II. A NEW APPROACH TO PREVENTION
Montana's MOST of Us Don't Drink and Drive campaign is based on social norms theory, which maintains that our individual behavior is strongly influenced by our perceptions of the attitudes and behaviors of our peers. If people think harmful behavior is typical, they are more likely to engage in it. If they think protective behavior is typical, then that type of behavior holds sway. For example, if young people hold an exaggerated idea of the rate of alcohol, drug, or tobacco use of their peers, they are more vulnerable to experimenting with, increasing, or continuing their own risky behavior.
Social norms programs focus on changing people's commonly held, erroneous beliefs and perceptions about peer norms. This innovative, science-based approach to health promotion has a demonstrated track record of changing perceptions, attitudes, and behaviors in a variety of target groups and on an increasingly broad range of issues.19 The social norms approach to prevention emerged as a way of explaining and shaping human behavior based upon the powerful role of perceptions.20 The promise of and growing track record of social norms programs led MDT and NHTSA to grant the necessary funds to test out this approach in a demonstration project in Montana.
Social norms are simply the actual majority behaviors or attitudes of the people in any given community or group. For example, if most people in a community do not smoke, then not smoking is the social norm. Not smoking is normal, acceptable, perhaps even expected in that population.
Perceptions of social norms are people's beliefs about the actual behavioral or attitudinal norms of their peers. Perceptions of social norms play an extremely important role in shaping our individual behavior. Our perception of what is acceptable, majority behavior - how fast we think "most people" drive, whether we think "most people" wear safety belts, how many drinks we think "most people" have before getting behind the wheel - play a large role in our own behavioral decisions. When we perceive that there is social support for or against certain activities, we are more likely to modify or continue our behavior to act in accordance with how we believe others behave or feel about an issue.
The relationship between perceptions and behavior becomes more complex when we discover that most people do not accurately perceive the social norms of their peers. Social norms studies have found, again and again, that people hold remarkably exaggerated views of the risk-taking behavior of their peers.19 Identifying and reducing the often great disparity between perceived and actual norms is the basis of the social norms approach to prevention.16 19 Social norms interventions have shown that if people's perceptions are corrected to reflect the less risky, more protective behaviors that are the actual norms in their communities, they are more likely to behave in accordance with those positive standards.1 19
For example, intensive social norms media campaigns were implemented at several college campuses to counteract student over-exaggerations of the prevalence of heavy episodic drinking. As the students grew informed about the actual majority norms of moderate alcohol use, each campus measured 18- to 21-percent reductions in high-risk drinking in as little as two years, against a national backdrop which remained virtually unchanged.3 4 5 18 21
Why do misperceptions occur? Several factors may contribute, ranging from the way we mentally process information to the kinds of cultural stimuli we receive.16 18 First, we tend to think that unusual behaviors exhibited by other people are typical of them, whether or not this is the case (an "attribution error," as it is described by psychologists). We assume that the behavior we observe in others is characteristic of them, even if it is a once-a-year or once-in-a-lifetime occurrence. We do this because we do not have enough information about most other people to contextualize such behavior as rare when we hear about or see it happening.
Second, casual conversation tends to focus on the escapades of peers who exhibit extreme or high-risk behaviors. Talk among friends usually emphasizes and exaggerates atypical, risky behaviors rather than the statistically normal behaviors that regularly occur. This amplified talk about the risky behavior, in turn, leads many to think such actions are normative.
The third factor involves the influential role of entertainment and the mass media, which is in the business of delivering sensational, memorable material. We are typically attracted to fictional stories and news coverage about the most dramatic, arresting, or shocking events. Information that is particularly vivid or emotionally evocative (such as media coverage of automobile crashes, or prevention campaigns that show gruesome images of the impacts of impaired driving) tends to have increased impact upon our perceptions, leading to exaggerated ideas about frequency and prevalence. Meanwhile, some of the most common killers of Americans - obesity, stroke and heart disease - seem to go relatively unnoticed. Thus, the process of media attending to and disregarding information contributes to the misperception of actual norms.
Misperceptions have been shown to fuel a less-protective social environment among college students with regard to alcohol abuse.18 The same is likely true of the misperceptions that exist in larger, statewide populations of young adults.8 People with ambivalent attitudes about a particular high-risk activity might nonetheless engage in it if they perceive it as the norm. Meanwhile, those people already at the high-risk end of the continuum will wrongly think their behavior is the acceptable practice of the majority, and this misperception perversely reinforces their high-risk behavior. Opposition or intervention by others to prevent high-risk behavior is also inhibited in an environment characterized by widespread misperceptions. People are reluctant to be "the only one" to refrain from a behavior or to intervene in their friends' behavior if, in so doing, they risk social disapproval. Misperceptions of the prevalence of impaired driving and of permissive attitudes about it could similarly create a more risky behavioral environment. People are less likely to designate a non-drinking driver or take the keys away from someone who has been drinking if they think most others would not take these protective actions.
Most people make positive decisions about their personal health and safety. Various social norms interventions have found that most people wear safety belts, drink moderately, and are drug-and tobacco-free.10 8 9 22 However, many prevention campaigns choose to highlight and publicize the dangerous activity of the minority, ignoring the fact that healthy, protective choices are normative. Fear, threats, shame, and anxiety are used in an attempt to scare people into good behavior. Inflating peoples' fears can backlash against the goal of health promotion, however, and can even do demonstrable
Social norms campaigns do not include frightening, threatening messages, nor do they seek to forbid people from engaging in certain behaviors. The lack of an explicit "don't do it" message does not mean that undesirable behaviors like impaired driving are supported or condoned. By providing people with clear, accurate information about the standards of behavior that exist in their communities, social norms campaigns change people's misperceptions about their peers' behavior. Misinformed decisions become informed decisions, and individuals become active stakeholders in their own community environments.