Public health theory links ... helpful for social and behavioral students (and everyone else!)

I'm a big advocate of using theory to create public health programs, instead of just trusting your "gut." Too many public health practitioners, who are poorly trained in theory and evidence-based approaches, put together programs like this: FocusDriven that are largely designed to appeal to our emotions and fear of physical injury. Although I suppose these worked at one time, campaigns such as these slip out of our conciousness the minute we navigate to a different page.

With that in mind, I've found some really awesome articles that summarize public health theories relating to behavior change, and I'm going to share them here! Get stoked!

• This article from the National Institutes of Health relates specifically to cancer, but the information can be generalized to most public health practice. This is probably the most practically applicable document I've seen that relates to public health theory.


• Here is a file that summarizes public health theory nicely, including some that you usually don't see, such as Protection Motivation Theory and the Elaboration Likelihood Model.


• Finally, it's important to recognize that different populations require different theoretical models to inspire interventions. Children are a particularly relevant group because their cognitive abilities differ greatly from those of adults. This article explains a child-specific model that can be used to spark behavior change.

Again, it's important that public health professionals adhere to existing scientific knowledge in crafting campaigns and interventions. Otherwise, taxpayer money and funds from private enterprise are essentially discarded as they are applied to feel-good efforts that really don't fix anything.

I'm continually shocked at the inability of our health community to lay proper foundations for research and intervention. Perhaps this is because many of us in this field are poorly educated about public health, considering the current clinical focus of medical technology today. It's clear that a paradigm shift must occur that stresses true evidence basis instead of self-serving, happiness-inducing, ineffective programming.

This means that we, as public health professionals, must acquire enough knowledge to recognize when something is a bunch of horse hockey. Learn your statistical measures. Understand what total crap looks like. Sources will tell you that D.A.R.E. is an effective program, for example ... but if you actually READ the studies, the evidence for this suddenly vanishes.

Think critically, people.

Graphic cigarette labels ... really?

Take a look at these:

Pretty pictures of new warnings that will be included on cigarette packs per 2009 legislation.

Now, take a look at any of the following:
Ineffectiveness of fear appeals in youth
How to use fear appeals
Fear appeals in traffic safety

When a person believes that he is not vulnerable to a risk, his behaviour will not be affected by information about the serious consequences and the recommendations for effective behaviour.

In other words ... now, stay with me ... fear appeals are largely ineffective, especially among younger populations. In simple terms, this is because young people don't understand how to effectively estimate risk. This is the root of the common "it won't happen to me" phenomenon, and the reason that many teenagers are drawn to risky behavior. Their brains are quite literally unable to process the seriousness of the danger inherent in many behaviors and situations.

Also, we've tried stuff like this before, when the tobacco companies were required to advertise to prevent youngsters from initiating smoking: Evaluation of youth response to tobacco-company sponsored messages.
Not surprisingly, these companies crafted their messages to appeal to adults who needed a warm, fuzzy feeling ... but the teen smoking rate increased. That's right, the public health ads that were supposed to prevent kids from smoking actually prompted more young people to light up. Brilliant!

What makes us think, then, that young people won't just discount these messages, ridiculing them in a defensive response? My prediction is that is exactly what's going to happen. These messages will be, at best (in younger populations), completely ineffective because they're mocked by kids for being entirely too graphic.

Even more importantly, sometimes fear appeals such as these can have an iatrogenic effect; that is, the intervention worsens the problem. Fear appeals provoke a defensive mechanism that prompts target audiences to engage in dangerous behavior simply to prove that they're immune to the behavior's negative health effects. In other words, people might start smoking more as a proverbial "middle finger" to the public health campaign. "See, I can do it, and I won't die!" ... or, they'll rationalize their behavior by pointing to anecdata that supports their behavior. Ex: "My grandpa smoked a pack a day for 80 years, and he lived forever."

Anyway, way to go, FDA, for being completely unoriginal and refusing to acknowledge the massive body of research that indicates the complete worthlessness of fear appeals. This legislation passed because we have a bunch of uneducated, self-righteous politicians who want to make themselves feel better because they're doing something. Well, they did something before, involving the tobacco companies, and they succeeded in making the problem worse instead of lowering smoking rates among our nation's youth.

Only time will tell whether this intervention will follow the same path.

ETA: Does anyone else think this is going to cause an increase in the sales of cigarette cases? I would rather have my smokes in a stylish vintage box instead of one of these horrifying boxes. People really can circumvent any intervention.

UPDATE: Check out this awesome editorial, which proves my point --- Smokers unmoved by graphic ads