Adrienne Keller, Ph.D., Research Director, National Social Norms Institute

I recently had the opportunity to think about what I considered the essential ingredients to reach college students about health issues. First of all, I realized that my thoughts immediately went to health education and health promotionrather than personal clinical information. Secondly, four thoughts came very readily to mind, making me realize that these are indeed the foundational principles that I use in my work. Thirdly, I think these thoughts can be generalized to other intended audiences. So here they are, pretty much as they came to me:

  1. PIE” (Positive, Inclusive, Empowering) rather than “health terrorism”2
  2. Use of social media3 and information in a format that is friendly for hand-held devices (e.g., QR codes)
  3. Working with members of your intended audience4, such as Peer Health Educators5, to ensure that the style of the message is appealing
  4. Using accurate and salient6data – recent, from your own intended audience – to illustrate the prevalence of healthy behaviors and choices

We are indebted to Michael Haines for the PIE acronym, which I find to be so helpful in evaluating any form of media or message. I believe Jeff Linkenbach coined “health terrorism”2, which is such an evocative description of one of the most common forms of health promotion.

My second and third points both speak to making sure your message reaches your intended audience in a way that they will pay attention to. To me, they echo Marshall McLuhan, “the medium is the message.” This means considering how and where your audience is most likely to see the message, as well as the content and style of the message: are the images and language ones that will appeal to and make sense to your audience.

Finally, while information alone does not change behavior, information often is the foundation from which the intention to change arises.7 And the more relevant the information, the more likely it is to have influence. Tailored health education materials8 are the most salient. Computerized personalized normative feedback9 compares an individual’s behavior to that of a relevant group (e.g., other students at their college), thus providing highly salient social norms information.

Although I have provided references for the key ideas, I do want to emphasize that this post is not a formal document but rather should be understood more as codified and annotated musings from the field.


  1. Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2008). Health behavior and health education: theory, research, and practice. John Wiley & Sons.
  2. Linkenbach, Jeffrey W. Beyond Health Terrorism: The Social Norms Approach to Community Health.” A keynote presentation and 2 hour workshop on state-wide implementation of the social norms approach to prevention. The Alaska Council on Prevention. Anchorage, AK (November 1998).
  3. Neiger, B. L., Thackeray, R., Van Wagenen, S. A., Hanson, C. L., West, J. H., Barnes, M. D., & Fagen, M. C. (2012). Use of social media in health promotion purposes, key performance indicators, and evaluation metrics. Health promotion practice, 13(2), 159-164.
  4. Baker, E. A., Kreuter, M., Homan, S. M., Starkloff-Morgan, S., Schonhoff, R., & Francioni, A. (2002). Using community-based participatory processes to bring health education technology to communities. Health Promotion Practice, 3(1), 83-94.
  5. Sloane, B. C., & Zimmer, C. G. (1993). The power of peer health education.Journal of American College Health41(6), 241-245.
  6. Neighbors, C., LaBrie, J. W., Hummer, J. F., Lewis, M. A., Lee, C. M., Desai, S., … & Larimer, M. E. (2010). Group identification as a moderator of the relationship between perceived social norms and alcohol consumption.Psychology of Addictive Behaviors24(3), 522.
  7. Montano, D. E., & Kasprzyk, D. (2008). Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. Health behavior and health education: Theory, research, and practice4, 67-95.
  8. Kreuter, M. W., Oswald, D. L., Bull, F. C., & Clark, E. M. (2000). Are tailored health education materials always more effective than non-tailored materials?.Health Education Research15(3), 305-315.
  9. Lewis, M. A., & Neighbors, C. (2006). Social norms approaches using descriptive drinking norms education: A review of the research on personalized normative feedback. Journal of American College Health54(4), 213-218.