From the issue dated July 28, 2000

From the issue dated July 28, 2000

  Colleges Use Peer Pressure to Encourage Healthy Behavior

  By LEO REISBERG

   Everybody's doing it.

  Most college students are, at least. The cool ones, anyway.

  They sure look happy about it, too.

  In its latest advertising campaign, Gustavus Adolphus College

  says that most students choose not to smoke cigarettes. At

  James Madison University, most male students respect a woman's

  decision when she says no to sex. At Hobart and William Smith

  Colleges, most students study hard and perform community

  service.

  College officials are discovering the power of positive peer

  pressure.

  It's called "social norms" marketing. Colleges hang up

  posters, display facts on World Wide Web sites, and give away

  key chains and T‑shirts telling students that, contrary to

  popular belief, it's normal to engage in healthy behavior ‑‑

  so they should. The messages often use statistics to support

  the assertions.

  Consider one eye‑catching poster at Virginia Commonwealth

  University.

  "Do you want to grow up to be a proctologist?" the poster

  asks, showing an image of a gloved hand with two fingers

  extended. Then comes another random question: "Do you want to

  grow up to be a daily smoker?" And then the tie‑in: "Most

  V.C.U. students say 'no way' to both!"

  It doesn't provide data on aspiring proctologists, but the

  poster cites a 1999 survey showing that 61.5 percent of

  students on the campus had not smoked in the past 30 days and

  only 15.9 percent smoked daily.

  The social‑norms model was developed on several campuses in

  the early 1990's to change the perception among students that

  most of their friends were frequently getting drunk. Advocates

  of the model say that, after some colleges got out word that

  the norm among students was to drink responsibly or not at

  all, the level of heavy drinking fell significantly.

  "College students tend to not realize they are as healthy as

  they are," says Michael P. Haines, coordinator of

  health‑enhancement services at Northern Illinois University

  and one of the pioneers of the social‑norms movement. "It's

  certainly been part of my hypothesis that some of the reason

  for this underappreciation of their health is because

  authorities on college campuses have focused on their problems

  and identifying all the ways they get into trouble."

  Many colleges have already started campaigns to change

  perceptions, behavior, and tolerance toward smoking, unsafe

  sex, sexual assault, and racism and homophobia. Others are

  considering ways to use social norms to prevent eating

  disorders and encourage a wiser use of credit cards.

  But some college‑health experts are skeptical of the

  social‑norms approach, saying there's no solid evidence to

  prove it's effective. Critics also say that the marketing

  campaigns may do more harm than good, by diverting resources

  away from creating programs and policies that might better

  address the problems that social‑norms advocates are trying to

  play down.

  "Pragmatically, I worry because what could be potentially a

  warm and attractive and hopeful idea has rapidly become

  adopted as the next saving grace of health education on

  campus," says Richard P. Keeling, editor of the Journal of

  American College Health.

  One problem, he argues, is that a prevailing social norm

  doesn't exist among all students, just as there is no such

  thing as a "universal college student." But there are norms

  that influence certain groups of students and "many of the

  behaviors we'd like to change are in fact associated with

  groups of students who do sustain those unhealtier norms and

  who don't misperceive them," Dr. Keeling says. For instance,

  while college students in general may drink responsibly, the

  norm that matters to the small group of students who do not

  drink responsibly is that most of their true peers do get

  drunk frequently.

  Since Dr. Keeling became editor of the journal in 1997, he

  says, the publication has received few submissions supporting

  the effectiveness of social norms on drinking, and "the ones

  that we have received have either produced negative results or

  have not been convincing pieces." He questioned the

  methodologies of those studies that link social‑norms

  marketing with a decline in high‑risk drinking, saying that

  the research does not take into account other factors that may

  have contributed to the results.

  In September, the journal will publish research studies from

  some colleges that tried social‑norms campaigns but saw little

  or no impact on curbing heavy drinking, Dr. Keeling says. He

  would not identify the colleges.

  The idea of applying social‑norms marketing to behaviors like

  smoking, unsafe sex, and violence is so new that most of the

  colleges that have tried such programs are not finished

  examining the results.

  The third National Conference on the Social Norms Model,

  sponsored by the BACCHUS & GAMMA Peer Education Network, will

  be held this week in Denver. The meeting, which in the past

  has focused on high‑risk drinking, will include sessions this

  year on how social norms can be applied more broadly.

  Linda C. Hancock, a nurse practitioner who spearheaded the

  Virginia Commonwealth campaign, says she will present findings

  that show that students now have a more accurate perception of

  how many of their peers smoke, and that their attitudes toward

  not smoking have improved.

  In addition to a series of funny posters, the campaign also

  included a mascot, "Darth Vapor," a take‑off of the Star Wars

  character, who wandered the campus last year and asked

  students to guess how many of their peers at V.C.U. didn't

  smoke. A correct guess would be rewarded with either a $1 bill

  or a keychain with a message like, "Surgeon General's Warning:

  Don't eat the yellow snow. Oh yeah, and don't smoke."

  BACCHUS, the association of students and health educators who

  advise students on health and safety issues, is working with

  nine colleges on a research project studying the effect of

  social‑norms marketing on sexual health and tobacco use. The

  projects began in the spring of 1999, when each college

  surveyed students to obtain baseline statistics about their

  sexual practices or tobacco use. With a $5,000 grant from the

  Centers for Disease Control and Prevention, each institution

  then conducted a yearlong media campaign, with three different

  poster messages carrying the theme "people are a lot like

  you," as well as newspaper advertising and distribution of

  highlighters and candy bearing social‑norms messages.

  One poster shows a handful of students walking across an

  idyllic campus and reads: "Most University of Hawaii‑Manoa

  students protect themselves in sexual situations." It cites

  the spring 1999 survey that found that 94 percent of the

  students at Hawaii's Manoa campus reduce their risk of

  sexually transmitted diseases, including H.I.V., by abstaining

  from sex,  using a condom, or choosing to be in a monogamous

  relationship.

  Jan L. Gascoigne, director of health promotions for BACCHUS &

  GAMMA, says that the results of the study are still being

  tabulated, but anecdotal evidence suggests that the campaigns

  have been effective.

  At the campuses that studied the impact of social‑norms

  marketing on students' tobacco use, officials said they

  noticed an increase in the number of students who visited the

  health center to ask about smoking‑cessation programs.

  "We would not be able to pinpoint that it happened because of

  social norming," Ms. Gascoigne acknowledges, "but we would

  hope that would've been one piece that caused students to look

  at their behavior."

  James Madison University, which used social‑norms marketing to

  reduce heavy drinking in 1998, is now applying it to

  sexual‑assault prevention and tobacco use.

  The sexual‑assault campaign, which started last year as an

  experiment, consisted of a survey last fall of 425 men at

  James Madison, and a research study involving male athletes

  and fraternity members.

  Based on the survey results, health educators chose to take an

  optimistic perspective and came up with this poster theme: "A

  man respects a woman; 9 out of 10 J.M.U. men stop the first

  time their date says 'no' to sexual activity."

  Susan E. Bruce, who was then assistant director for health

  promotion at James Madison, says that men on the campus were

  randomly asked their opinions of the poster designs before

  they were used for the study. Many of them were bothered by

  the statistics: If nine out of 10 students stopped when a

  woman said no, that meant that 10 percent of men did not stop,

  they figured. Another poster indicated that three out of four

  men "think it's not okay to pressure a date to drink alcohol"

  to have sex. The men who saw the posters "looked around and

  asked, 'OK, who's the jerk, who's the one guy?'" Ms. Bruce

  says.

  She explains that the surveyed students who did not agree with

  the statement, "It's not OK to pressure a date to drink

  alcohol," either were unsure about the statement, were

  neutral, or disagreed with the statement. In response to the

  question asking if they stopped when a date said no to sex,

  about 10 percent said they "sometimes," "rarely," or "never"

  stopped.

  "We did hope that would raise some red flags and prompt some

  discussion," says Ms. Bruce, who is now director of the Center

  for Alcohol and Substance Education at the University of

  Virginia. "The majority saw it as a concern, but some students

  thought that nine out of 10 [who said they stopped when a date

  said no] was way too high. They thought it would be lower."

  As part of the study, the posters were hung in a couple of

  fraternity houses and in locker rooms for some athletes, and

  those study participants were required to attend a play about

  male socialization, called Crimes Against Nature. Other

  fraternity members and athletes were used as a comparison

  group and were not exposed to the educational materials.

  The students were surveyed again this spring. In response to

  the statement, "I stopped the first time my date said no,"

  88.5 percent of the men who were exposed to the posters and

  the play agreed, up from 85.2 percent before the project

  began. Of the control group, 85.3 percent agreed with the

  statement, down from 92.8 percent before the project began.

  Ms. Bruce called the data "statistically insignificant," but

  she hopes the campaign will make a bigger impact when it goes

  campuswide this fall, with posters, newspaper ads, magnets,

  and telephone calling cards bearing the message, "A man

  respects a woman."

  "We're sending out the message that being loyal to your

  friends doesn't mean whatever your buddy says is OK," Ms.

  Bruce says. "If you see a buddy hitting on a very drunk woman,

  loyalty means you need to stop your friend."

  At Western Washington University, officials are using

  social‑norms marketing to combat sexism, racism, and

  homophobia.

  This fall, health educators will train dormitory advisers,

  student‑government officers, athletes, and other groups on

  normative behavior toward those "social‑justice issues." They

  are also planning a poster campaign that suggests that most

  students at Western Washington are intolerant of sexism,

  racism, and homophobia.

  But that campaign, known as "ally‑building," is short on

  statistics and long on assumptions. The project is based on

  focus‑group discussions last year with students who were

  already active with social‑justice issues.

  "There are people in the social‑norms movement who will tell

  you that using qualitative data is risky," says Patricia

  Fabiano, director of prevention and wellness services at

  Western Washington. "The way I justify it is that our common

  sense tells us that the majority of our students have not

  committed hate crimes or overt acts of bigotry and

  discrimination. There is latent in our students a desire to

  see a diverse community that lives in harmony."

  At Hobart and William Smith Colleges, one of the first

  institutions to use social‑norms marketing to promote

  responsible drinking, two faculty members have developed a

  multimedia campaign to promote academic and community‑service

  work.

  As part of the "campus factoids" program, H. Wesley Perkins, a

  sociology professor, and David W. Craig, a chemistry

  professor, post statistics in a newspaper column, on the

  campus Intranet, and on a computer screen‑saver program, about

  students' health habits, scholarly efforts, and their opinions

  about the death penalty, abortion, and gay rights.

  A few samples: "Twelve percent of the 1999 senior class had

  presented/published a paper off campus during their time at

  H.W.S." "One out of five spent more than 10 hours per week

  exercising or playing sports while 14 percent reported almost

  no exercise." "Over two‑thirds of the class had participated

  in volunteer service during college."

  "There are a lot of misperceptions in the campus community

  about what student priorities are, about what the campus

  culture is and what is expected," says Mr. Craig. "Students

  think that they're alone, that everyone else is partying and

  not studying, and they think, 'What's wrong with me? I guess

  I'm not so bright because I'm studying so much.'"

  Aaron Frishman, who graduated last month from Hobart with a

  bachelor's degree in history, says that he was surprised by

  some of the factoids that dealt with student drinking, study

  habits, and community service. He thinks that the college can

  influence student behavior ‑‑ or at least their attitudes ‑‑

  by explaining the true social norms on the campus.

  "I don't think people see the factoids and say, 'I'm going to

  change my life,'" Mr. Frishman says. "But every time you  turn

  on the computer, it's just a little reminder, and it's so

  repetitive that I think it changes the way people think."

  Mr. Frishman says it was encouraging to learn that he was

  among the majority of students who studied hard and drank

  little. "Often I was made fun of for doing homework at times

  when other people were out having fun, so I could tell people

  that I'm not the one who's different," he says.

  Mr. Haines, the health coordinator at Northern Illinois, says

  he is excited that his social‑norms concept has attracted a

  loyal following, but he also worries that it could become

  overkill.

  "We're concerned that people will wear it out," he says. "If

  we start seeing broad, one‑size‑fits‑all, national campaigns,

  it could start looking like a gimmick."

  Still, Mr. Haines, who will become director of the National

  Social Norms Resource Center when it opens this fall at

  Northern Illinois, does what he can to promote the model and

  encourage its use. At the conference, he plans to illustrate

  its success by talking about one of his earliest experiments

  with the strategy ‑‑ a campaign he started in 1990 to promote

  the use of condoms at Northern Illinois.

  Posters and newspaper ads said that most students who were

  sexually active used condoms. In fact, Mr. Haines says, the

  surveys found that "it was actually non‑normative to have sex,

  but people thought that students were getting laid all the

  time."

  The social‑norms campaign produced promising results: Between

  1989 and 1997, condom use doubled, the intercourse rate

  declined by 4 percent, the number of sexually transmitted

  diseases dropped 66 percent, and the number of insurance

  claims for abortions fell by 42 percent.

  "There is no other approach in the college health field that

  has outcome data as solid as the social‑norms approach," Mr.

  Haines says.

  Such examples of success explain why the social‑norms movement

  is "exploding," he says. But there's probably another reason

  behind its growing popularity.

  Because everybody else is doing it.

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Copyright 2000 by The Chronicle of Higher Education