Social marketing campaigns aimed at preventing drunk driving

Social marketing campaigns aimed at preventing drunk driving


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1. Diffusion is the method by which an innovation spreads through certain channels in particular social settings.




1. What does “social system” mean in terms of diffusion of innovation?




1. How does social maketing differ from commercial marketing?




1. Why is it important to segment your audience for social marketing?





1. Social norms marketing is a type of social marketing designed to address normalizing the desired behavior.




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A review and recommendations

Magdalena Cismaru and Anne M. Lavack Paul J. Hill School of Business, University of Regina, Regina, Canada, and

Evan Markewich Johnson-Shoyama Graduate School of Public Policy, University of Regina,

Regina, Canada


Purpose – The purpose of this paper is to examine the role of social marketing programs in preventing drunk driving, and how protection motivation theory (PMT) can be used to create effective anti drunk driving communications.

Design/methodology/approach – Communication and program materials aimed at reducing drunk driving were identified and gathered from English-language websites from the USA, Canada, UK, Australia, and New Zealand, and a qualitative review was conducted.

Findings – The review provides a description of the key themes and messages being used in anti drunk driving campaigns, as well as target population, campaign components, and sources of funding. A key facet of this review is the examination of the use of PMT in social marketing campaigns designed to prevent drunk driving.

Originality/value – The review presents social marketing campaigns aimed at preventing drunk driving in English-speaking countries, and shows that PMT can be successfully used in this context. The paper provides a guide for future initiatives, as well as recommendations for social marketing practitioners.

Keywords Drink driving, Social marketing, Qualitative research

Paper type Research paper

Introduction According to the World Health Organization (WHO, 2004a), an estimated 1.2 million people worldwide are killed in road crashes each year, and as many as 50 million are injured. Many of these accidents are alcohol-related crashes. Indeed, out of 42,642 total traffic fatalities in the USA in 2006, 17,602 people died due to alcohol-related traffic injuries (41 percent). Of these, an estimated 13,470 involved a driver with an illegal blood alcohol concentration (BAC) of 0.08 or greater (Century Council, 2006; Mothers

The current issue and full text archive of this journal is available at

This research is supported with funds from the University of Regina and Saskatchewan Health Research Foundation. The authors thank Adina Rudrick and Brad Smith for their contribution in the early stages of this research. The authors also thank the Editors and the anonymous reviewers for their valuable guidance.

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Received December 2007 Revised May 2008 Accepted February 2009

International Marketing Review Vol. 26 No. 3, 2009 pp. 292-311 q Emerald Group Publishing Limited 0265-1335 DOI 10.1108/02651330910960799



against drunk driving, MADD, 2008). Due to these staggering death tolls, governments and nonprofit organizations have become interested in using social marketing as a tool to prevent and reduce drunk driving (WHO, 2004a).

We examined the role of social marketing programs in preventing and reducing drunk driving, by collecting English-language drunk driving communication and program materials posted on the Internet. We conducted qualitative research to review these materials, in order to determine the nature of these social marketing efforts, key themes, campaign components, and targeted populations, as well as to examine how protection motivation theory (PMT), a well-established theory of health behavior (Rogers, 1983), can be used to create effective social marketing campaigns designed to prevent drunk driving.

This paper reports on the trends and key features revealed during this qualitative analysis. We begin with a review of the literature outlining issues regarding drunk driving, as well as aspects of social marketing and PMT. We then present the methodology for our study and provide a description of key findings. Social marketing implications are discussed.

Drunk driving Drunk driving is usually defined as driving with a specific amount of alcohol in the blood – known as an individual’s BAC – which can be measured through blood, urine, and breath tests that estimate the number of grams of ethanol per 100 ml of blood (Century Council, 2006; Robin, 1991). The legally allowable level for an individual’s BAC varies from 0 to 0.08 g/100 ml in various countries. For example, in Australia and Germany, a BAC of 0.05 g/100 ml is the legal limit for driving, while in the USA, Canada, and New Zealand the BAC limit is 0.08 g/100 ml (WHO, 2004a). It should be noted that the phrase “drunk driving” does not necessarily mean “drunkenness”; rather, it simply denotes that the person is over the acceptable BAC level for operating a motor vehicle (Ross, 1992).

Alcohol has a depressant effect on the brain and nerve pathways that control muscle actions (Buckner et al., 2007). With a high BAC, brain functions are slowed and it is more likely that a person’s reaction time, vision, information processing, and judgment while driving will be adversely affected (Hannigan et al., 1999). The intensity of the effects of alcohol can vary from person to person, depending upon physical and mental health, mood, and other factors. Nevertheless, as an individual consumes more alcohol, the BAC increases dramatically (Solomon et al., 2006). As well, an individual’s risk of being in a traffic accident increases as his/her BAC level increases (Kaplan and Prato, 2007). Indeed, studies show that the relative risk of crash involvement starts to increase significantly at a BAC level of 0.04 g/100 ml. At 0.10 g/100 ml the crash risk relative to a zero BAC is approximately five times as high, while at a BAC of 0.24 g/100 ml the crash risk is more than 140 times the risk relative to a zero BAC (Global Road Safety Partnership, 2007).

Significant economic costs result from drunk driving, including the direct costs of health care, property damage, motor vehicle repair, emergency attendance, and death (WHO, 2007). Other costs include increased law enforcement, social costs, imprisonment, compensation payments, unemployment, health and disability insurance, and loss of productivity in the workplace from injury or premature death.

Preventing drunk driving




In 2002, the economic cost of alcohol-caused crashes in the USA totaled approximately $51 billion (Centers for Disease Control and Prevention, 2006).

Drunk driving, along with its risk factors and economic costs, is largely preventable. Preventative options include policies to reduce alcohol consumption, such as an increased tax on alcohol in order to reduce heavy drinking (Levitt and Porter, 2001), as well as linking the advertising for alcoholic beverages with pro-health and safety messages (Marshall and Oleson, 1994). Other policy options are aimed at encouraging people to think ahead and plan a safe ride home, such as the promotion of taxi companies (Transport Canada, 2005), encouraging people to avoid riding with someone who has been drinking, encouraging the use of seat belts, and increasing advertising to educate the public about drunk driving avoidance strategies (Dejong and Atkin, 1995). Some policy options focus on imposing stiffer penalties for drunk driving, including promptly suspending the driver’s license of anyone who drives while intoxicated, and using advertising to increase public knowledge of penalties imposed on drunk drivers (Sen, 2005). Enhanced law enforcement efforts can also reduce drunk driving, through increasing the number of sobriety checkpoints (Kenkel, 1993), and encouraging the public to report suspected drunk drivers to law enforcement (MedicineNet, 2004). Some policies are aimed at making it easier for authorities to prove a drunk driving offence has occurred, such as mandatory authorization for breath or blood tests from a driver in the event of a crash (de Cicco and Solomon, 2001). Still other policy efforts focus on ensuring that previous drunk driving offenders do not re-offend, such as mandatory rehabilitation programs for offenders (Transport Canada, 2005) and the introduction of alcohol ignition interlock devices (Canada Safety Council, 2006). Finally, many jurisdictions are investigating the possibility of reducing the legal BAC level in order to reduce the number of traffic accidents (Centers for Disease Control and Prevention, 2006) and, in particular, lowering the legal BAC level for minors (Dejong and Russell, 1995) or imposing zero BAC tolerance for new drivers (Maskalyk, 2003). Social marketing campaigns aimed at publicizing, implementing, and reinforcing these policy recommendations have been developed in several countries.

Social marketing and drunk driving Several studies have examined preventive measures and the policy environment, and how these relate to drinking and driving. For example, enforcement of drinking and driving laws has led to an overall reduction in drunk driving among college students (Wechsler et al., 2003). Increased promotion of safe ride programs in some areas has also reduced drunk driving (Caudill et al., 2000). As well, reductions in legal BAC levels in some jurisdictions are believed to have reduced accidents and deaths due to drunk driving (Wagenaar et al., 2001).

Most of the literature examining social marketing in the context of drunk driving deals with the effects that the media have on reducing drunk driving. For example, Elder et al. (2004) examined the effectiveness of mass media campaigns for reducing alcohol-impaired driving and alcohol-related crashes, which included a review of eight studies published between 1975 and 1998. Their analysis showed that the mass media campaigns were generally carefully planned, well executed, attained adequate audience exposure, and had the effect of significantly reducing the number of alcohol-related crushes.

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A study by Murry et al. (1993) evaluated whether a paid advertising campaign was effective at reducing young male drinking and driving, by using surveys at both the campaign site and a control site. Their analysis showed that the advertising campaign reduced drinking and driving behavior, and consequently reduced alcohol-related traffic accidents. A study evaluating the effectiveness of anti-drunk driving public service announcements (PSAs) found that ads focusing on relevant localized consequences have more meaning to undergraduate college students than the more general campaigns they usually reported seeing (Gotthoffer, 1999). In order to be effective, PSAs must take into account the frequency of binge drinking, gender, and age, which are factors that influence perceptions of drunk driving risk (Gotthoffer, 2001). Research suggests that media should not be viewed as a short-term behavioral change agent, but rather as a change agent intended to gradually restructure the public’s cognition about various issues related to drunk driving (Bang, 2000).

It should be noted that even though these studies discuss using educational materials or communication campaigns to fight drunk driving, few mention social marketing or refer to the full range of elements that would comprise an effective social marketing campaign. However, these studies demonstrate that mass media campaigns, combined with increased media attention, are effective in reducing the number of alcohol related vehicle crashes (Elder et al., 2004; Yanovitzky and Bennett, 1999).

Protection motivation theory Researchers have long attempted to understand the factors that influence the persuasiveness of health communication, using theoretical frameworks such as PMT (Prentice-Dunn and Rogers, 1986; Rogers, 1983). In our analysis of social marketing campaigns aimed at drunk driving, we employ PMT because it is a highly comprehensive theory of health communication (Boer and Seydel, 1996) that is well accepted and widely used. Anti-drunk driving social marketing campaigns seek to influence many of the cognitions that are the focus of PMT (Greening and Stoppelbein, 2000; Murgraff et al., 1999; Simons-Morton et al., 2006).

According to PMT, protection motivation is maximized when: . the threat to health is severe (high perceived severity); . the individual feels vulnerable (high perceived vulnerability); . the adaptive response is believed to be an effective means of averting the threat

(high response efficacy); . the costs associated with the adaptive response are small (low costs); and . the person is confident in his or her abilities to complete successfully the

adaptive response (high self-efficacy) (Rogers, 1983).

Such factors produce protection motivation and, subsequently, the enactment of the adaptive or coping response (Prentice-Dunn and Rogers, 1986; Rogers, 1983). Among these factors, self-efficacy is believed to have the most significant impact on one’s decision to adopt a recommended health behaviour (Milne et al., 2000; Rogers, 1983).

Threat appraisal Within the PMT model, the threat appraisal mechanism is comprised of vulnerability and severity. Using the drunk driving context, perceived vulnerability to the threat

Preventing drunk driving




refers to one’s subjective perception of the risk of causing a car accident. Perceived severity of a threat refers to feelings concerning the seriousness of an accident. This dimension includes evaluation of both health consequences (e.g. death, disability, and pain) and possible social consequences (e.g. impact of the resulting health condition on work, family life, and social relations). Previous research has shown that higher levels of perceived vulnerability and perceived severity can produce greater changes in protection motivation (Floyd et al., 2000; Milne et al., 2000). Previous research has also shown that a minimum level of threat is required in order for a person to act. In other words, if a person does not feel vulnerable, there will be no intention to change a behavior. If the threat does not feel severe enough to warrant action, no response will take place (Thesenvitz, 2000).

Coping appraisal The coping appraisal mechanism is comprised of response efficacy, self-efficacy, and perceived cost. Perceived response efficacy refers to a person’s belief that the recommended behaviors will be effective in reducing or eliminating the danger. Self-efficacy refers to the person’s belief that he or she has the ability to overcome the cost involved by the adoption of the recommended behavior. Perceived cost represents the sum of all barriers to engaging in the recommended behavior, including monetary costs and non-monetary costs such as: time, effort, inconvenience, discomfort, social disapproval, etc. Research suggests that higher levels of self-efficacy and response efficacy and lower levels of perceived cost can produce significantly greater changes in protection motivation and persuasion (Floyd et al., 2000; Milne et al., 2000). According to theory (Rogers and Prentice-Dunn, 1997) as well as empirical data (Milne et al., 2000), the coping variables (response efficacy, self-efficacy, and costs) have a higher impact on persuasion measures in comparison to the threat variables (vulnerability and severity).

PMT (Rogers, 1983) has been widely used to help create social marketing campaigns (Eppright et al., 2002; Lawrence, 1995). Indeed, a review of the research using PMT (Rogers and Prentice-Dunn, 1997) shows that numerous studies have tested either the threat appraisal and/or the coping appraisal in a wide variety of health contexts with public policy implications such as change in lifestyle (e.g. smoking, regular exercise, stress reduction), change in sexual behavior (e.g. AIDS-preventive actions), or change in healthcare practices (e.g. inoculation against a virus, breast self-examination, mammography), among others. Correlation studies, as well as studies using experimental manipulations of PMT variables (particularly response efficacy and self-efficacy), often produce main effects on intentions (Eagly and Chaiken, 1993). Indeed, two meta-analytic reviews of 65 and 27 studies, respectively, representing over 20 health areas which included approximately 37,700 participants (Floyd et al., 2000; Milne et al., 2000) demonstrated that, in general, increases in severity, vulnerability, response efficacy, and self-efficacy facilitated adaptive intentions and behaviors. In addition, several recent reviews of social marketing campaigns in the area of preventing and controlling obesity, limiting smoking, as well as underage drinking (Cismaru and Lavack, 2007a, b and Cismaru et al., 2008) show PMT as a theoretical framework which can be successfully used to create persuasive social marketing campaigns.

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Consider the following example of a social marketing campaign aiming to eliminate drunk driving, which illustrates use of PMT principles. The “Tie One on for Safety” public awareness project, running for more than 20 years, asks Americans to tie a silver ribbon to their vehicles as a symbol of the driver’s pledge to drive safe, sober, and buckled up ( Program.aspx?program¼10). The campaign’s fact sheet shows statistics describing how many people are involved in drunk driving crashes and how many are injured or die as a result (i.e. “Each year, nationally, more than 1,000 people typically die between Thanksgiving through New Year’s in drunk driving crashes”). This information is meant to increase perceived vulnerability and severity for the reader. The fact sheet posted on the web site provides specific recommendations about how to host a party responsibly, and what it means to designate a non-drinking driver before partying begins (i.e. “Being the designated driver doesn’t mean the ‘least drunk’ person drives home. It means that, before celebrations begin, an adult is designated to provide safe and sober transportation home and only drinks non-alcoholic beverages”). These recommendations can be considered to increase response efficacy, since the designated driver provides “safe transportation home,” but also may involve some costs for taxi fare or non-monetary costs such as inconvenience for the person who needs to abstain from drinking alcoholic beverages at the particular party in the particular example provided. Other recommendations found on the same web site suggest that solving the problem is easy, thereby increasing self-efficacy (i.e. “It’s easy to help reduce drunk driving through Tie One On For Safety. Click here to locate your local MADD office – then make a call to find out how you can help”). Specific numbers showing how effective this campaign is in terms of reducing accidents or deaths due to drunk driving indicate high response-efficacy (i.e. “Since 1980 – the year Mothers Against Drunk Driving was founded – alcohol-related traffic fatalities have decreased by about 44 percent, from over 30,000 to under 17,000 and MADD has helped save over 300,000 lives”). This example demonstrates how PMT principles can guide the creation of social marketing communication materials aimed at reducing drunk driving.

In the following section, we outline the methodology for our review of social marketing programs and campaigns relating to drinking and driving, as well as our examination of the use of PMT in this particular social context. This study addresses a gap in the literature by providing a qualitative analysis of English-language social marketing campaigns, discussing major themes, campaign components, and target population, as well as assessing the appropriateness of the usage of the PMT (Rogers, 1983) in a drunk driving prevention context.

Research design and methodology This research involved conducting a qualitative analysis of English-language anti-drunk driving communication materials posted on the Internet. We searched for keywords including “anti-drinking campaigns,” “drinking and driving,” “drunk driving,” “drink driving,” “driving under the influence,” “alcohol and driving,” “protection motivation theory and drunk driving,” and “social marketing and drunk driving.” We also searched health-related government websites such as the US Department of Health and Human Services, National Institutes of Health, Health Canada, and similar websites from five English-speaking countries (USA, Canada, UK, Australia, and New Zealand). References to campaigns and programs discussed in

Preventing drunk driving




academic papers located through Medline, ABI-Inform, PsychInfo, and other databases were also used as a means of finding additional campaigns.

Once identified, each individual campaign’s information was evaluated in terms of its content to assess its salient components as well as the presence of the variables considered by PMT to be important predictors of behavioural change. For example, regarding vulnerability, we looked for statistics meant to make the reader aware of the fact that the risks of someone causing a car accident significantly increases if one drives under the influence. Links such as “statistics,” “incidence,” or “the issue” were accessed to locate this information. Regarding severity, we searched for information showing the severe consequences of drunk drinking. Keywords such as “death,” “fatalities,” and “victims” were particularly relevant. Regarding self-efficacy and costs, phrases such as “it is easy,” “here are some steps,” and “tips” were searched, whereas response-efficacy information was generally found when there was a formal evaluation. However, there were few campaigns that neatly showed all of the information about all of the PMT variables on a single page; rather, the information was often spread over several pages and/or links. For this reason, we considered it appropriate to conduct a qualitative analysis of the materials, by reading them in their totality and looking for keywords that helped us assess the presence of variables considered by PMT to be important predictors of behavioural change. As part of this process, we created Table I, which lists the salient components of each campaign, including campaign title and year, campaign description and web address, initiator of the campaign, campaign components, and our assessment of the campaign’s adherence to the tenets of PMT.

Qualitative research findings Our search revealed over 25 anti-drunk driving programs or campaigns (Table I). Some of these were developed by nonprofit organizations such as MADD and Students against Drinking and Driving (SADD), or nonprofit organizations such as the Canadian Public Health Association. In some countries, federal or state/provincial governmental organizations took the lead (e.g. Texas Department of Transportation). Still other campaigns were developed by organizations or companies involved in the alcohol industry, such as the Brewers Association of Canada, or Molson Breweries. Although most of the campaigns are intended to either create awareness about the risks associated with drunk driving (e.g. Smashed), provide guidelines regarding sensible drinking (e.g. Drinking & You), or provide alternatives to drunk driving (e.g. Miles With a Mission), some go beyond this and encourage the public and businesses to call police if they see an impaired driver (e.g. Operation Lookout).

Campaigns included a wide variety of different components, including websites and print materials such as posters and brochures, as well as radio and TV PSAs that included celebrity spokespersons or interviews with victims and survivors. In addition, some campaigns incorporated community and mass-media events, partnerships with retail stores, awards, newsletters, scholarships, insurance folders, litterbags, t-shirts, car wash kits, magnets, buttons, etc. Campaigns took place at the international, national, provincial/state, or community level. Some of the campaigns include involvement with liquor stores, restaurants, bars, and other public places where drinking and driving behavioural change could take place.