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> "Selling" Prevention – Applying Social Marketing Principles To Promote Wellness
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The Drug and Alcohol Forum

"SELLING" PREVENTION – APPLYING SOCIAL MARKETING PRINCIPLES TO PROMOTE WELLNESS

by Cele Fichter, MPM, CPS
Program Manager, Prevention Education
St. Francis Medical Center, Pittsburgh, PA

Abstract

Using The Center for Substance Abuse Prevention (CSAP) and The National Institute of Drug Abuse (NIDA) research-based prevention guidelines and current marketing theory, this article illustrates the need for designing targeted prevention strategies. Not all individuals are at equal risk for developing problems with Alcohol, tobacco or other drugs (ATOD). A variety of factors including unique genetic make-up, environmental influences and developmental history can affect one’s vulnerability to ATOD problems. As sellers of prevention, ATOD prevention practitioners need to be in touch with both the science of prevention and the science of marketing. The best prevention message in the world will be ineffective if it falls on deaf ears. The implications and the challenges for the prevention field lie in our ability to do further research not only into the science of the disease and behaviors associated with substance abuse but also into the science of marketing and communication for positive behavior change.

After completing the article, participants will:

  • Identify the value of marketing theory to prevention practice
  • Recognize that the uniqueness of individual risk requires a corresponding individualized prevention plan
  • Identify six categories of targeted prevention strategies

Kevin is sixteen years old and has begun to date steadily. Kevin has also begun to brush his teeth steadily. Kevin just bought a toothpaste that promises fresher breath, whiter teeth and a sexier smile. Since this same toothpaste also delivers a fluoride formula, gum protection and tarter control, Kevin just "bought" prevention. Ironically, this product with its sought after formula for physical attraction and sex appeal is the same product which Kevin has ignored for its formula for cavity reduction and tarter control. The manufacturers have decided to respond to Kevin's needs, wants and desires in an effort to affect behavior change i.e. capture an adolescent and young adult market. While receiving his chosen benefit of fresher breath and whiter teeth, Kevin's parents and dentist are receiving their chosen benefit of improved dental hygiene and healthier teeth.

Advertising, sales promotion and public relations experts have long recognized the benefit of choosing the "right" message delivered by the "right" medium to the "right" target audience in order to affect the "right" behavior change. The belief that the tobacco industry had chosen children and adolescents as their "right" target audience rightly angered parents, educators, health officials and child welfare advocates. As much as one might disagree with the ethics and motivation of the tobacco industry, no one can argue with the fact that they used research, resourcefulness and revenues to produce results. Marketing is not by nature either unethical or evil. The nature of marketing is to raise awareness, provide information and incite action. Many successful businesses and organizations, including health care, are recognizing that in order to raise awareness, provide information and incite action, they must pay attention to the needs and requirements of their customers. Total quality improvement programs are built on the premise that continuous communication resulting in responsive action is the cornerstone of any successful organization.

In their book, the New Marketing Paradigm, authors, Schulz, Tannenbaum & Lauterborn (1997) recognize that the "mass market" (if it ever really existed) is dead. The assumptions which led to the delivery of a single message to a broad population, delivered by mass media are no longer valid. New technologies make it possible for "buyers" to differentiate themselves from the masses. The proliferation of segmented magazines, websites, cable channels and customized merchandise give a multitude of choices to fit every need and desire. New technologies also make it possible for "sellers" to differentiate their "buyers" from the masses. The availability of on-line marketing data and target population demographics make it possible for "sellers" to recognize and communicate with discrete audiences, using discrete messages, in discrete environments.

Like marketers of products, the marketers of prevention can use marketing principles to raise awareness, provide information and incite action. The promoters of health and welfare, not unlike the tobacco companies, can utilize research, resourcefulness and revenues to produce powerful results. Just as not all individuals are equally receptive to buying a manufacturer's particular product, not all individuals are equally at risk for developing a particular problem (Tarter, 1992). For example, alcohol, tobacco and other drug (ATOD) prevention researchers have learned that a variety of factors including unique genetic make-up, environmental influences and developmental history can affect one's vulnerability to ATOD problems. Using the results of more than two decades of studies into the origins and pathways of ATOD abuse, the National Institute on Drug Abuse (NIDA) recognizes that not only are there factors associated with greater potential (risk) for ATOD use, but there are also factors associated with reduced potential (protection) for such use. The NIDA research-based guide "Preventing Drug Use Among Children and Adolescents" (NIDA, 1997) indicates that risk factors can occur in the areas of family, school, peers and community. These risk factors include: chaotic home environments, particularly in which parents abuse substances or suffer from mental illnesses; ineffective parenting, especially with children with difficult temperaments and conduct disorders; lack of mutual attachments and nurturing; inappropriate shy and aggressive behavior in the classroom; school performance failure; poor social coping skills; affiliations with deviant peers, or peers around deviant behaviors; and perceptions of approval of drug-using behaviors in the school, peer, and community environments. Research-identified protective factors include: strong bonds within the family; experience of parental monitoring with clear rules of conduct within the family unit and involvement of parents in the lives of their children; success in school performance; strong bonds with pro-social institutions such as the family, school and religious organizations; and adoption of conventional norms about ATOD use. The impact of any risk or protective factor varies depending on the developmental phase of the individual and other factors such as the degree, intensity, duration and quantity of risk or protective factors present.

The uniqueness of individualized ATOD risk and protective factors requires a corresponding uniqueness of individualized ATOD prevention efforts. With the advent of more sophisticated prevention research, new individualized types of prevention interventions are being designed. The Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Administration (SAMHSA), utilizing research conducted by the Institute of Medicine (SAMHSA, 1995), is recommending three broad types of preventive interventions by which to focus prevention efforts.

Universal Preventive Interventions: Targeted to the general public or a whole population group that has not been identified on the basis of individual risk.

Selective Preventive Interventions: Targeted to individuals or a sub-group of the population whose risk is significantly higher than average.

Indicated Preventive Interventions: Targeted to high-risk individuals who are identified as having minimal but detectable signs or symptoms, but who do not meet diagnostic levels at this time.

CSAP further guides prevention efforts by suggesting six different categories of targeted prevention strategies (SAMHSA, 1995):

Information Dissemination: One-way communication from source to audience

Education: Two-way communication between educator and participants

Problem Identification and Referral: Strategies which identify and reverse problem behaviors

Community-Based Process: Participation with the community to enhance ability to provide more effective atmosphere and services

Environmental Process: Strategies which change written and unwritten community laws, standards, codes attitudes

Alternative Activities: Opportunities for individuals to engage in activities which do not involve the use of harmful substances or behaviors

The six categories in conjunction with the types of preventive interventions serve as a framework and provide information on the different avenues and vehicles to be used in ATOD prevention efforts but leave the designing of individualized messages as well as the choice of which vehicle for which population up to the individual prevention practitioner. As with other health promotion strategies designed to reduce adverse outcomes like skin cancer, heart disease and adult smoking, ATOD prevention programs have proven successful when effectiveness is measured by examining which strategies work with which individuals in which environments (Tobler, 1992). The evaluation of ATOD prevention programs (SAMSHA, 1995) has taught us:

  • No single approach works for everyone
  • A psychosocial approach emphasizing personal skill development and task-oriented learning often reduces ATOD use among children and adolescents
  • Changing policies, regulations and laws to alter the community environment reduces ATOD problems among adults
  • Among adolescents at significant risk, individual counseling and family intervention show promise in affecting long-term risk and protective factors
  • Sensitivity to, and inclusion of, the cultural values of the target community enhances effectiveness.

Prevention practitioners are learning along with marketing gurus that the challenge involved in effective "selling" is to sell to individuals rather than markets. The best marketing and the best prevention strategies are not one shot promotions, but are multiple strategies provided in multiple environments across multiple time frames.

The effectiveness of this approach recently became clear to me when I was the target of a marketing strategy. Due to a variety of circumstances in and out of my control, I am not yet the proud owner of an Internet account or an e-mail address. Up to this point, I have been able to rely on the kindness of strangers and friends who wish they were strangers to supply me with my on-line needs. My receptiveness to purchasing an on-line service is increasing as I am bombarded with multiple strategies (offers of free America On-line hours, cajoling, whining, nagging and pleading from friends and co-workers, and written promises of free on-line information and services from professional organizations). Unfortunately these strategies are not confined to the work environment but invade multiple environments like my home mailbox, my answering machine and my church and community interactions. These interventions have not occurred for one day or one week, but have continued to be repeated over multiple time frames, to the point where I am almost ready to spend the $19.95/month. I think one more strategy in one more environment over one more time frame will just about do it.

Effective marketing, communication and prevention strategies take into account what the "buyer" needs and wants to hear, not only what the "seller" needs and wants to say. These integrated approaches blend the technology, the research and the knowledge of the "seller" with the perceptions, needs and benefits desired by the "buyer". As "sellers" of prevention, ATOD prevention practitioners need to be in touch with both the science of prevention and the science of marketing. The best prevention message in the world will be ineffective if it falls on deaf ears. Kevin, the previously mentioned, steadily dating adolescent has not been particularly receptive to prevention messages which warned of gum disease and painful cavities. As a teenager, he's not even aware he has gums let alone aware or concerned that they might become diseased. He is concerned about his self-image, his attractiveness and his ability to get close to a girl without fear of embarrassment due to stained teeth or bad breath. In order to "sell" prevention to Kevin, one must first identify and respond to what motivates or benefits Kevin. A prevention practitioner developing an ATOD prevention strategy for adolescents like Kevin could design print messages for dissemination which portrayed the attractiveness to the opposite sex of not using ATOD and the benefit of not having beer breath or tobacco stained teeth; educational classes which give adolescent boys and girls the opportunity to hear accurate ATOD information and to role-play together social situations and refusal skills; and alternate activities like ATOD-free dances or parties.

Since successful marketing strategies are interactive in nature and are based on listening and learning as well as "telling and selling", we can identify what motivates or benefits our audience whether they are adolescents, students, parents, clients or patients by asking them. Patient satisfaction surveys, focus groups, direct mail responses, telephone calls, face:face interviews, classroom discussions, program evaluations and community meetings, in addition to any existing demographic and psychographic data, can provide information on the beliefs, attitudes, needs and desires of our target audience. Integrated prevention plans can be designed which include the problem (what behavior needs to be prevented), the audience (who needs to be prevented from doing the behavior), the benefit or promise to the audience (why should they stop or not start the behavior), the strategy (message and medium to be used to prevent behavior) and the desired outcome (what result will occur if the problem is successfully prevented).

For example, a prevention specialist designing programs for parents could use the research conducted by the National Center on Addiction and Substance Abuse (CASA) at Columbia University which indicates that both parents and teens believe that the most serious problem teenagers face is illegal drugs (CASA, 1996). CASA has also discovered that 40% of the parents (target audience) surveyed think they have little or no influence over their adolescent’s decision whether to use drugs or not (problem or behavior to be changed). Strategies geared to parents could be designed to educate them about ways to protect their children, promote no-use norms for teens and provide opportunity for ATOD-free, family-oriented events (message and medium). CASA findings can then be combined with the results of the 1996 Parents’ Resource Institute for Drug Education Survey (PRIDE) which concludes that when parents warn their children about drugs, use is lower (expected outcome/benefit) (PRIDE, 1996). Both CASA and PRIDE surveys provide us with valuable insight into the fears, beliefs and motivation of a potential target group (parents) as well as with data as to what result can be expected from changing or introducing new behaviors.

The implications and the challenges for the prevention field lie in our ability to do further research not only into the science of the disease and behaviors associated with substance abuse but also into the science of marketing and communication for positive behavior change. We must be motivated to listen and learn before we speak and use our science and creativity to serve those who are most in need.

REFERENCES

Grede, R. (1997). Naked Marketing. Englewood Cliffs, NJ: Prentice Hall.

National Center on Addiction and Substance Abuse. (1996). 1996 National Survey of American Attitudes and Substance Abuse II. [On-line], Columbia University: www.pitt.edu/~mmv/cedar.html

National Institute on Drug Abuse. (1997). Preventing drug use among children and adolescents: A research-based guide (NIH Publication No. 97-4212). Washington, DC: U.S. Government Printing Office.

Parents Resource Institute for Drug Education (1996). National Parents’ Resource Institute for Drug Education: Ninth Annual Survey [On-line], www.pitt.edu/~mmv/cedar.html.

Schultz, S., Tannenbaum, S. & Lauterborn, R. (1997). The New Marketing Paradigm. Lincolnwood, IL: NBC Business Books.

Substance Abuse and Mental Health Services Administration. (1995). CSAP, Drug-free for a new century: A chart book by the Center for Substance Abuse Prevention (DHHS Publication No. [SMA95-3044). Washington, DC: U.S. Government Printing Office.

Substance Abuse and Mental Health Services Administration. (1995). Making Prevention Work (DHHS Publication No. [SMA] 95-120). Washington, DC: U.S. Government Printing Office.

Tarter, R. (1992). Prevention of drug abuse, theory, and application. The American Journal on Addictions, 1(1), 2-20.

Tobler, N. (1992). Drug prevention programs can work: Research findings. Journal of Addictive Diseases, 11(3), 1-27.

COMPLETE TEST FOR 1 PCACB–APPROVED CREDIT HOUR

(Record Answers for FICHTER Test on Answer Sheet)

1. The Institute of Medicine has described three broad types of preventive intervention as:

a. universal, targeted, indicated
b. universal, selective, indicated
c. universal, specific, tertiary
d. targeted, indicated, selective

2. Effective marketing is based on the principles of:

a. Telling and Selling
b. Listening and Learning
c. Sharing and Caring
d. a & b

3. ATOD risk factors include:

a. chaotic home environments
b. drug-using approval of community
c. poor school performance
d. all of the above

4. To effectively reach a target audience you should:

a. use mass marketing principles
b. use multiple strategies in multiple environments over time
c. use advertising and public relations experts
d. address both protection and risk factors

5. Indicated prevention interventions are:

a. targeted to individuals or a sub-group of the population whose risk
    is significantly higher than average
b. targeted to individuals or a sub-group who have minimal risk,
    but have family members who are at great risk
c. targeted to high-risk individuals who are identified as having minimal
    but detectable signs or symptoms, but do not meet diagnostic levels
    at this time
d. a & c