Community Generated Protective Norms Reduce Risk and Promote Health

Community Generated Protective Norms Reduce Risk and Promote Health

Michael P. Haines, MS

This is a reprint of an article from: ACTION Newsletter of the American College Health Association vol.38 no.3 April/May/June 1998

As many of you already know, the University Health Service at Northern Illinois University has had remarkable success in reducing "binge" drinking (down 44%), alcohol related injuries to self (down 47%), and injuries to others (down 76%) over the last nine years. In addition, NIU has also seen dramatic increases in condom use (up 100%) and decreases in STD (down 63%) over a five year span. The University of Arizona has replicated the NIU model and reduced binge drinking by 26% in the first three years. This was accomplished by using a PROTECTIVE NORMS MODEL of health promotion.

This article will briefly introduce a general theory of INDIGENOUS PROTECTIVE NORMS and then describe some of the components of the specific model that was developed at NIU.

INDIGENOUS PROTECTIVE NORMS(after Webster)

INDIGENOUS= having originated in and being produced, growing, living, or occurring naturally in a particular region or environment. Innate, Inborn, Native.
PROTECTIVE= to cover or shield from exposure, injury, or destruction.
NORM= a principle of right action binding upon the members of a group and serving to guide, control or regulate proper and acceptable behavior OR a pattern or trait taken to be typical in the behavior of a social group.

Thus, Indigenous Protective Norms are innate shielding principles or traits which guide human behavior. A key here is that these shielding patterns of behavior are innate, native. They are already there. But, they may not be evident or easy to see. They exist in all social groups. Health professionals do not need to create protective norms. What we need to do is identify these traits so that we are better able to understand and support them while not interfering with their protective qualities.

Ideas like indigenous protective norms are not new. Similar concepts are found in ecology, physics, economics, and philosophy. It is discussed in the physiology of healing and the self-limiting nature of epidemics. But it is curiously absent from public health literature.

In the early seventies Andrew Weil studied native people's drug use to determine what protected these cultures from the potential harm associated with powerful plant based medicines. He found that indigenous cultural rituals and norms played an important role in protecting the individuals from drug abuse. Currently, Dr. Weil is enjoying the rewards of back-to-back national best sellers, Eight Weeks to Optimal Health and Self Healing. In these works he continues to explore the phenomenon of self-generated health and healing in both individuals and in communities.

The famous ecologist Aldo Leopold, described the self-regulating nature of predator-prey relationships and virtually founded the field of ecology at the University of Wisconsin in the 1930s. He was one of the first scientists to recognize that what appeared as dangerous fluctuations in predator-prey demographics were actually stabilizing adjustments necessary to insure specie survival. Furthermore, he noted these adjustments were inherent patterns of the animal groups and he warned that even the most well intended human intervention which did not understand and maintain these patterns was likely to cause harm to the animals.

Emmy Werner in her thirty year study of children from extremely dysfunctional families surprised nearly everyone when she found that most of the sample developed in a normal manner. She studied these "well" kids to find out why they were resistant to the problems which should have occurred to abuse victims. She identified protective factors which came from their socii-familial network and correlated highly with resiliency.

A recent article in the New Yorker describes "a group of young scholars at the University of Chicago Law School who have made the study of 'social norms' the most provocative new movement in the legal academy." They have recognized that communities have natural "laws", norms, which have a powerful impact on people's behavior. The article reports, "Dr. Tracy Meares and her colleagues are studying ways that norms can influence behavior more effectively than law; ways that norms and laws together can influence behavior; and ways that norms and laws can influence each other."

Dr. Stuart Kauffman's discovery of self-organizing tendencies in apparently chaotic phenomenon has changed the way physicists, biologists, economists view systems. He and other Nobel Laureates at the Santa Fe Institute found that apparently chaotic systems ("primordial soup", free market economies, computer "fractals") share a self-organizing inclination. This inherent self-organizing quality keeps the system from chaotically exploding or statically imploding. Self-organizing systems theory may explain why cultures already possess the solutions to their own problems.

THE PROTECTIVE NORMS (NIU) MODEL

Alan Berkowitz and H. Wesley Perkins described "false norms" in research they conducted among college students. They noted that student drinking attitudes were actually much more moderate and protective than students (or anyone else) thought they were. Research at NIU showed that in addition to false attitudinal norms there were also false behavioral norms. Students believed that binge drinking, alcohol related injuries and fights were the norm and that everybody was getting drunk and getting hurt. In fact, moderation was the norm and fights and injuries were uncommon. Perkins and Berkowitz assumed that this belief in a false norm was creating "imaginary peer pressure" to drink in careless and unsafe ways. There is large and growing body of research which supports the idea that norms, real or false, have a powerful influence on behavior.

The reason false norms are so harmful is that they interfere with the expression of the natural protective norms. These false norms can be unintentionally reinforced and spread by many "carriers" on campus. Alcohol Educators, Greek Liaisons, Judicial Officers attempting to solve the problem by highlighting the atypical harmful behavior actually reinforce the false norm. Awareness weeks, screening days, and victim speakers reinforce the erroneous idea, "Everybody's doing it!" and further suppress the protective norm.

The hypothesis that grew from this research and was ultimately tested at NIU and then Arizona was: If the number of students who believed the false norm could be reduced, then the number of students with behavior that was consistent with the true norm would increase. In other words, moderate alcohol use would increase, and binge drinking, injuries, and fights would decline as the true norm was fortified.

The false norm was defeated because the intervention used in the NIU model was consistent with the moderate drinking norms that were already held by but unknown to most college students. Another way in which this concept may be applied would be a campaign to reduce alcohol related residence hall damage. Most students drink and, also, most students do not approve of damage to their residence hall. An intervention which attempts to reduce damage by cracking down on student drinking is likely to fail because it works against the student norm: drinking. Whereas, an effort which gets tough on those who damage the hall is more likely to succeed. It is consistent with the student norm: intolerance of hall damage without opposing the commonly held value that drinking is O.K.

The successes at NIU and Arizona relied on a comprehensive social marketing effort to counter false norms and reinforce the indigenous protective norms of most college students. Social marketing uses commercial marketing methods to achieve social benefit. Alan Andreasen, author of Marketing Social Change, notes, "The basic goal of marketing is to influence behavior, whether that behavior is buying a Big Mac, flying United Airlines, practicing safe sex, or getting one's child immunized."

It is important to note the difference between social marketing and social norms. The NIU model uses the methods of social marketing (mass media, direct mail, incentives, and market "reps") to correct student perceptions of a false norm in order to influence their behavior. This is a mass behavior change strategy, a community health promotion design. It is cost effective, using limited resources for broad impact. There are other methods which may also be useful in supporting and enhancing the indigenous protective norms of college students. Peer education, "curriculum infusion", policies , or a combination of all of these techniques need to be tested to see if they too could have results similar to the NIU model. It is exciting to be part of an emerging paradigm for community centered health promotion. Take time to familiarize yourself with indigenous protective norms, self-regulating systems, natural resiliency, self-healing and then consider ways of applying these ecological concepts to your campus and community.

References:

Haines, MP A Social Norms Approach to Preventing Binge drinking at Colleges and Universities, The Higher Education Center for Alcohol and Other Drug Prevention, Newton MA 1996

Haines, MP "Spare the Rod and Get Results: A Wellness Approach to Health Promotion Media" Wellness Management, v13:3, 1&4, Fall 1997

Weil, A Spontaneous Healing: how to discover and enhance your body's natural ability to maintain and heal yourself Alfred A. Knopf, Inc,. New York, 1995

Leopold, A: Game Management, C. Scribner's Sons, New York,1946

Werner, EE: Protective Factors and Individual Resilience@ in Handbook of Early Childhood Intervention, Cambridge University Press, New York, 1990

Kauffman, SA,: At Home in The Universe, Oxford University Press, New York 1995

Perkins HW,: "College Student Misperceptions of Alcohol and Other Drug Norms Among Peers: Exploring Causes, Consequences, and Implications for Prevention Programs" in Designing Alcohol and Other Drug Prevention Programs in Higher Education, pp107-206 The Higher Education Center for Alcohol and Other Drug Prevention, Newton MA 1997

Berkowitz AD,: "From Reactive to Proactive Prevention: Promoting an Ecology of Health on Campus" inSubstance Abuse on Campus: a Handbook for College and University Personnel, pp119-139 Greenwood Press, Westport CN 1997

Waldrop MM,: Complexity: the emerging science at the edge of order and chaos, Simon and Schuster, New York 1992

Rosen J,:"The Social Police", The New Yorker, pp170-181, Oct.20 & 27, 1997

Andreasen AR,: Marketing Social Change, Jossey-Bass, San Francisco, 1995