I.
Introduction
Public
health professionals and critics point out that carbonated sugar
beverages are associated with more than 180,000 obesity-related deaths per
year all over the world. (1) When people, especially adolescents take too many
sugar beverages in their daily diet, the excessive calories may cause several
kinds of chronic disease, such as obesity, cardiovascular disease, diabetes,
and insulin resistance. These empty calorie beverages comprise a substantial
percentage of caloric intakes among adolescences currently. Therefore, sugar
sweetened beverages (SSB) have become a critical public health issue that are
viewed as related to teenage obesity and obese related diseases. To combat
childhood obesity, many states and some school districts have implemented a
soda ban policy to limit high school students’ access to SSB. (2) After the
policy was adopted, 14 states banned sodas in school vending machines, and
other schools also banned them in cafeterias. (2) By the start of the 2009-2010
school year, six states prohibited all sugary drinks in high school vending
machine, and six other states prevented students from accessing SSB in school
cafeterias. (2) The School Beverages Guideline was established by the American
Heart Association, American Beverage Association and Clinton Foundation to
enhance the nutritional content of school beverages by the start of 2009-2010
school year as well. (3)
Even
though these policies were well intentioned and based on plausible logic
to achieve the goal of reducing teenage SSB consumption, the act was not
attractive to adolescents and didn’t result in a decrease of SSB consumption.
(4) The states’ policies hope to
change high school students’ SSB consumption behavior by reducing students’
opportunities of getting sodas. (5) But, in fact, schools are not a major
source of SSBs for teenagers; they have many other convenient ways to gain
access to these beverages. (6) The intention of these policies to reduce the
amount of SSBs consumption via limited access failed, and there was only a
modest association between decreased SSB access in schools and decreased SSB
consumption. (5) States’ policies that prohibit all SSBs in high school vending
machines or cafeterias reduced the SSB access in school for teenagers but did
not show statistically significant evidence to demonstrate that access
limitation did reduce the total SSBs consumption among adolescents. (5) The
intention of the policies was to promote healthier drinking pattern by banning
SSBs for teenagers to prevent them from becoming obese, but based on the
information provided above, the policies failed to meet the goal. This critique
will analyze three flaws of the SSB ban policies and provide three possible
interventions to improve the result.
II. a.
Banning Access to SSB Lacks the Means to Boost Self-Efficacy Towards Healthy
Drinks
The states’ soda ban policies simply inhibited
teenagers from gaining access to SSBs at school. The action itself did not
provide adolescents with any implications about why or how to choose healthy
drinks, and thus, failed to promote self-efficacy towards establishing a
long-term healthy diet concept. Therefore, even if the access of SSBs slightly
decreased for adolescences in high school, the total consumption did not
decrease compared with states that did not adopt the SSBs access ban policies.
(5) Lacking an appropriate direction to show children why or how to drink can’t
lead them to a healthy diet path by simply banning SSBs in school. Children are
just being asked not to drink SSBs but still keep their original diet pattern
once they leave school. Although excessive intake of SSBs increase the future risk
of developing diabetes, heart disease, and insulin resistance, teenagers feel
it distant from these risks and their current lives. In sum, public health
policies drew an image of SSBs and health together in an authoritative tone,
non-engaging motives, and negative results if someone did not obey the
admonition. The long-term chronic health diseases themselves were not powerful
enough to boost teenagers’ self-efficacy to replace SSB with healthy drinks in
their diet.
The reason why adolescents felt long-term chronic
diseases distant from themselves can be explained by inter-temporal model of
behavior change. When it comes to preventive behavior, a decision maker’s
temporal preference is very important since it plays a decisive role in
determining relative receptiveness of an preventive intervention. (7)
Preventing children from accessing to sodas is a choice for kids to weigh
between immediate pleasures and benefit of good health in the future. Since
teenagers are obstinate and value happiness of the moment more than long-term
health, they discount chronic obese-related diseases and don’t think of the
possibility of developing them. (8-9) In addition, Kahneman and Tversk found
asymmetry in risk aversion and concluded that certain to uncertain gains are
preferred. Whereas, when it comes to losses, uncertainty to certainty is
preferred. (10) Under the soda ban policy situation, the immediate action of
giving up sodas gave children a high degree of certainty of loss while gaining
good health in the future was uncertain. Thus, the high degree of certainty of
loss induced children to act in exactly the opposite way from the policies
intended them to do. Consequently, the
SSBs ban policy is flawed because it failed to consider the temporal preference
in teenagers and lacked a clear frame to promote children’s self-efficacy
toward healthy drinking habits. By simply suppressing adolescents’ desire of SSBs,
the intention of policies was hard to attain.
II. b. How
to Promote Self-Efficacy to Healthy Diet While Banning SSBs Access
Considering
the inter-temporal model-temporal preference of teenagers and the discount
effect (8), improvement to advocating banning sodas to teenagers is to first
identify the position of how teenagers relate to sodas. Do they consider the
long-term consequences or do they simply make decisions based on their
immediate benefit? By grasping this core way of thinking of children, we can
frame a better story to promote their self-efficacy to replace sodas with water
or milk. Teenagers’ concern about their daily life helps them to make
decisions. They care about their appearance to the opposite sex, and they value
the immediate happiness of sharing Coca-Cola together with friends. Hence, the
SSBs consequences should be framed within some immediate reality that teenagers
really care about instead of some distant future with chronic health diseases.
According to Ortendahl’s article, “effects are
mostly temporary and viewing behavior as sequences of outcomes evidently has
implications for behavior change effects are mostly temporary and viewing
behavior as sequences of outcomes evidently has implications for behavior
change”. (8) Therefore, for the second step, policy makers may articulate a
specific benefit of not drinking sodas over a certain period of time or an
immediate health problem they might encounter occurring at different time
intervals if they keep drinking soda. The most direct problem adolescents can
identify immediately with and care about the most is poor appearance.
Considering this, we can frame our story related to immediate consequences such
as increasing body weight (11) and having unhealthy teeth (12), which are easy
to understand and imagine for teenagers. We should clearly demonstrate the
advantages of giving up soda and the disadvantages of drinking them in small
brochures and put them on every table in the cafeteria to remind children
everyday.
To promote the self-efficacy of
choosing healthy drinks, we should use easy, clear and encouraging words with a
specific time period to let children understand the consequences
comprehensively. For example, drinking one soda per day for a month will cause
tooth decay. If they keep drinking one soda per day for two months or more,
their teeth will be discolored and it will be hard to recover their original
color. We can also add some actual pictures along with the slogans to
strengthen their power. With a clear sequence of time periods, it may be easier
for teenagers to understand this negative consequence and link it to their
daily lives. Or we can frame it in a positive way like mentioning the
advantages of not drinking sodas. For example, if they do not drink sodas for a
week, they may lose 0.7 pounds, and if they replace soda with water for one
month, they may probably lose more than 3 pounds and look slimmer. Just a
little will power for their choice and then they can make a big difference to
their body shape and surprise their friends. Either way, these brochures
provide teenagers with reasons they should quit drinking sodas and how they could
take action to change their body and health. Adolescences can understand and
visualize bad or good conditions and connect those impacts with their
appearance in their day-to-day reality. With better framing stories in a
brochure and clear guide of what to change, children will no longer feel the
soda-related diseases distant from their daily lives and believe that it’s not
too hard for them to change. When children start believing that they can
actually do something about the changing their diet patterns to a healthier
way, we better promote their own self-efficacy.
III. a. The
SSBs ban Policies Failed to Take the Effect of Social Cognitive Theory into
Account
Adolescents’
minds are complex. Teenagers are not mature enough to be adults, but they are
eager to grow up. They deal with all kinds of emotions during this period such
as expectations from parents, peer pressure, and self-exploration. At this
stage, the impact of peers and friends are huge. The reason why the SSBs ban did not
successfully decrease the consumption of SSBs can be explained by social
cognitive theory. Social cognitive theory assumes that the three factors -
environment, people and behavior - are constantly influencing each other. The
theory concludes that portions of an individual's knowledge acquisition and
decision-making patterns are associated with observing others within the context of social interactions,
experiences, and other environmental influences. (13) Research has revealed
that there is no significant evidence that the policies actually reduced the
total SSBs consumption. (5) The researchers’ further supplementary analyses
even showed that there was even a slight increase in frequent consumption of
SSBs, implying that “heavier consumers compensated effect” cause increased
consumption outside of school. (5) The soda ban implementation’s lack of
considering social cognitive theory in the development of this policy may have
increased the consumers’ compensated effect.
Imagine
if a group of teenagers decide to grab cokes at a convenience store together
after school. Will a teenager say no to his/her friends just because of the
health risks? The answer is probably not because teenagers will not break with
their teen social norms easily. Teenagers value belonging with their peer group
more than anything else, so when they see their peers drinking sods outside of
school, they usually will join them. By contributing to activities with their
friends, teenagers feel they are accepted as members of the group. Not being an
outsider is much more important than an individual’s health consideration. (14)
The reciprocal determinism of social cognitive theory explains why each
teenager has such great power to affect the other. In addition, after being
part of the group, there will be reinforcement of that behavior in a positive
way. Although the policies ban the access to SSBs in school, they can’t change
the whole environment. Drinking soda has been part of the culture of the United
States and sodas are sold almost everywhere. Therefore, simply suppressing
access to SSBs without implementing any other related policies is not going to
achieve the intention of decreasing adolescent SSBs consumption. This may
indicate why SSBs ban policies had modest outcome and could account for some
adverse outcomes. (5)
III. b.
Policy Makers Should Take Advantage of Social Cognitive Theory to Achieve the
Goal
How
can public health policy take advantage of social cognitive theory to reduce
total teenage SSBs consumption? The answer lies in changing the values inside
adolescents’ minds instead of prohibiting access on the surface of this
problem. Policy makers should come up with a strategy that will at least change
some of the teenagers’ attitudes, and if they successfully change some
teenagers’ drinking patterns, the rest will follow the new drinking pattern due
to the power of social cognitive theory. Making an attractive advertisement
related to a new drinking pattern and broadcasting them to students during
school time is a way that would work. The soda industry has poured a lot of
money into creating fancy advertisements that usually catch teenagers’
attention with strong core values such as freedom and happiness. The National
Children’s Bureau (NCB) Report on 2006 about food and drink advertising and
pointed out that “children are drawn towards (food) products that are heavily
branded and marketed, which tend to be of little nutritional value”. (15)
According to advertising theory, soda advertisements are more attractive,
powerful, and persuasive to adolescents compared with healthy food
advertisements. The soda industries market their products with movie stars,
celebrities or sports heroes. They create an image that by drinking those
sodas, adolescents feel cooler or more popular.
To promote
healthy drinks, public health officials should think of a new way to frame
advertisements of healthy drinking patterns. Policy-makers should explore
techniques used in soda advertisements to create a new image of healthy drinks
and make healthy drinking patterns themselves attractive and fashionable to
youth. For example, creating a story within advertisements that fits teenagers’
social reality. The story could be about a group of popular basketball player
drinking water and milk after winning a game, and teammates sharing their
healthy drinks together on the go. This image will demonstrate core values such
as autonomy and the coolness of healthy drinks to children. This new
advertisement of water and milk will clearly convey that healthy drinks can
also be part of the teens’ social norms and make healthy drinks as attractive
as SSBs. The most important thing to change teenagers’ decision-making patterns
and choose healthy drinks is to make them believe that when they drink water or
milk, they fit in better with their peer group and feel their desire fulfilled
with a strong sense of belonging. If policy-makers successfully create more
attractive healthy drink advertisements, they may be able to change children’s
drinking patterns. Once these patterns are changed, they will not trying to get
more sodas after class dismissed even if soda access is limited at school.
Finding a sense of belonging is the most important aspect of teens’ social
reality. Thus, as long as policy-makers can connect healthy drinking patterns
with peer belonging, they can exert the power of social cognitive theory to
successfully reduce the total consumption of SSBs.
IV. a. The
Violation of Psychological Reactance Theory
According to
the psychological reactance theory, once people’s freedom is threatened, their
first reaction is to restore their freedom by doing what they are asked not to
do immediately. (16) People will want to protect their freedom right away.
Whenever a free behavior is restricted, people will experience psychological
reactance. (16) Banning SSBs access at school is sending teenagers a message
that their freedom of choice is being deprived. Once teenagers experience
reactance, they will feel that SSBs are even more attractive to them, and they
will aim to restore their freedom by drinking more soda. (17) This act
stimulates adolescents’ desire to drink more soda once they are able to buy it.
This phenomenon also explains the reason why “heavier consumers compensated
effect” may increase teenage SSBs consumption outside of school for states that
adopted soda ban policies. (5) Because adolescence’s desire is suppressed at
school, they try to protect their freewill by consuming more soda after the
suppression is over.
Therefore, states
SSBs ban policies are flawed because they violate the psychological reactance
theory. Reactance will induce an unfavorable attitude towards the banning
action that has been imposed. Prohibition of SSBs access may not achieve the
intention that policy makers assumed to reach,; in contrast, the imposed
behavior might foster teenager adverse attitude toward the restrictions. (18)
Furthermore, reactance even stimulates adverse emotions towards the source of
the restriction. (19) Banning soda access in high school may not help policy
makers reduce the total SSBs consumption; in contrast, it may increase the
possibility that children will consume more out of the will to defend their
freedom.
IV. b. The
Ways to Avoid Psychological Reactance
To
avoid psychological reactance, health experts and policy makers should try to
deliver their message in a way that caters to teenagers. Using the tactic of
similarity can reduce psychological reactance and may gain a better passageway
to touch adolescents’ minds effectively. Similarity enhances the positive force
toward compliance via increasing liking. (20) If policy-makers can figure out
some way to make adolescents like them, then this “liking” will increase their
tendency to like what the policy makers like too. Similarity may decrease the negative force toward resistance and
liking may increase the positive force toward compliance; these two elements
together may possibly affect teenagers’ perspective towards soda ban policies.
How
can one create similarity along with the SSBs ban policies? Policy-makers can
look for a group of teenagers of various in ethnicities and ages to deliver the
message. Maybe they can produce a commercial or a promotional video talking
about the main purpose underlying the SSBs ban policies. Teenagers will be more
likely to accept a message that comes from their similar peer group because
they will give more credit to the messenger’s words and connect the message
with their social reality together. (21) Once adolescents feel that the person
delivering the message has needs similar to their own, stand in their shoes,
and has their perspective, children will establish a special credibility
towards the messenger. (22) Adolescents will feel less threatened when
accepting the message of the soda ban form peer-like people, who are less
threatening so they will feel the resistant force weakened. Similarity deflects
psychological reactance (22) and thus, the policies’ real intention of children
reducing their total SSBs intake may be more easily achieved.
The
final way to deflect psychological reactance is not to challenge teenagers’
beliefs and values, but to reinforce them to support the soda ban policies. We
need to understand the core value of why teenagers love sodas and frame
healthier drinks such as water, skim milk, and orange juice in the same way as
sodas. Framing good drinks with a creative approach and using messengers
similar to teenagers’ social reality are necessary to show that good drinks are
cool and children are “loving” it.
V. Conclusion
Based
on the evidence presented above, the SSBs ban policy adopted in high school is
flawed. There are three reasons why the policy failed to reduce total
consumption among adolescence. Among them, the lack of promotion of
self-efficacy towards healthy drinking pattern, the lack of promoting the power
of peers through social cognitive theory, and the lack of consideration of the
psychological reactance theory. The three interventions or approaches I
provided to correct those flaws are conveying clear, encouraging information
with immediate outcomes and temporal sequences to children, creating belonging
along with the ban policy to exert the power of social cognitive theory, and
using similarity and the effect of liking to deflect psychological reactance.
VI.
References
- Castillo M. NYC refreshes anti-sugary drink campaign with new ads. CBS NEWS. June,4,2013; Retrieved from http://www.cbsnews.com/8301-204_162-57587576/
- Mello M. et al. The interplay of public health law and industry self-regulation: The case of sugar-sweetened beverage sales in schools Am J Public Health, April, 2008, 98(40): 595–604 http://ajph.aphapublications.org.ezproxy.bu.edu/doi/full/10.2105/AJPH.2006.107680
- Alliance for a Healthier Generation. Competitive beverage guidelines. http://www.healthiergeneration.org/companies.aspx?id=1376. Accessed February 7, 2011.
- Blum E et al. Reduced availability of sugar-sweetened beverages and diet soda has a limited impact on beverage consumption patterns in Maine high school youth. Journal of Nutrition Education and Behavior, 2008; 40(6): 341-347. Retrieved from http://www.sciencedirect.com.ezproxy.bu.edu/science/article/pii/S1499404607011311
- Taber R. et al. Banning all sugar-sweetened beverages in middle schools. Arch Pediatr Adolesc Med. 2012;166(3): 256-262
- Wang YC, Bleich SN, Gortmaker SL. Increasing caloric contribution from sugar sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004. Pediatrics. 2008; 121(6):1604-1614.
- Chapman, Gretchen B.; Brewer, Noel T.; Coups, Elliot J.; Brownlee, Susan; Leventhal, Howard; Levanthal, Elaine A. Value for the Future and Preventive Health Behavior.Journal of Experimental Psychology: Applied, 2001; 7(3): 235-250. http://psycnet.apa.org.ezproxy.bu.edu/journals/xap/7/3/235/
- Ortendahl, M. and Fries, J.F. Framing health messages based on anomalies in time preference. Med Sce Monit 2005; 11(8): 253-256 http://www.medscimonit.com/download/index/idArt/202641
- Ortendahl M, Fries F. Time-related issues with application to health gains and losses. Journal of Clinical Epidemiology 2002;55: 843-848. http://www.sciencedirect.com.ezproxy.bu.edu/science/article/pii/S089543560200447X#
- Kahneman D, Tversky A. Prospect theory: an analysis of decision under risk. Econometrica 1979; 47(2): 263–291.
- Vartanian, R. et al. Effects of soft drink consumption on nutrition and health: A systematic review and meta-analysis. 2007; 97(6): 667-675. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829363/
- ADA Report. Position of the American Dietetic Association: Oral Health and nutrition. Journal of the American Dietetic Association 2003; 103(5): 615-625.
- Bandura, A.. "SOCIAL COGNITIVE THEORY: An Agentic Perspective". Annual Review of Psychology, February, 2001; 52 (1): 1–26.
- Wills W et al. The influence of the secondary school setting on the food practices of young teenagers from disadvantaged backgrounds in Scotland. Health Education Research 2004;20(4):458-465.
- Lewis, E. Children’s views on non-broadcast food and drink advertising, Report for the Office of the Children’s Commissioner. UK National Children’s Bureau, Office of the Children’s Commissioner. September 2006; 1-20.
- Brehm SS, Brehm JW. Psychological reactance: A theory of freedom and control. Academic Press; New York: 1981.
- Steindl C, Jonas E. What reasons might the other one have?—perspective taking to reduce psychological reactance in individualists and collectivists. Psychology(Irvine), 2012; 31(3): 1156-1160. Retrieved from http://europepmc.org/articles/PMC3694311
- Quick, B. L., & Stephenson, M. T. Further evidence that psychological reactance can be modeled as a combination of anger and negative cognitions. Communication Research, 2007; 34: 255-276.
- Miller, C. H., Lane, L. T., Deatrick, L. M., Young, A. M., & Potts, K. A Psychological reactance and promotional health messages: The effects of controlling language, lexical concreteness, and the restoration of freedom. Human Communication Research, 2007; 33: 219-240.
- Byrne, D. An overview (and under review) of research and theory within the attraction paradigm. Journal of Social and Personal Relationships, 1997; 14: 417–431.
- Hovland, C. I., Janis, I. L., &Kelley, H. H. Communication and persuasion. New Haven, CT: Yale University Press. 1953
- Silvia, P. J. Deflecting reactance: The role of similarity in increasing compliance and reducing resistance. Basic and Applied Social Psychology, 2005; 27: 277-284. http://libres.uncg.edu/ir/uncg/f/P_Silvia_Deflecting_2005.pdf
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