Using social norms to drive positive health change

Oill-intentioned efforts to help others often backfire, but we can learn from our mistakes.

Vaping has caught national attention with news that it can be deadly, but many Americans are still buying e-cigarettes. And despite large-scale public health campaigns advocating vaccination, the United States is experiencing outbreaks of vaccine-preventable diseases. Our country is trying to contain the rising methamphetamine usebut without much luck.

When faced with health threats, there are two popular responses, but neither reflects the science behind behavior change.


A common response is to fight with facts. We assume that people don’t make healthy choices because they don’t know the scary statistics associated with the alternatives.

For example, public health officials often claim that parents will be more likely to have their children vaccinated against the human papillomavirus (HPV), which causes various cancers, if they learn more about the infection. So they fund fact-inundated campaigns about HPV. The World Health Organization, American Cancer Society, Centers for Disease Control and Prevention and other organizations publish public service announcements that aim to educate us about the disease. The presumption is that people who know the facts about HPV at their fingertips will choose vaccination, while those without this knowledge will not.


But that’s not what usually happens. This type of factual knowledge does not make parents more likely to have their children vaccinated. Although knowledge can be power, it does not always change the way we act.

Making the decision to quit smoking or vaping is also not tied to having these kinds of facts. We want people to know how dangerous smoking is, hoping that if they know, they’ll make the right choice, but smokers tend to think smoking is more dangerous than it actually is.

Remarkably effective strategies exist for persuading people, even if they are underutilized. Perceived social norms – our beliefs about what others do – are a powerful driver of behavior change. They often create pressure to act the same way, like a kind of peer pressure that shapes adult behavior as well as adolescent behavior. If you think your neighbors recycle regularly, for example, you’re more likely to do it yourself. And if you think your peers are paying their taxes on time, you’ll feel motivated to do so.

Social norms can be used by health campaigns that focus our attention on people doing the right thing, urging us to do the same. However, when not carefully crafted, these messages can backfire and actually increase unhealthy behaviors.

Consider the well-meaning college administrators who worried about high rates of heavy drinking on campus. They placed signs around campus warning of the scale and extent of the problem. After students encountered these signs, they were actually more likely to binge on alcohol.

Campus messages about alcohol had the opposite effect of what was intended, as the onslaught of signs gave students the impression that many of their peers were drinking heavily. When students believe that binge drinking is rampant, they may feel normative pressure to drink more, which further fuels binge drinking.

Public health campaigns aimed at reducing drug use have failed for similar reasons; some have even been linked to increased drug use. When a federally funded drug campaign broadcast television spots showing kids getting high, teenagers viewing these videos could easily conclude that drug use was common and that many of their peers were probably using drugs. The more they looked at these images, the more likely they were to start using drugs.

South Dakota’s controversial new anti-meth campaign, created by an advertising agency for nearly half a million dollars, risks backfiring.

The campaign motto, “Meth. We take care of itis illustrated with photos of teenagers and adults seemingly from all walks of life who each announce to the camera, “I take meth.” The motto and these images give the impression that most of the community uses methamphetamine. This feeling can inadvertently increase drug use.

Instead, health messages should turn to positive social norms and focus on those who make healthy choices. Colleges can point out that a majority of students drink responsibly. Public health campaigns against drugs can focus on the millions of people who avoid vaping or avoid opioids or methamphetamine. These messages harness the positive power of standards. By adopting this approach, the truth initiative produced video spots which, scene after scene, show teenagers throwing their e-cigarettes. The images are accompanied by words specifying the thousands of people who are stopping.

Each of us is sensitive to the subtle social pressure of perceived norms. They influence the decisions we make, often without our being aware of their effects. While this influence can sometimes be a bad thing, it can also provide opportunities to use the science of perceived social norms to our collective advantage.

Jessica Fishman, Ph.D., is a behavioral scientist with a cross appointment from the Perelman School of Medicine and the Annenberg School at the University of Pennsylvania and the author of “Death Makes the News: How the Media Censor and Portray Death(NYU Press, 2017).

About Marjorie C. Hudson

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