Using social norms to drive positive changes in health

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

Vaping has captured the nation’s 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 U.S. is experiencing outbreaks of vaccine-preventable diseases. Our country is trying to contain the growing use of methamphetamine, but without much luck.

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

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

For example, public health officials often argue that parents will be more likely to vaccinate their children against human papillomavirus (HPV), which causes a variety of cancers, if they learn more about the infection. So they fund campaigns flooded with facts about HPV. The World Health Organization, American Cancer Society, Centers for Disease Control and Prevention, and other organizations issue public service announcements that focus on educating us about the disease. The presumption is that individuals who have the facts about HPV at their fingertips will choose vaccination, while those who lack this knowledge won’t.

But that isn’t what usually happens. This kind of factual knowledge doesn’t make parents more likely to have their children vaccinated. While knowledge can be power, it does not always change how we act.

Making the decision to quit smoking or vaping isn’t linked to possessing these kinds of facts, either. We want people to know how dangerous smoking is, expecting that if they know, they will make the right choice, but people who smoke tend to think that smoking is more dangerous than it actually is.

Remarkably effective strategies exist for persuading people, though they are underused. Perceived social norms — our beliefs about what other people are doing — are a powerful engine of behavior change. They often create pressure to act similarly, like a kind of peer pressure that shapes adult behavior as well as it does adolescent behavior. If you believe that your neighbors regularly recycle, for example, you are more likely to do so yourself. And if you believe your peers are paying their taxes on time, you will feel motivated to do that.

Social norms can be used by health campaigns that focus our attention on people doing the right thing, nudging us to do the same. When they aren’t carefully designed, though, these messages can backfire and actually increase unhealthy behaviors.

Consider the well-intended college administrators who were concerned about the high rates of binge drinking on campus. They placed signs around campus warning about the size and scope of the problem. After students encountered these signs, they were actually more likely to binge drink.

The campus messages about alcohol had the opposite effect than what was intended because the onslaught of signs gave students the impression that many of their peers were drinking heavily. When students believe that heavy drinking is rampant, they can feel normative pressure to drink more, which fuels more binge drinking.

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

South Dakota’s controversial new anti-methamphetamine campaign, created by an ad agency for nearly a half-million dollars, runs the risk of backfiring.

The campaign motto, “Meth. We’re On It” is illustrated with pictures of adolescents and adults from seemingly all walks of life who each announce to the camera, “I’m on meth.” The motto and these images give the impression that most of the community is doing meth. This impression can inadvertently increase drug use.

Health messages should instead turn to positive social norms and focus on the many who make healthy choices. Colleges can highlight that a majority of students drink responsibly. Public health antidrug campaigns can focus on the millions who avoid vaping or sidestep opioids or meth. These messages harness the positive power of norms. Embracing this approach, the Truth Initiative has produced video spots that, in scene after scene, show teens throwing away their e-cigarettes. The images are accompanied by words specifying the many thousands who are quitting.

Each of us is susceptible 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 offer opportunities to use the science of perceived social norms to our collective advantage.

Jessica Fishman, Ph.D., is a behavioral scientist with a joint appointment at 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 Depict Death” (NYU Press, 2017).