1. Most of us don’t know what most of us are doing; Using Social Norms Theory to prevent injury SMARTRISK Learning Series February 20, 2007 Frances Wdowczyk Dr. Jeff Linkenbach

2. Ask the question; Are we getting the results that we want with our injury prevention programs?

3. Institutional Insanity: Doing what we have always done in our programs and expecting different results.

4. Health Promotion and Injury Prevention “Just say no” “Don’t drink and drive” Versus “Just do it”

5. Warning: Bridge Out Ahead!

6. individual

7. Assumption of the traditional (individual choice) approach to prevention: The social system is working fine and the fault for health problems resides solely with people and their choices.

8. If the problem is defined as: Lack of knowledge = educate Disease = provide treatment Lack of self esteem = enhance self concept Lack of skills = skill building Lacking awareness = increase awareness Lack of enforcement = tough on crime

9. Research indicates: Programs which focus on increasing individuals’ knowledge, skills, awareness, etc… are successful in increasing these objectives... …but they do not necessarily translate into changed social norms for large populations.

11. Do we have “youth at risk” or do we have youth living in risky environments?

12. Teen Pregnancy Data In Montana 60% “teen pregnancies” caused by men over the age of 21 (MDHES, 1991). Only 1.5 % of all pregnancies in the U.S. and only 8% of all “teen” pregnancies actually involve two minors (children). (U.S. DHHS, 1990).

13. Environmental Conclusion: The most important thing adults can do about the “epidemic of teen pregnancy” in Montana and other states is to stop causing it! (Kirk Astroth, 1995)

14. Personal Choice? Numerous studies indicate that social class is still the single most important determinant of health with most diseases.

15. Examples of Environmental Prevention Approaches: Laws and Policies. Taxes and price increase. Density of outlets/ controlling access. Hours of operation. Events management. Increasing enforcement.

17. In a well designed environmental prevention system, social norms are targeted directly and not just assumed to follow regulations, laws, enforcement or restricting access.

19. If 75% of a population are already engaging in healthy behaviors why do we focus on the 25% who are not? We must reverse the ratio

20. The Social Norms Approach

21. Simple Model of Peer Influence on Personal Drinking & Drug Use

22. Perception of Peer Influence on Drinking & Drug Use

23. Research finds: A disparity exists between actual alcohol use by college students and their perception of other students’ alcohol use. (* Perkins & Berkowitz, 1988)

24. Cause of Misperceptions Error of attributions (individuals not the environment). Failure to contextualize (always extreme). Memory & conversation distortions (funny, scary, sickening -- not the mundane). Media & advertising distortions (reinforce the misperceptions-- spring break on MTV).

25. Consequences of Misperceptions Self-fulfilling prophesy (reign of error). Actual use increases. Compounding layers of misperceptions -“I do what you do because it’s what we do.” Opposition is discouraged from speaking. Intervention by others declines (bi-stander). Carriers of misperceptions.

26. Perceptions of norms are more powerful influences on behavior than actual norms. For certain populations it is more important to be normal than to be healthy!

27. 2003 All Canada Data Over-estimate the amount of risky or harmful behaviors in their “peers.” Underestimate the amount of healthy or protective behaviors.

28. Misperceptions Go on and On…. Actual Norm- 63% of students drink twice a month or less often Misperception – 80% of students think students typically drink once per week or more often. One third of students erroneously believe students in general most commonly drink at least 3 times per week

29. The Social Norms Approach Disparity between actual & perceived norms Behavior, attitudes, policy support, etc. Changed perceptions lead to changed behavior

30. University of Arizona

32. Seat Belt Use by Individuals in Montana

33. DATAMESSAGEDOSAGERESULTS Fidelity ConferencesMeetings Strategic Planning Capacity Building More Focus Groups Training Refining Goals Staffing Peer Programs Technical Assistance (T.O.T.) Advocacy

34. The Vision: A cultural environment in which media reflects clear, consistent, pervasive messages which accurately depict protective measures as the expected norm for community participation.

35. “People live with a lot of wrong perceptions, ideas, and notions, and when they invest their lives in them it is dangerous.” Ticht Nhat Hanh