techniques to reflect high production quality. For example, although people generally do pay more attention to materials that use color, black and white Please feel free to be a "copy cat" and materials can be very appealing. Use screens to make all the copies you want. achieve various shades ofgray; box in some copy; use photographs, figures, and bullets. You have our permission! Developed andProducedbythe CSAPCommunications Team. Patricia A. Wright, Ed.D., Managing Editor. Distributed by the National Clearinghouse for Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20852. This bulletin is one in a series developed to assist programs that are working to prevent alcohol, tobacco, and other drug problems. We welcome your suggestions regarding information that may be included in future bulletins. For help in learning about your audience, developing messages and materials, and evaluating communication programs, contact the CSAP Communications Team, 7200 MD Wisconsin Avenue, Suite 500, Bethesda, 20814-4820, (301) 951-3277. i 8