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November 4, 2013

The Next Step

Social Norms Marketing: How can it be done? What are the results? Linda Hancock, FNP, PhD Wellness Resource Center

Behind every successful project is a great team!

VCU is one of 10 colleges working with the National Social Norms Institute (NSNI)

NSNI Social Norms Grantees

Grantee funding made possible by the support of the Anheuser-Busch Foundation

Central Washington University Florida State University Georgetown University Michigan State University Radford University University of Hawaii University of Kansas University of Texas at Austin University of Virginia Virginia Commonwealth University

Special THANKS to NSNI for all they have done to assist VCU Helpful information and research at:

Who am I? • A Nurse Practitioner • Director for the Wellness Resource Center at VCU • PhD - Primary Investigator on VCU’s Social Norms Grant • Like you… • I care about young people and their health.

I don’t look like a college student‌

but I talk like one!

Clicker lessons




1. Yes

• Immediate Audience Response Device • Anonymous • Radio Frequency- you don’t have to point it at anything • You can change your response by just hitting a different number, but … • ONLY one response will record per person!

Clicker Practice Who are you? 51%

1. Male 2. Female

e m al Fe


al e


What community are you from? Odder Favrskov Syddjurs Norddjurs Samsoe Aarhus Randers


20% 14% 8%

8% 4%

rs nd e Ra

hu s Aa r

Sy dd ju rs No rd dj ur s Sa m so e

v Fa vr sk o



Od d

1. 2. 3. 4. 5. 6. 7.

How well do you understand English? 54%



qu ic k ak sp e

Pe r

fe c


l– el yw

ly. .

... re a at

sp ea k

ak sp e Ve r

rly Fa i





el l–

sp ea k




sl. .


it t l. . .


No t

1. Not well- speak VERY slowly 2. Fairly well – speak a little slowly 3. Very well – speak at a regular pace 4. Perfectly – speak quickly I get bored

Who is in the room? Police Teacher Social Worker Youth Worker Street Worker SSP Consultant Other



17% 15% 14%

er Ot h

nt su lt a

Co n


St re


W or

ke r

ke r W or

W or

Yo ut h

ial So c


ke r

r ac he Te



Po l

1. 2. 3. 4. 5. 6. 7.

True or False The youth crime rate in Denmark is at an all time LOW. 83%

1.True 2.False 17%



Have you seen or heard this “good news” in the media? 83%

1. Yes 2. No


Ye s


What you focus on grows! • If you focus on problem, you grow more problem. • If you focus on health, you grow more health!

What is wrong with this sign?

Theory and MISPERCEPTIONS (Social Norms Approach by Wes Perkins & Alan Berkowitz)



Unhealthy visible behaviors -smokers, drunks, violence, goofing off, credit card debt, etc.


Underestimate Healthy less visible behaviors


-non-smokers, moderate drinkers academic seriousness, prayer

The majority versus the minority

Social Norms Marketing focuses on supporting health

How our brains get in RUTS in the real world • Spell TOPS 3 times out loud • 3 Items – what color? When our culture says… • Don’t drink,

• Don’t drink,

• Don’t drink… • We think everyone….Drinks! When our culture says… • Don’t have sex

• Don’t have sex

• Don’t have sex… we think…

Take the Awareness Test

There are many ways to focus on healthy norms! • Small or large group immediate feedback – Education, surveys, clickers (BLING sessions)

• Online – and provide immediate feedback – Much research has been done by Dr. Clayton Neighbors

• Social Norms Marketing Campaigns

Be honest: Do you believe most US College students have 0-4 drinks when they go out? 37%


M ay be

Ye s

1. Yes 2. Maybe 3. No!!!!

No !!! !


VCU combines a campus wide social norms marketing with large group clicker sessions.

How many energy drinks do you think most American teens have per week?





or e

ly da i

th a


On e

da i





on e



None 1-2 3-4 5-6 One daily More than one daily

No ne

1. 2. 3. 4. 5. 6.


Energy Drink Perception (VCU Freshmen Fall 2013 n=375)

Energy Drink Behavior (VCU Freshmen Fall 2013 n=375)

Smoking perception (VCU Freshmen Fall 2013 n=375)

Daily smoking reality (VCU Freshmen Fall 2013 n=375)

Alcohol drink reality (VCU Freshmen Fall 2013 n=375)

Alcohol use reality (VCU Freshmen Fall 2013 n=375)

VCU’s current social norms campaign

YOUR PERCEPTION How many sex partners do most American college students have in a year? 57%

O-1 2-3 4-5 6-9 10 or more





or m








1. 2. 3. 4. 5.

Sex partner perception(VCU Freshmen Fall 2013 n=375)

Sex partner reality(VCU Freshmen Fall 2013 n=375)

Fall 2008 BLING Freshmen Sessions (Brief Live Interactive Normative Groups) WELCOME WEEK • 10 Clicker sessions over 4 days: – “Love ‘n’ Liquor: What’s normal? What’s not?

• 1,824 freshmen attended 11 WEEKS LATER • 5 sessions for Orientation class freshmen • Asked… “Did you go to a clicker program at Welcome Week?”

VCU freshmen 11 weeks after a Love n Liquor Brief Live Interactive Normative Groups n=412 (about half had attended)

(X2 = 16.2, df = 6, p = .013).

Behavior change was MORE impressive

(X2 = 23.3, df = 6, p = 0.001)

Goals: • Provide an overview of Social Norms Marketing (SNM) – Why use SNM? – How to use SNM? – 5 main steps • Point out common mistakes to avoid • Discuss the data – process and outcome evaluation • Maybe mention a few NEW interventions that work well with Social Norm – (Motivational Interviewing, genetics & alcohol, mindfulness)

• Time for Questions and Comments

Why use marketing for social norms? • Because marketing WORKS! • Marketers change behavior.

• Marketing is a highly refined research process. • We can use those same strategies for health and safety!

Why does marketing work? Because marketers focus on their target audience (customer) and LISTEN to them.

Be consumer focused!


Based on research findings

Consumer Focused The 4 “P�s





GOAL: Sell Products

GOAL: Behavior

or services


Social Norms Marketing (SNM) Goal: Promote healthy social norms

Important Concepts for SNM 1. “If you focus on problems, you grow more problems. If you focus on health, you grow more health.”- Michael Haines 2. Look for “Hidden Goodness” or “Bright Spots” – What strategies do healthy teens use to stay healthy? . Keep messages P.I.E.  Positive  Inclusive  Empowering (give them skills)

4. Media is done in the spirit of Motivational Interviewing and harm reduction (Research of William Miller)

Let’s play a Game • The game is called

–WIN AS MUCH AS YOU CAN!!! – Stand up – Find a partner – place right feet side by side – “shake” right hands

If you push‌

people just naturally push back.

Age of Reason 7 to 12 Age of Rebellion 13 to 25 Middle school students -concrete thinkers -need clear rules and positive guidance High school students -abstract thinkers -don’t like being told what to do - Facts, non- judgmental approaches that invite them to question the status quo work more effectively.


Health Terrorism

"We're always telling them, 'Don't do this' and 'Don't do that.' Scaring them ‌is not a way to get them to do something good." NPR Quote July 30, 2012 fromDr. Flaura Winston, Prevention Director at Children's Hospital of Philadelphia

We need a Paradigm Shift 66% empty 33% filled Both statistics are TRUE! Focus on the minority to get a grant. Focus on the majority to grow health

“Social Norms is NOT just a poster. It is a paradigm shift.” -Jennifer Bauerle, Director NSNI

• It’s focusing on health & telling the TRUTH.

• It’s collecting accurate data and health strategies used by the target audience and then communicating it back to them. • Use media channels that REACH your community persistently over time.

Young person who Old has media “issues�

Healthy Person standing alone against the crowd

Healthy Crowd Drug users & willing to help Heavy theDrinkers minority

The Monkey Business Illusion

Break time

Where Social Norms Marketing for alcohol harem reduction began in America Michael Haines University of Northern Illinois

Gathered data and strategies from students

Michael Haines, Northern Illinois University (source:

Impact on Alcohol Related Harm

2 basic requirements must be met before you use an SNM Intervention • There must be a perception-reality gap. – The majority of people must overestimate the problem, and under estimate healthy behavior.

• There must at least be 51% with healthy behaviors or attitudes.

What is wrong with this Social Norms Marketing Campaign? Tarrant County & Texas Christian University

• 1 in 4 is not a majority • No data source

5-Step Approach to Social Norms Marketing 1. Choose the Audience 2. Gather & Evaluate Data

3. Develop & Test the Message 4. Implement Campaign 5. Evaluate Effectiveness

What is your target audience? 61%

ho ol (

ch oo l Hi gh


eS id dl M



9. ..


Ot h

1. Middle School 2. High School (9th grade or older) 3. Other

Useful analogies for talking to youth about alcohol.

Heimlich Maneuver


We teach youth about health problems, but don’t expect them to choke on a hot dog or have a heart attack. We can educate about alcohol and expect them not to drink.

Get out the measuring cups/spoons. “Bartender School”

1. Choose the Audience

Do you ever get to talk to parents?



Ye s

1.Yes 2.No


Good campaigns not only provide norms data they also help to teach health/safety strategies Turner Fall, Massachusetts USA

How large is your municipality? 23%

Less than 25,000 25,000-30,000 30,001-50,000 50,001-100,000 Over 100,000

25 ,0 00 n st ha

19% 16%

25 ,0 00 -3 0, 00 0 30 ,0 01 -5 0, 00 0 50 ,0 01 -1 00 ,0 00 Ov er 10 0, 00 0


Le s

1. 2. 3. 4. 5.


Virginia Commonwealth University has a large & diverse student body.

32,000 students

We avoid using pictures of people in our ads. We try to use images that avoid gender and race.

Get a FREE REAL RAMs T-shirt or Button Play “Match the REAL stats”

Students make our efforts more creative!

Tone for Social Norms Marketing Media • Use a “motivational Interviewing” style • Do not preach, lecture, or terrorize. • Simply share normative facts and what others have found helpful. • Provide the data source to increase credibility.

2. Gather and Evaluate the Data • Ideally, this would be a random sample. – Randomly selected people, classes or groups.

• Method- online, mailed, or phone. • Include misperception questions that match the behavioral/attitudinal questions EXAMPLE: • How many drinks do you think MOST people have in a week? • How many drinks do you have in a week?

Do you do research as part of your job? 1. Never 2. Rarely 3. Sometimes 4. Frequently




Fr e

qu e

nt ly

es et im So m

re ly Ra

Ne v



How big does your sample need to be?

Ideal – “Random Sample” Each member of a population has an equal chance of being in the sample.

Ideally the sample is a “mini-me” of the population.

3. Develop and test the message LISTEN and work together with your Target Market At VCU we avoid an alcohol only focus!

Early alcohol SNM efforts at VCU...

The “SPOOF” (Why I’ve worked with students for 15 years.)

The future… Continue to use campaigns that blend SN & Protective Strategies

Perhaps…. Recycle the 5th pocket or Create a Party Smart Pocket

A Common Mistake- Mixing messages • Don’t put images of the behaviors you are trying to reduce! • Media Balloting – Vote on the final versions (we use clickers) – Test the “Blink” message (to avoid mixed messages) – Test the fine print

The Credibility Gap • People won’t believe your data. • Expect that. • We wouldn’t need SNM campaigns if people believed them.

The purpose of Pilot testing

Use experts…ask for feedback EARLY

4. Implement the campaign

• Process Research is important! • Media Habits Survey – – Where do people look/listen/see information?

• Mall Intercept Surveys – test how it is being accepted – Convenience sample, just go up and talk to people – It’s okay if they don’t believe it as long as they are mostly positive about it

• Test Market Saturation and Penetration – 80/50 guideline - 80% need to have seen the media & 50% need to have seen it 5 or more times – Include Market saturation questions for final evaluation


If I have to put up another poster today, I’m going to vomit!

5. Evaluate Effectiveness • Evaluation is VERY challenging & often done wrong. • Consult an expert in SNM evaluation. • The Iceberg analogy

Addicted Those who can change

Most people are healthy and don’t need to change. Keeping them the same IS a success.

Used with permission: National Social Norms Institute

Every complex problem has a simple solution‌ and it is usually wrong! Social Norms Marketing is just one part of a comprehensive multi-leveled prevention program. It keeps the healthy people healthy and grows more health.

Excellent References & Abstracts at

Good Reading

How are you feeling? A little confused? Any questions?

Conclusion • Youth are healthier than you think. • Collect data to look for perception/reality gaps. • Where gaps occcur you can use social norms marketing to grow more health. • Look for hidden goodness and market healthy norms and positive harm reduction strategies.

New areas of research • Bystander Education • One size does NOT fit all prevention – Understanding Genetics and Alcohol problems

• Mindfulness – awareness, presence

Do your youth get training in the bystander effect? 60% 1. Yes 2. No 3. Not sure


e su r No t


Ye s


Step up if you suspect alcohol poisoning

At VCU call 828-1234

Genetic Snowflakes

One time harm

Biology + How much/How often you drink = Risk

Addiction Prevention Research Institute

Family History: Does someone in your family have a problem with alcohol? 48%


Yes Maybe No Don’t know



no w Do n’ tk


ay be

0% Ye s

1. 2. 3. 4.

The first 5 times you drank, how many did it take for you to feel tipsy or have a buzz? 26%



14% 11%

5% 2%


ra n


10 9-

8 7-

6 5-




5 4-

Ov er 1





ne ve rd

N/A never drank 5 times 1 2 3 4-5 5-6 7-8 9-10 Over 10 /A

1. 2. 3. 4. 5. 6. 7. 8. 9.

Level of Response is a genetic thing High Responder “Cheap Drunk”

Low Responder “Hollow leg”

1. These are NOT trained monkeys 2. “Teetotaler� means a total non-drinker

Alcoholic Vervet Monkeys BBC

20% don’t drink at all 60% drink in moderation 20% drink heavily

Fanta Soda


Comments from students • “I didn’t see the soda, I thought all the monkeys were drinking. I guess I’m like the teetotaler monkeys. I hold a solo cup but don’t drink.”

• “We laugh at the monkeys but really it’s kinda sad. It’s also sad when laugh at our friends who drink too much.”

Genetics is not destiny! • Genes only influence one's disposition to develop a particular outcome. • The environment and choice still plays a critical role. • BRIEF motivational interviewing sessions can help youth overcome ambivalence about alcohol choices.

Short breaks can make you more stress resilient

If you carry all the baggage from the past and all the worries of the future, you can’t function in the NOW.

Mindfulness in Middle School Moments of Silence & Breath Movie “Room to breathe”

After long and thoughtful consideration, I have come to a rather interesting conclusion.

Even though the global population is soaring into the billions, with thousands of religions, languages, philosophies and cultures represented,

ultimately, there are only two kinds of people.

There are those that are certain the world is going to hell in a hand basket,

and those that believe the best is yet to come.

Grantee schools vs. all NCHA schools Drinks When Socializing Declining in all Grantee Schools While National Average is Flat

drinks when socializing

6 5,5 nat'l


fsu gtown


hawaii 4

msu vcu

3,5 3



All data is from the ACHA-NCHA. NOTE: Between 2008 and 2010 the drinks when socializing for these schools taking the ACHA-NCHA declined while the national average stayed the same.

eBAC Declines in 2006 to 2010 in All Grantee Schools While National Average is Flat Grantee schools vs. all NCHA schools

Instrument change

All data is from the ACHA-NCHA. eBAC is Estimated Blood Alcohol Concentration, a measure of percentage of alcohol in blood. For example, a BAC of 0.10 means that 0.10% (one tenth of one percent) of your blood is alcohol. It is estimated as the components are from self report data. NOTE: Over the last 10 years (2000-2010) the median eBAC for all schools taking the ACHA-NCHA has not changed, maintaining at .05

College let’s you do you!

4 11 social%20norms%20marketing%20nov%204%202013%20with%20clicker%20questions

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