LITERATURE REVIEW (12-16 pages) This essay is basically synthesizing 10 sources to support the new research im proposing that needs to be done. The sources needs to be categorized into 3/4 subheadings

LITERATURE REVIEW (12-16 pages) This essay is basically synthesizing 10 sources to support the new research im proposing that needs to be done. The sources needs to be categorized into 3/4 subheadings
Jo u rn al o f M ed ia P sy ch olo g y: T h eo rie s, M eth od s, a n d A pplic a tio n s Effe ctiv e n ess o f a S ch ool-B ase d I n te rv e n tio n t o E m pow er Ch ild re n t o Cop e W it h A dve rtis in g Esth e r R oze nd aal a nd B ern d F ig ne r Onlin e F ir s t P u b lic atio n, S epte m ber 2 6 , 2 0 19. h ttp ://d x.d oi. o rg /1 0.1 027 /1 86 4-1 105/a 0 0026 2 CIT A TIO N Roze nd aal, E ., & F ig ne r, B . ( 2 0 19, S epte m ber 2 6 ). E ffe ctiv e ne ss o f a S cho ol- B ase d In te rv e ntio n t o Em pow er C hild re n t o Cope W it h A dve rtis in g . Jo urn al o f M edia P sy ch olo gy: T heorie s, M eth ods, and A pplic a tio ns . A dvance o nlin e p ub lic atio n. h ttp ://d x.d oi. o rg /1 0.1 027 /1 86 4-1 105/a 0 0026 2 Original Article Effectiveness of a School-Based Intervention to Empower Children to Cope With Advertising Esther Rozendaal and Bernd Figner Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands Abstract:This study tested the effectiveness of a theory-driven, school-based advertising intervention entitled Ad Masters that aimed to stimulate children’s advertising coping behavior in the current media landscape. A cluster randomized controlled trial was completed among 704 children (7–12 years old) in schools. The schools were allocated to either the intervention group (n= 399) or control group (n= 305). Both short-term (directly after the intervention) and long-term effects (3 months after the end of the intervention) were measured. Bayesian mixed- effect analyses showed positive short- and long-term effects of the intervention on children’s understanding of advertising’s tactics. Structural equation analysis showed that the intervention-induced changes in children’s understanding of advertising’s tactics were not related to any changes in their use of advertising coping strategies or their advertising susceptibility. No other intervention effects were found. However, structural equation analyses showed that, regardless of the intervention, motivation and ability to use advertising coping strategies are both associated with children’s actual coping behavior. These findings indicate that motivation and ability to effectively use advertising coping strategies are important empowering factors that should be taken into account in future research on children’s advertising coping behavior and in advertising intervention development. Keywords:advertising, children, intervention, advertising literacy, coping strategies Today’s children are facing a media environment increas- ingly saturated with advertising. Research has demon- strated that this increased commercialization of the media environment stimulates children’s desire of advertised products, which can have undesirable consequences for their well-being (e.g., materialism, parent–child conflict, unhealthy food preferences; e.g., Buijzen & Valkenburg, 2003). Additionally, issues of fairness have been raised, because children’s advertising-related knowledge is still underdeveloped (Kunkel et al.,2004). Having knowledge of advertising is considered to be a necessary precondition for children to cope with advertising, because it is only whentheyareabletorecognizeamessageasaformof advertising that they will have the opportunity to enact cer- tain coping strategies. These issues of fairness are even more severe in the contemporary media environment, which is characterized by subtle advertising formats that are integrated in entertainment. Children have great diffi- culty recognizing the commercial nature of these practices (DeJans,VandeSompel,Hudders,&Cauberghe,2019). As a result of these concerns, there is an increasing call for the development of educational interventions to empower children as consumers (Nelson,2016). Over the past few years, a number of intervention programs havebeen implemented (e.g., http://www.mediasmart.uk.com; http://www.admongo.org). These programs focus primarily on increasing children’s advertising knowledge, also referred to asadvertising literacy(Hudders et al.,2017; Rozendaal, Lapierre, Van Reijmersdal, & Buijzen,2011). Although such interventions indeed are effective in increas- ing advertising literacy (e.g., Jeong, Cho, & Hwang,2012; Nelson,2016),researchindicatesthatthisdoesnotauto- matically enable children to cope with advertising (Living- stone & Helsper,2006;Nairn&Fine,2008; Rozendaal et al.,2011). To cope with advertising successfully, children need to engage in advertising coping strategies (e.g., avoid- ance, formulate critical thoughts). However, insights regarding children’s advertising processing (Buijzen, Van Reijmersdal, & Owen,2010) and cognitive development (Brucks, Armstrong, & Goldberg,1988; Moses & Baldwin, 2005) suggest that, due to the powerful emotional appeal of advertising, combined with children’simmaturecogni- tive abilities, children will not be motivated or able to use their coping strategies. To stimulate children’s advertising coping skills, interventions should therefore not only increase their advertising literacy (i.e., awareness and understanding of advertising), but also provide them with the motivation and ability to effectively enact their coping 2019 Hogrefe PublishingJournal of Media Psychology(2019) https://doi.org/10.1027/1864-1105/a000262 strategies. Thus far, no advertising interventions exist that focus on all three components (i.e., advertising literacy, motivation, and ability). The current study addresses this gap by testing the effec- tiveness of a new theory-driven, school-based intervention entitled Ad Masters. The proposed intervention is funda- mentally different from existing advertising interventions in that it is designed to not only increase children’s adver- tising literacy, but also toactually change the way they respond to advertising by increasing their motivation and ability to cope with advertising. To this end, the interven- tion uses an unconventional combination of theory-based behavior change techniques (self-persuasion, emotion labeling, and implementation intentions) from the field of persuasive communication and social and developmental psychology. The intervention targets children in Grades 3–5in elementary school (approximately8–11years of age), because children in this age range still have major difficulty enacting advertising coping strategies, but already possess the sociocognitive skills that are necessary to participate in the proposed intervention program (Moses & Baldwin,2005). Theoretical Framework Motivation to Cope With Advertising A common technique used in persuasion research to motivate people to change their behavior is by providing arguments of why it is important to change. However, when faced with counter-attitudinal arguments, most people will not comply (Aronson,1999). Therefore, it is expected that providing children with arguments of why it is important to critically cope with advertising (to which they generally hold positive attitudes; e.g., Rozendaal, Slot, Van Reijmersdal, & Buijzen,2013) will not motivate them to activate coping strategies. Self-persuasion may overcome this problem (Aronson, 1999). Self-persuasion stems from Festinger’scognitive dissonance theory (Festinger,1957), which states that disso- nance (an unpleasant feeling) is aroused when individuals notice inconsistency between their attitudes and their behavior. To reduce dissonance, people try to restore bal- ance by changing their attitudes or behavior. Self-persua- sion uses this principle by asking people to argue in favor of a desired behavior (“Write down two arguments that stress why it’s important to be critical about advertising”). Once a relevant situation occurs (when confronted with advertising), people have the tendency to rely on these self-generated arguments in order to avoid dissonance. Self-persuasion is a powerful technique because it increases people’s intrinsic motivation to change(Mussweiler & Neumann,2000). It has been shown to be effective in a wide variety of contexts (e.g., condom use, smoking behavior, alcohol use; Banerjee & Greene,2007; Briñol, McCaslin, & Petty,2012;Mülleretal.,2009), yet has not been applied in the context of advertising or with children. Children as young as4can already experience dissonance (Egan, Santos, & Bloom,2007). Therefore, self-persuasion may be an effective intervention technique to increase children’s motivation to enact advertising coping strategies. Ability to Cope With Advertising Children’s ability to cope with advertising depends largely on their cognitive skills (Moses & Baldwin,2005). To cope with advertising, children need to have the cognitive control to stop their initial emotional responses to the advertising message and instead react alternatively (i.e., enact coping strategies). This process is also referred to as thestop- and-think response(Rozendaal et al.,2011), since it requires that children control their emotional responses to the advertisement (i.e., stop) and then enact a strategy to help cope with advertising (i.e., think). Thestoppart of the stop-and-think response is closely linked to children’s emotion regulation skills (Rozendaal et al.,2011). Emotion regulation refers to the processes that aid in the experience, monitoring, and control of emotions (Gross,1998), and does not reach adult levels until late ado- lescence (Diamond,2002). Emotion regulation is expected to play an important role in children’s ability to stop and think about advertisements, particularly because so much of the content in contemporary advertisements is centered on emotional cues. Children with less of an ability to control affect via emotion regulation will be overwhelmed by the emotional cues in advertising and, therefore, less able to enact their advertising coping strategies. Prior research has shown that children with lower emotion regulation skills are indeed more susceptible to advertising (Lapierre, 2013). Although emotion regulation skills naturally develop when children mature, research has shown that these skills are trainable and can be improved at any age (e.g., Greenberg, Kusche, Cook, & Quamma,1995; Izard et al., 2008). Social–emotional development programs (e.g., PATHS; Greenberg et al.,1995; Head Start, Izard et al., 2008; mindfulness, van de Weijer-Bergsma, Langenberg, Brandsma, Oort, & Bögels,2014) offer useful techniques in this respect. In these programs, children learn to become aware of and express their emotions. The premise behind this is that increasing children’s ability to understand and label their feeling states or emotion experiences will increase their conscious control of them (Izard et al., 2008, Greenberg et al.,1995). Thus, the labeling of Journal of Media Psychology(2019) 2019 Hogrefe Publishing 2 E. Rozendaal & B. Figner, School-Based Advertising Intervention for Children emotionsmaybeaneffectiveinterventiontechniqueto increase children’s ability to cope with advertising, because it increases their emotion regulation which can facilitate the “stop”part of the stop-and-think response. Once children are able to control their emotional responses toward an appealing advertisement, they also need to be able to enact a script or strategy to cope with the advertisement (i.e., thethinkpart of stop and think). This ability is closely linked to children’s information- processing abilities. Successful coping with advertising requires children to process the advertising message and, at the same time, activate and apply an effective coping strategy. Because children’s cognitive abilities are still maturing, they are unlikely to engage in such a high level of information processing. Instead, they are more likely to rely on simple cues or shortcuts, using low-effort mechanisms to respond to an advertising message (Buijzen et al.,2010; Rozendaal et al.,2011). A technique that could increase children’s ability to actu- ally enact their advertising coping strategies under condi- tions of low information processing is implementation intentions. Implementation intentions are simple if–then plans that specify when and how one’sgoalwillbeputinto practice (i.e.,“IfsituationXoccurs,thenIwillrespondin this way”; Gollwitzer,1999). With practice, this process can become a mental routine and subsequently lead to behavior change in relatively automatic ways, while using few cognitive resources. The efficacy of this behavior change technique has been demonstrated convincingly in various domains (e.g., Gollwitzer & Sheeran,2006; Hagger & Luszczynska,2014), yet has only recently been related to the goal of coping with advertising (Hudders et al.,2017). Implementation intentions may be a powerful interven- tion technique for increasing children’s ability to cope with advertising, as it can help them to actually enact a coping strategy (thethinkpart of stop and think) by relying on sim- ple and low-demand if–then rules. Hypotheses The Ad Masters intervention aims to increase the advertis- ing literacy (i.e., knowledge), motivation, and ability that children need to effectively cope with advertising by combining advertising literacy education methods with behavior-change techniques (i.e., self-persuasion, emotion labeling, and implementation intentions). It is expected that combining these techniques will yield a synergy effect, such that: Hypothesis1(H1): Children in the intervention condi- tion (as compared with controls) (a) have a higher level of advertising literacy, (b) have a higher motiva- tion to engage in advertising coping strategies, (c) have a higher ability to engage in advertisingcoping strategies, (d) are more likely to actually use advertising coping strategies, and (e) are less suscep- tible to advertising’s effects (i.e., advertised product desire and advertised product choice). Furthermore, based on insights from the persuasion and resistance literature (e.g., Knowles & Linn,2004), the fol- lowing mediation effects are hypothesized: Hypothesis2(H2): Children in the intervention condi- tion (as compared with controls) have a higher moti- vation to engage in advertising coping strategies, which leads to an increase in their actual use of such strategies, which in turn diminishes their susceptibil- ity to advertising’s effects. Hypothesis3(H3): Children in the intervention condi- tion (as compared with controls) have a higher ability to engage in advertising coping strategies, which leads to an increase in their actual use of such strate- gies, which in turn diminishes their susceptibility to advertising’s effects. On the basis of earlier research on the relation between children’s advertising literacy and advertising susceptibility (see Rozendaal et al.,2011), we did not have any strong the- oretical reason to expect that intervention-induced increases in advertising literacy (i.e., understanding intent and tactics) lead to any changes in their use of advertising coping strategies and advertising susceptibility. Method and Research Plan Study Design A two-arm parallel cluster randomized controlled trial was conducted among7-to12-year-old children of primary schools (Grades3–6). Randomization occurred at the school level to avoid contamination between conditions. Schools were allocated to one of the two conditions: (1)theAd Masters intervention or (2) the wait-list control condition. Children in the control condition followed the regular school curriculum and participated in the Ad Masters inter- vention after the posttest measurement. Children in both conditions completed questionnaires including pre- and posttest measurements during school hours before (base- line) and immediately after the intervention (6weeks after baseline). To measure long-term effects in the intervention condition, follow-up took place3months after the end of the intervention. The authors have preregistered this research with an analysis plan at theJournal of Media Psychology. 2019 Hogrefe PublishingJournal of Media Psychology(2019) E. Rozendaal & B. Figner, School-Based Advertising Intervention for Children 3 Participants The study was conducted in15schools in different urban and suburban regions of The Netherlands. Schools were recruited via the network of the Nationale Academie voor Media en Maatschappij (https://www.mediaenmaatschap- pij.nl), a well-known Dutch national media literacy organi- zation. The inclusion criterion was that the children had notparticipatedinanyadvertising-relatedintervention before. The final sample for the analysis included704chil- dren (48% girls) between7and12years old (M=9.22±SD =0.92), with399(57%) in the intervention and305(43%) in the control group. The sample size of this study was pre- specified based on an a priori power analysis computed in G*Power (Faul, Erdfelder, Lang, & Buchner,2007;see Electronic Supplementary Material, ESM1). Informed con- sent was obtained from schools and parents, and informed assent was obtained from the children. The intervention procedure received approval by the Ethics Committee of the Faculty of Social Sciences at Radboud University, The Netherlands (ECSW2016-1403-382). Intervention The Ad Masters intervention consisted of six60-min ses- sions. The first three sessions aimed to increase advertising literacy based on educational techniques that are derived from the media and advertising literacy education literature (e.g., Nelson,2016) and existing advertising interventions (e.g., Media Smart). Children learned how to recognize dif- ferent forms of advertising and were taught about advertis- ing’s intent, source, and tactics. The fourth session aimed to increase children’s ability to cope with advertising, specifi- cally thestoppart of the stop-and-think response. By using the emotion labeling technique, children learned to become aware of and control their initial emotional responsestoward appealing advertisements. The fifth session also aimed to increase children’s ability to cope with advertising, now focusing on thethinkpart of the stop-and-think response. By using implementation intentions, they learned to actually enact their preferred advertising coping strategy. The final session aimed to stimulate children’s motivation to engage in advertising coping strategies by using the self-persuasion technique. See ESM2for a more detailed overview of the Ad Masters intervention. Measures Means and standard deviations of all measures for the intervention and control group at the three measurement time points are presented in Table1. The questionnaire consisted of57items, which are listed in ESM3.Cronbach’s αvalues of all measures for all three measurement time point (pretest, posttest, and follow-up posttest) are pre- sented in ESM4. Susceptibility to Advertising Effects Children’s susceptibility to advertising effects was mea- sured as (a) children’s advertised product desire and (b) advertised product choice. In order to measure these adver- tising effects, children were first individually exposed to three different types of advertising (i.e., a commercial, an “unboxing”video on YouTube, and a brand placement in a vlog on YouTube). The advertisements showed brands that are popular among children. Two noncommercial media messages (i.e., a fragment from a TV show, a fragment from a YouTube vlog without brand placements) were included as fillers. The commercial and noncommer- cial media messages were shown in randomized order. After being exposed to all the media messages, the children were asked to make a shopping list in order to test their Table 1.Means and standard deviations of the main variables Pretest (Time 1) Posttest (Time 2) Follow-up (Time 3) Intervention Control Intervention Control Intervention Control M(SD)M(SD)M(SD)M(SD)M(SD)M(SD) Understanding selling intent 3.06 (0.74) 2.96 (0.78) 3.25 (0.64) 3.10 (0.72) 3.38 (0.63) 3.34 (0.64) Understanding persuasive intent 3.02 (0.75) 2.91 (0.78) 3.27 (0.71) 3.09 (0.75) 3.42 (0.65) 3.40 (0.68) Understanding persuasive tactics 2.89 (0.68) 2.81 (0.69) 3.20 (0.64) 2.97 (0.66) 3.31 (0.64) 3.31 (0.60) Advertising skepticism 3.28 (0.68) 3.17 (0.76) 3.43 (0.58) 3.30 (0.70) 3.45 (0.64) 3.42 (0.65) Advertising disliking 2.57 (0.75) 2.68 (0.76) 2.36 (0.61) 2.37 (0.70) 2.27 (0.67) 2.30 (0.65) Motivation to use coping strategies 0.74 (1.06) 0.70 (1.06) 1.03 (1.08) 1.13 (1.11) 1.22 (1.17) 1.41 (1.14) Ability to use coping strategies 3.05 (0.65) 3.02 (0.76) 3.24 (0.58) 3.19 (0.62) 3.30 (0.60) 3.29 (0.63) Use of coping strategies 2.84 (0.88) 3.00 (0.65) 2.96 (0.89) 2.99 (0.93) 2.99 (0.96) 3.03 (0.97) Advertised product desire 2.88 (0.68) 2.88 (0.65) 2.87 (0.59) 2.85 (0.63) 2.87 (0.63) 2.85 (0.65) Advertised product choice 1.85 (0.99) 1.93 (0.92) 1.85 (0.93) 1.81 (0.90) 1.79 (0.93) 1.84 (0.93) Journal of Media Psychology(2019) 2019 Hogrefe Publishing 4 E. Rozendaal & B. Figner, School-Based Advertising Intervention for Children (hypothetical) product choice. They were shown a list of20 food products (i.e., the three products that were promoted in the advertisements and17filler products). For each pro- duct they were asked whether they wanted to put it on their shopping list. The variable advertised product choice was constructed by summing the number of promoted products that were included on the shopping list. Since there were three advertised products, scores could range between0 and3. A higher score indicated more advertised products on the shopping list. After the product choice task, the children were asked to indicate how much they liked and how much they wanted to have eight different products (i.e., the three products that were promoted in the advertisements and five filler prod- ucts; Rozendaal et al.,2013; Van Reijmersdal, Rozendaal, &Buijzen,2012). To construct the variable advertised product desire, the items asking for children’s liking and desire for the three products that were promoted in the advertisements were averaged. Scores could range between 1(=notatall)and4(=very much). Use of Advertising Coping Strategies To measure children’s use of advertising coping strategies, a scale was developed based on earlier work on advertising coping strategies (Fransen, Smit, & Verlegh,2015;Rozen- daal, Opree, & Buijzen,2016). Four different advertising coping strategies were distinguished: cognitive avoidance (CA), mechanical avoidance (MA), negative affect (NA), and disbelief (DB). Children were asked how often they had used these strategies in the previous week. A total score for the use of advertising coping strategies was constructed by calculating an average across the four different strate- gies. Scores could range between1(=never)and5(=almost always). Motivation to Use Advertising Coping Strategies The measure for children’s motivation to use advertising coping strategies was based on the Self-Regulation Question- naire (SRQ; Ryan & Connell,1989), which assesses individ- ual differences in the types of motivation (i.e., extrinsic vs. intrinsic) to perform a certain behavior. The children were asked why they engage in each of the four different advertis- ing coping strategies, thereby making a distinction between extrinsic motivation (EM) and intrinsic motivation (IM). The motivation to use advertising coping strategies scale was created by subtracting the extrinsic motivation subscale from the intrinsic motivation subscale (Ryan & Connell, 1989). Thus, a total score for children’smotivationtouse advertising coping strategies was created by subtracting the average score for children’s extrinsic motivation to use the four advertising coping strategies from the average score for children’s intrinsic motivation to use the four coping strategies. Scores could range between 3and3.Ahigherpositive score means a higher intrinsic motivation and a higher negative score means a higher extrinsic motivation. Ability to Use Advertising Coping Strategies Children’s ability to use advertising coping strategies was measured by asking children to indicate the extent to which they believe in their own ability to use the different coping strategies outlined earlier (i.e., perceived self-efficacy; Bandura,1997). A total score for children’s ability to use advertising coping strategy was constructed by calculating an average across the four items. Scores could range between1 (=no, I’m certainly not able to do so)and4(= yes, I’m certainly able to do so). Advertising Literacy To measure children’s advertising literacy, several subscales of the advertising literacy scale for children (ALS-c; Rozendaal, Opree, & Buijzen,2016)wereused. Three components of conceptual advertising literacy were measured: understanding of selling intent (e.g.,“Is the purpose of advertising to make you buy the advertised products?”), understanding of persuasive intent (e.g.,“Is the purpose of advertising to make you feel good about the advertised products?”), and understanding of persua- sive tactics (e.g.,“Do you think advertisers try to get your attention by making ads funny?”). Scores could range between1(=no, certainly not)and4(=yes, for sure). A higher score indicates a better understanding of advertis- ing). Additionally, children’s evaluative or attitudinal adver- tising literacy was assessed by measuring their advertising skepticism (e.g.,“How often do you think advertising is truthful?”) and their general critical attitude toward adver- tising (e.g.,“How often do you think advertising is irritat- ing?”). Scores can range between1(=almost always)and 5(=never). A higher score indicates a higher level of attitu- dinal advertising literacy (and thus a more critical attitude toward advertising). Background Variables Several background variables were assessed, including children’s age, gender, and prior brand use. Prior brand use was measured by asking children to indicate how often they eat or drink the advertised products. Scores can range between1(=never)and5(=very often). Results Preparatory Analyses Prior to analyses, we checked for outliers by means of the three-sigma rule; no participants were excluded from data 2019 Hogrefe PublishingJournal of Media Psychology(2019) E. Rozendaal & B. Figner, School-Based Advertising Intervention for Children 5 analysis. Additionally, a randomization check was con- ducted by means of independent-samplesttest and Pear- son’s chi-square test to assess whether the randomization resulted in a balanced distribution across the intervention and control group. The analyses for the variables at pre-intervention demonstrated that the intervention and the control group did not differ with respect to gender, w 2(1)=1.65,p=.223,Cramer’sV=.05and prior brand use,t(702)=1.09,p=.275,d=.08. However, the interven- tion and the control group did differ with respect to age, t(702)=4.29,p<.001),d=.33. The children in the inter- vention group (M=9.4;SD=1.01) were slightly older than the children in the control group (M=9.1;SD=0.77). Also, to determine whether age, gender, and prior brand use were correlated with the dependent variables, Pearson’s correla- tion analyses were conducted. These analyses showed that gender, age, and prior brand use were significantly corre- lated with the dependent variables at the pretest measure- ment (see ESM5). Therefore, age, gender, and prior brand use were included as covariates in the analyses as a robustness check (see Plan of Analyses, details in ESM6) Main Effects of the Intervention To test the main effects of the intervention (H1), we used Bayesian mixed-effects models carried out in R using the brms package (Bürkner,2017). For more details on our plan of analyses, see ESM7. For the Bayesian analyses, we deemed a coefficient statistically significant if the associ- ated95% posterior credible interval was non-overlapping with0. We report unstandardized regression coefficients (B; all continuous predictors were standardized but not the dependent variables; categorical predictors were sum- to-zero coded: The intervention group was coded as 1 and the control group as +1, thus a negative regression coef- ficient for a condition effect indicates higher values on the DV for the intervention compared with the control group). We observed that each dependent variable (i.e., their score at Time2on the respective scale) was significantly pre- dicted by the respective score at Time1(i.e., pretest). The posttest variables understanding selling intent and understanding persuasive tactics differed significantly between intervention groups (selling intent_B= 0.06, SE=0.03,95%CI[ 0.11, 0.0007]; tactics_B= 0.10, SE=0.03,95%CI[ 0.16, 0.03]. See Table1for the means and standard deviations of all measures for the intervention and control group. In addition, there was a significant interaction between intervention group and Time1score for the variable advertising skepticism (B=0.05,SE= 0.03,95%CI[0.02,0.10]). On overview of all the results is provided in ESM8. As mentioned in our plan of analyses (ESM6), we ran two robustness checks: We once repeated the multivariateanalysis with the covariates gender, age, and prior brand use (details in ESM9), and we ran ordinal univariate item-level analyses, with and without the added covariates (details available upon request). The effect of the interven- tion on posttest understanding persuasive tactics scores was significant in all these analyses, indicating a robust effect. The intervention effect on understanding advertising’ssell- ing intent and the interaction between Time1and interven- tion on advertising skepticism were significant in none of the robustness checks. Accordingly, we only deem the inter- vention effect on understanding advertising’s persuasive tactics trustworthy. Also, from the a priori power analyses, we would expect that we had more than sufficient power to detect even small effects (as our sample size was a bit lar- ger than what the power analysis indicated). Thus, any real effect–if there is one–on the variables of understanding selling intent and advertising skepticism is most likely very small and thus perhaps also negligible. Our analysis investigating the stability of the intervention effects over time compared the scores of the intervention group at Time3(follow-up) with the scores of the control group at Time2(controlling for Time1scores and the pos- sible interaction between condition and Time1scores). Understanding or persuasive tactics showed a significant effect with higher scores of the intervention group at Time 3compared with the control group at Time2,suggesting that the effect of the intervention was still detectable at the follow-up period (B= 0.15,SE=0.04,95%CI [ 0.22, 0.07]). As in the previous multivariate model, we observed that each Time1score significantly predicted the respective Time2score, and we again observed a signif- icant condition effect for understanding advertising ’s selling intent (B= 0.13,SE=0.03,95%CI[ 0.19, 0.06]). In addition, we observed a significant condition effect for understanding of persuasive intent (B= 0.14,SE= 0.04,95%CI[ 0.23, 0.06]). Means and standard devi- ations are reported in Table2. On overview of all the results is provided in ESM10. The robustness check model with the covariates age, gender, and prior brand use replicated these three significant condition effects (tactics:B= 0.15,SE=0.03,95%CI[ 0.21, 0.09]; selling intent: B= 0.12,SE=0.03, 95%CI[ 0.18, 0.06]; persuasive intent_B= 0.13,SE=0.03,95%CI[ 0.19, 0.07]). For more details see ESM8). Thus, these results suggest that the effect of the intervention on understanding advertis- ing’s persuasive tactics seems to persist beyond the imme- diate time after the intervention, further corroborating its robustness. More tentatively, there might be evidence that the intervention could have a more longer-term effect on the additional constructs of understanding selling and per- suasive intent; however, as these effects were not observed at Time2, we are hesitant to interpret these effects as strong before an independent study replicates them. Journal of Media Psychology(2019) 2019 Hogrefe Publishing 6 E. Rozendaal & B. Figner, School-Based Advertising Intervention for Children Indirect Effects of the Intervention To test the indirect effects of the intervention on children’s use of advertising coping strategies and advertising suscep- tibility via their motivation and ability to use coping strate- gies (H2and H3), we used structural equation modeling (Amos25.0). Since the mixed-effects analyses showed an unexpected significant main effect of the intervention on children’s understanding of advertising’s persuasive tactics, we explored the indirect effect of the intervention on use of advertising coping strategies and advertising susceptibility via understanding of advertising’s persuasive tactics as well. The hypothesized model is presented in Figure1.Two model fit indices were used: the comparative fit index (CFI), and the root mean square error of approximation index (RMSEA). CFI values between .90and .95were con- sidered as being acceptable, CFI values above .95as being good. In addition, RMSEA values between .05and .08were considered as being acceptable, RMSEA values below .05as being good (Byrne,2001). For more details on our plan of analyses, see ESM4. The hypothesized model resulted in an acceptable model fitw 2(df=31;N=704)=132.76,p<.001,CFI=.95,RMSEA =.07withp-close .006. Model modification indices were explored and model fit was improved by allowing for a rela- tionship between understanding advertising’s tactics and ability to use coping strategies and between motivation and ability to use coping strategies. The adjusted model resulted in good fit:w 2(df=29;N=704)=73.56,p< .001,CFI=.98,RMSEA=.05withp-close .64.Thestruc- tural equation model is presented in Figure2.Table2 shows all direct effects. In line with the mixed-effects anal- yses, the results of the model showed no significant direct effect of the intervention on ability to use advertising cop- ing strategies. Also, as was found in the mixed-effects anal- yses as well, the results indicated that there was a direct effect of the intervention on understanding of advertising’s persuasive tactics. Interestingly, results now showed a Figure 1.Hypothesized model for the indirect effect of the intervention via motivation (H2), ability (H3), and understanding persuasive tactics (additional). Table 2.Regression weights of the conceptual model Effect of OnBSEB95% CIβ Intervention Motivation to use advertising coping strategies .16* 0.07 [0.104, 0.267] .07 Ability to use advertising coping strategies .01 0.04 [ 0.083, 0.072] .00 Understanding persuasive tactics .18*** 0.04 [ 0.307, 0.007] .14 Motivation to use advertising coping strategies Use of coping strategies .19*** 0.03 [0.130, 0.261] .23 Ability to use advertising coping strategies Motivation to use advertising coping strategies .32*** 0.06 [0.189, 0.436] .18 Use of coping strategies .48*** 0.06 [0.365, 0.583] .31 Understanding persuasive tactics Ability to use advertising coping strategies .18*** 0.03 [0.107, 0.257] .20 Use of coping strategies .07 0.05 [ 0.180, 0.046] .05 Use of coping strategies Advertised product desire .03 0.02 [ 0.075, 0.011] .05 Advertised product choice .01 0.02 [ 0.046, 0.049] .01 Advertised product desire Advertised product choice .95*** 0.04 [0.870, 1.045] .64 Note.*p< .05; ***p< .001. 2019 Hogrefe PublishingJournal of Media Psychology(2019) E. Rozendaal & B. Figner, School-Based Advertising Intervention for Children 7 significant direct effect of the intervention on motivation to use advertising coping strategies. We did not find this effect in the mixed-effect analyses. With regard to the indirect effects, the results showed no significant indirect effects of the intervention on children’s advertising susceptibility (i.e., advertised product desire and advertised product choice) via motivation and ability to use coping strategies and subsequently actual use of coping strategies. Therefore, H2and H3are rejected. Interestingly, although we did not hypothesize any indirect effects of the intervention via children’s understanding of advertising’s tactics, the results showed a significant indirect effect of the intervention on children’s ability to use coping strate- gies via their understanding of advertising’stactics(indirect =0.03,SE=0.01,95%CI[0.015,0.061]. No other signif- icant indirect effects of the intervention were found. Thus, the intervention increased children’s understanding of persuasive tactics, which in turn increased their ability to use coping strategies. However, this intervention-induced increase in understanding and ability was in turn not related to any changes in the children’s actual use of coping strategies or their advertising susceptibility. Discussion This study investigated an intervention named Ad Masters that was designed to increase the knowledge, motivation, and ability children need to effectively cope with advertis- ing by combining an unconventional combination of advertising literacy education methods with behavior regu- lation techniques (i.e., emotion labeling, self-persuasion, and implementation intentions). Based on our findings, five main conclusions can be drawn. First, the Ad Masters intervention has a robust long-term (3months) positive effect on children’s understanding ofadvertising’s persuasive tactics. This result is in line with earlier research, showing that advertising literacy training can increase children’s cognitive advertising literacy, including their understanding of advertising tactics (De Jans,Hudders,&Cauberghe,2017;Nelson,2016). No robust intervention effects were found for any of the other cognitive advertising literacy components (i.e., understand- ing selling and persuasive intent). An explanation for this could be that of all cognitive advertising literacy compo- nents, at pretest, children scored lowest on understanding persuasive tactics. This suggests that, for the children par- ticipating in this study, the greatest room for improvement was in their understanding of advertising tactics. This is in line with earlier research showing that the age of10marks an important shift in children’s understanding of advertis- ing tactics (Rozendaal, Buijzen, & Valkenburg,2011). Also, no intervention effects on children’s attitudinal advertising literacy were found. An explanation could be that the inter- vention materials did not explicitly focus on installing skep- tical attitudes in children. The second conclusion is that the intervention has no direct effects on children’s motivation and ability to use coping strategies. Although we did find some evidence for a direct effect of the intervention on children’s motivation to use coping strategies in the structural equation analysis, we did not find support for such an effect in the mixed- effects analyses. Therefore, we do not consider this as a robust effect. Not finding a direct effect of the intervention on motivation and ability is surprising because the interven- tion contained training modules and exercises that, on the basis of theory and earlier research, were expected to stim- ulate these mechanisms. There are several possible expla- nations for the absence of an intervention effect on children’s motivation and ability to cope with advertising. A first explanation is the duration of the intervention. The intervention consisted of six60-min sessions. Only three Figure 2.Structural equation model for the indirect effect of the intervention via motivation (H2), ability (H3), and understanding persuasive tactics (additional). Coefficients represent standardized beta weights, all significant atp< .001. Dotted arrows are nonsignificant pathways. Journal of Media Psychology(2019) 2019 Hogrefe Publishing 8 E. Rozendaal & B. Figner, School-Based Advertising Intervention for Children of these sessions focused on training children’s motivation and ability to cope with advertising. Although research among adults has shown that brief interventions can signif- icantly improve motivation and ability to perform a certain behavior (e.g., Banerjee & Greene,2007; Briñol, McCaslin, & Petty,2012; Gollwitzer & Sheeran,2006;Hagger& Luszczynska,2014; Müller et al.,2009), this may work dif- ferently among children. Future research could explore whether a longer intervention period that provides more time for pupils to practice applying coping strategies and cultivate intrinsic motivation to actually use those coping strategies increases Ad Masters’effectiveness on children’s motivation and ability to cope with advertising. Another explanation for the absence of intervention effects on children’s motivation and ability to use advertis- ing coping strategies is that the intervention may not have been successful in addressingthe individual learning needs of the participating children. Like many media literacy education programs, the Ad Masters intervention was set up as a traditional educational program in which the pupils sitattheirdesk,listentothetrainer’s lesson together, and all make the same assignments. A flaw of this“onesizefits all”teaching approach is that it assumes that all students learn in the same way. However, owing to individual differ- ences, children vary in learning styles and in prior levels of advertising literacy, motivations, and coping skills and as a result they learn and advance in different ways and at different speed. Future research on advertising and media literacy education could explore the possibilities of differen- tiated or adapted learning, a style of teaching that gives students the power to tailor their learning experiences in a way that best suits their unique needs (Kerr,2015; Morgan,2014). A final possible explanation for not finding any main effects of the intervention on children’s motivation and ability to cope with advertising has to do with the interven- tion techniques used. Even though the intervention techniques were carefully selected based on extensive liter- ature research and have a strong theoretical foundation, they may not have been successful in reaching their goals for this particular target group (8–12-year-olds) or for this particular behavior. Future research could explore other intervention techniques that are more effective in stimulat- ing children’s motivation and ability to engage in advertising coping behavior (see Michie et al.,2013). Although no direct effects of the intervention on chil- dren’s motivation and ability to cope with advertising were found, the structural equation analysis did show an indirect effect of the intervention on children’s ability via their understanding of advertising’s persuasive tactics. This indi- cates that having knowledge of persuasive advertising tac- tics is an important precondition for feeling able to cope with advertising, and more importantly that the interven-tion is only successful in stimulating the ability of children to cope with advertising, if there is also an increase in knowledge of the tactics that advertisers use. The third conclusion that can be drawn from this study is that the intervention-induced changes in children’s under- standing of advertising’s persuasive tactics do not lead to increased use of coping strategies or reduced advertised product desire and choice. This finding is in line with earlier research showing that increasing children’s advertising lit- eracy through intervention does not automatically change the way children cope with advertising (Livingstone & Hel- sper,2006; Nairn & Fine,2008). The fourth conclusion is that children who are more motivated and better able to use advertising coping strate- gies actually do use such those strategies more often. This confirms our expectation that motivation and ability to use coping strategies function as important mechanisms in determining their advertising coping behavior. This finding is in accordance with theories on behavior regulation and behavioral change, which indicate that when the perceived ability to perform a behavior and the motivation or inten- tion to do so are higher, people are more likely to put effort in regulating their behavior (Ajzen,1991; Bandura,1997; Baumeister & Vohs,2007; Deci & Ryan,2000). Finally, our fifth conclusion is that the use of advertising coping strategies does not relate to children’s advertised product desire and advertised product choice. An explana- tioncouldbethatinthecurrentstudyweusedself-report to measure children’s use of coping strategies, which has several disadvantages that decrease the validity of these measures (e.g., social desirability, inaccurate recall; Baumeister, Vohs, & Funder,2007). Future research could explore other data collection methods to measure children’s advertising coping behavior and advertising responses that are less subject to these types of response bias (e.g., observa- tion of behavior in digital simulation environments or games; Shute, Wang, Greiff, Zhao, & Moore,2016). To conclude, the present study does not provide evidence for the effectiveness of the Ad Masters intervention in stim- ulating children’s advertising coping behavior. However, to establish the effectiveness of an intervention, randomized controlled trials (RCTs) are not the only method on which conclusions should be drawn. Future research could use qualitative methods (e.g., observations, in-depth interviews) alongside quantitative methods to explore the working and effectiveness of the Ad Masters intervention programs. Theoretical Implications Although the results of the current study do not provide evidence for the intervention’s effectiveness, the study does provide understanding of the theoretical mechanisms that explain children’s use of advertising coping strategies. 2019 Hogrefe PublishingJournal of Media Psychology(2019) E. Rozendaal & B. Figner, School-Based Advertising Intervention for Children 9 In the child and advertising literature it is traditionally assumed that children can defend themselves against the persuasive appeal of advertising by gaining a better under- standing of advertising’sintentandtactics(Brucksetal., 1988; Gunter, Oates, & Blades,2005;Kunkeletal., 2004; Livingstone & Helsper,2006). The findings of the current study extend this traditional cognitive approach to advertising defenses by showing that motivation and ability to use advertising coping strategies are more important fac- tors than knowledge in determining children’s advertising coping behavior. As such, the current study lays a founda- tion for a new theoretical behavior regulation-oriented approach to children’s advertising defenses. This opens up new horizons for future research on children’s coping with advertising and other types of media content (e.g., social media images, fake news). Practical Implications An important question in the debate about children and media is how to empower children to cope with off- and online commercial media content. The findings of this study are relevant to this debate and offer concrete implica- tions for advertising literacy educators and intervention developers. The study showed that increasing children’s advertising knowledge, specifically their understanding of advertising’s tactics, through advertising education does not automatically stimulate them to use advertising coping strategies more often. This indicates that education pro- grams that focus solely on teaching children about the intent and tactics of advertising may not be effective in stimulating their coping behavior. The current study showed that children’s motivation and ability to use adver- tising coping strategies are important factors in children’s actual coping behavior. Advertising intervention developers are thus advised to further explore intervention techniques and strategies that can increase children’s motivation and ability to cope with advertising. Electronic Supplementary Materials The electronic supplementary material is available with the online version of the article at https://doi.org/10.1027/ 1864-1105/a000262 ESM1.A priori power analysis ESM2.Ad Masters intervention ESM3.Overview of items ESM4.Reliability scores (Cronbach’s alpha) for the main variables) ESM5.Correlations between all independent, mediating, and dependent variables and covariates at pretest (Time1)ESM6.Plan of analysis ESM7.Time2as a function of Time1and condition (with- out covariates) ESM8.Time2as a function of Time1and condition with covariates ESM9.Time3(intervention)/Time2(control) as a func- tion of Time1and condition (without covariates) ESM10.Time3(intervention)/Time2(control) as a func- tion of Time1and condition with covariates References Ajzen, I. (1991). 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Journal of Interactive Marketing, 26(1), 33–42. https://doi.org/ 10.1016/j.intmar.2011.04.005 History Received January 27, 2016 Revision received April 30, 2019 Accepted May 5, 2019 Published online September 26, 2019 Publication Ethics The intervention procedure received approval by the Ethics Committee of the Faculty of Social Sciences at Radboud Univer- sity, The Netherlands (ECSW2016-1403-382). Funding This research has been supported by the Nederlandse Organisatie voor Wetenschappelijk Onderzoek (grant no. 451-14-021) to Esther Rozendaal. ORCID Esther Rozendaal https://ordic.org/0000-0003-1234-8496 Esther Rozendaal Behavioural Science Institute Radboud University 6500 HE Nijmegen The Netherlands [email protected] Esther Rozendaal works as an asso- ciate professor in Communication and Media at the Behavioural Science Institute, Radboud University, The Netherlands. She is an expert on young people’s media and consumer behavior. Her research focuses, in large part, on children and advertis- ing. In addition to her research and educational activities, Esther Rozen- daal focuses on bridging the acade- mia–society divide. Bernd Figner works as associate professor in Psychology at the Be- havioural Science Institute, Radboud University, The Netherlands. His re- search investigates the psychological and neural mechanisms of different types of decisions and behaviors that involve risk-taking and impulsivity and how people deal with different types of uncertainty. He is interested in understanding individual and group differences in more optimal versus more problematic decisions in healthy-normal and developing pop- ulations (particularly the transitions into and out of adolescence) as well as clinical populations. Journal of Media Psychology(2019) 2019 Hogrefe Publishing 12 E. Rozendaal & B. Figner, School-Based Advertising Intervention for Children
LITERATURE REVIEW (12-16 pages) This essay is basically synthesizing 10 sources to support the new research im proposing that needs to be done. The sources needs to be categorized into 3/4 subheadings
Advertising and Obesity: A Behavioral Perspective JANET HOEK AND PHILIP GENDALL Massey University, Palmerston North, New Zealand Concern over the levels of obesity observed in Western countries has grown as researchers forecast a rapid growth in the medical care that a progressively more obese population will require. As health workers deal with increased incidences of diabetes and other obesity-related disorders, policymakers have examined the fac- tors contributing to this problem. In particular, advertising that promotes high fat and high sugar products to children has come under increasing scrutiny. Advertisers have rejected claims that advertising contributes to obesity by arguing that it cannot coerce people into purchasing a product, and does not affect primary demand. This reasoning overlooks the role advertising plays in reinforcing and normalising beha- vior, however, and it assumes that only direct causal links merit regulatory attention. Ehrenberg’s ‘‘weak’’ theory suggests advertising will support unhealthy eating beha- viors, while the wide range of sales promotions employed will prompt trial and reward continued consumption. This article presents an alternative analysis of how marketing contributes to obesity and uses behavior modification theory to analyse the ‘‘fast-food’’ industry’s promotions. We also review the New Zealand government’s response to obesity and suggest policy interventions that would foster healthier eating behaviors. Although obesity always has been associated with serious health conditions such as diabetes and heart disease, its increased incidence, particularly among young people, has led health lobbyists to call for a reexamination of the factors that influence young people’s eating patterns (Diabetes New Zealand Inc. and Fight the Obesity Epidemic Inc., 2003). Unprecedented numbers of children now feature in obesity statistics (Cristol, 2002; Ebeling, Pawlak, & Ludwig, 2002; Fight the Obesity Epidemic [FOE], 2004), leading commentators to describe the growth in obesity as an epidemic. Health lobby groups have responded to the increase in obesity levels by calling on governments to take urgent steps to prevent further escalations in the proportion of obese individuals (FOE, 2004; Hawkes, 2004). In New Zealand, health groups such as Fight the Obesity Epidemic (FOE) and the Obesity Action Coalition have lobbied strongly for a ban on advertising of all ‘‘fast-food’’ items during children’s television programs, among other measures. Analyses of television advertising direc- ted at children have led to concern over the number of ‘‘fast-food’’ advertisements many children see. Zuppa, Morton and Mehta’s (2003) content analyses of Austra- lian advertisements shown during children’s programs revealed that promotions Address correspondence to Professor Janet Hoek, PhD, Department of Marketing, College of Business, Massey University, Private Bag 11-222, Palmerston North, New Zealand. E-mail: [email protected] Journal of Health Communication, 11:409–423, 2006 Copyright#Taylor & Francis Group, LLC ISSN: 1081-0730 print=1087-0415 online DOI: 10.1080/10810730600671888 409 featuring high-fat, high-sugar, and high-salt items accounted for more than half their sample (see also Hill & Radimer, 1997; Kotz & Story, 1994). These findings have focused attention on the effect food advertisements may have on young people’s behavior. Not surprisingly, the advertising industry has reacted strongly to suggestions that governments restrict or ban advertising screened during children’s programs and there has been intense media debate over advertisers’ rights and responsibilities. This debate has raised several issues, including the role played by parents in moderating their children’s behavior, the effects advertising has on behavior, and the multiple factors alleged to contribute to obesity (Ambler, 2004). Advertising and industry spokespeople argue that children’s food consumption is a matter for parents to determine (Sykora, 2003). Parents, advertisers assert, should guide their children’s media use, help them interpret advertising, explain why certain food groups should be consumed in moderation, and resist requests that would exceed a moderate consumption level. Ellis (2003) summarized this view: ‘‘We shouldn’t get too far away from the key to all this, which is parental responsibility. Kids might watch the food advertisements, but it’s the parents who do the shopping and who control the environment’’ (p. 2). Parents’ role in guiding their children’s media and good consumption is undeniable. Even the most cautious parents cannot monitor their children’s viewing behavior constantly, however, and the argument that advertisers have the right to communicate with children, while parents must take responsibility for the consequences of these communications, is clearly unbalanced. Advertisers also claim that food advertising aims to change brand preference and suggest it has little or no effect on the aggregate demand for a product category (Young, 2003). According to this argument, advertising does not create a desire for ‘‘fast food,’’ but reorders the hierarchy of brands from which consumers choose. Recent research from Hastings, Stead, and McDermott (2004), however, challenges this view and highlights the need to consider the broader effects of food advertising on consumption. Because the causes of obesity are complex, advertisers have argued that their products and advertising make a negligible contribution to the problem (Divehall, 2003). Instead, they note that people now exercise less, have more sedentary lifestyles, and make greater use of convenience foods (Lvovich, 2003). While dispro- portionate consumption of ‘‘fast foods’’ may contribute to obesity, advertisers argue that the specific role played by these types of food remains impossible to define. As a result, they conclude that measures targeting one component of the problem are both unfair and unlikely to succeed (Young, 2003). The competing views of health and industry spokespeople appear irreconcilable. Advertisers demand evidence of a causal relationship between food advertising and obesity before they will accept that regulatory intervention may be warranted. Social science research can never establish causality with certainty, however, and instead provides estimates of the probable relationship between two variables. Because many inter-related factors, including poor nutritional habits, overeating, and reduced levels of physical activity, all contribute to obesity, it is difficult to quantify the pre- cise role played by each of these variables. Deferring action until a specific causal relationship between advertising and obesity levels has been established would over- look actions that could be taken using knowledge of how advertising supports and maintains behavior. 410 J. Hoek and P. Gendall In this article, we thus examine an alternative means of framing the debate and explore the role advertising plays in reinforcing behavior patterns. We suggest that food advertising is not innocuous and that, in depicting frequent consumption and consumption of larger portion sizes (‘‘up-sizing’’) as normal behaviors, it contributes to the rise in obesity that nations around the world have experienced. We begin by examining the arguments presented by health lobbyists and the advertising and fast- food industries before analysing different perspectives on advertising and how it affects consumers’ behavior. We conclude by discussing a public policy response to obesity, the New Zealand Healthy Eating, Healthy Action Plan, and suggesting additional measures more likely to shape desirable behavior. The Advertising–Obesity Debate Parental Control Though advertisers and health lobbyists agree that childhood obesity figures warrant serious attention, they disagree over the action that ought to be taken to address the problem. Advertisers have argued strongly that individuals need to take greater responsibility for their own behavior and the behavior of those for whom they are responsible, and have claimed public opinion supports their stance. For example, Spungin (2004) noted that 80% of parents surveyed said their children had asked them to purchase a specific brand. Less than half of these, however, would examine the nutritional value of the product before deciding whether to buy it, although only 14% would allow their children to try a new product without vetting it in some way. Despite these rather discrepant findings, Spungin concluded that parents willingly act as gatekeepers who review the appropriateness of their children’s requests. Even putting to one side the equivocal status of these results, Spungin’s evidence applies only to new products and does not offer insights into how parents respond to adver- tising for products they or their children have previously consumed. Spungin (2004) also found that only 12% of parents believed advertising to children should be banned, while 45% believed advertisements were a commercial reality. Because Spungin did not disclose either the actual statement wording or the full response distribution, however, it is difficult to tell what parents responded to in his survey. That is, it is not clear whether respondents disagreed with a ban on advertising directed at children, or whether they were simply ambivalent about this prospect. Surveys based on simple attitude statements do not adequately test the range of regulatory interventions possible, and are not a sufficient basis for con- cluding that no further action is necessary. Furthermore, because it is difficult for parents to reject responsibility for controlling young children’s access to fast-food items, social desirability error will inflate the proportion of respondents who agree with statements that parents are primarily responsible for controlling what their children eat. While it is reasonable to expect parents to exert control over their children’s con- sumption behaviors and the with which media they engage, the advertising industry appears reluctant to accept that fast-food advertising is likely to make parents’ tasks more complicated than would otherwise be the case. Although the New Zealand Bill of Rights affords some protection to commercial speech, it is important to balance advertisers’ rights to promote products against parents’ rights to raise their children in an environment that is conducive to healthy eating behaviors.Advertising and Obesity 411 Confounding Factors Few contributors to the debate would dispute that obesity is a complex problem, created through the interaction of a range of factors, of which food advertising is only one. Changed lifestyle patterns involving a reduction in physical exercise are also likely to contribute to obesity, particularly when coupled with an increase in energy intake. Although researchers agree that obesity represents a complex pro- blem, however, the individual factors that contribute to it may still be addressed through voluntary industry initiatives or policy changes. The debate over the effects of tobacco promotions and the relationship between bans on these and overall con- sumption highlights the difficulty of defining the precise contribution made by each factor. More seriously, efforts to quantify the specific role played by each factor risk deflecting attention away from the more important task of identifying and evaluat- ing options that could reduce the current levels of obesity. Advertising—Caused or Causal? Advertisers, and those who oppose a ban on advertising of fast foods, have argued that there is no causal link between advertising and the consumption of fast food (Young, 2003). For example, Young and Webley (1996) argued claims of causality are mistaken, because research into the effects of fast-food advertising is rarely longitudinal or experimental. Advocates of tobacco advertising bans, however, have argued establishing causality is an impossible goal. Hastings, Aitken, and Mackintosh (1994) suggested it required that: ‘‘We would not pronounce any link between smoking and lung cancer untilallsmokers died of the disease and allits victims were smokers’’ (p. 197). Because they believe there is no causal link between advertising and aggregate consumption, opponents of advertising restrictions argue these would have little effect. They claim that advertising changes brand preferences within mature markets and does little to generate primary demand for a product category (Ambler, 2004). Put simply, advertising persuades consumers to buy one brand rather than another, thereby increasing that brand’s market share, but does not increase overall consump- tion of a product category. As one commentator has noted, advertising shampoo is unlikely to make people take more showers to wash their hair more often, though it may prompt them to use Brand A instead of Brand B (Calfee, 2003). These arguments parallel the logic relied upon by the tobacco industry. Cigarette manufacturers fought a rear-guard action to stave off advertising restrictions by arguing that their promotions had no effect on nonsmokers and sought only to change brand preferences among existing smokers. Like fast-food manufacturers, tobacco companies claimed that new recruits were attracted to smoking not by advertising, but by the behavior of their peers and other social groups (Smith, 1990). The role tobacco promotions play in smoking initiation remains disputed. Evidence relating to food advertising, however, suggests it may affect primary demand. Hastings and colleagues’ (2003) comprehensive and systematic review of research examining food advertising found only weak evidence of brand switching and much stronger evidence of category switching (p. 19). Despite the growing evidence to the contrary, the advertising industry conti- nues to argue that advertising does not affect overall market size. This view leads logically to the conclusion that additional regulation of food advertising is overly maternalistic and unnecessary. Some researchers have drawn parallels with tobacco 412 J. Hoek and P. Gendall regulation; they suggest that the alleged failure of tobacco advertising bans to reduce tobacco consumption means food advertising restrictions would be ineffective (Ambler, 1996; Boddewyn, 1989; 1994). This argument overlooks the highly addictive nature of smoking however, and erroneously assumes the removal of a weak reinforcer such as advertising can pro- duce immediate short-term results (Hoek, 1999). High fat and sugar foods do not create a physiological addiction in the same way as nicotine does; thus, removal of advertising could produce more immediate results. At the very least, it would eliminate a reinforcer that supports continued consumption of fast foods. Restric- tions on food advertising also would reduce the social approval that advertising confers on a product category. In summary, arguments that advertising of ‘‘fast foods’’ affects only brand pre- ference, and that restrictions are therefore unwarranted, rely on flawed logic because they assume that advertising works only through persuasion. Although advertising can prompt behavior, its main role is to reinforce and maintain existing behavior patterns. The view of advertising as a reinforcer rather than as a cause of behavior aligns strongly with operant conditioning and a more behavioral theory of advertis- ing. Ehrenberg (1974) first applied behavioral learning theory to advertising and developed what has become known as the ‘‘weak’’ theory of advertising; we examine this theory in the following section before using it to explore the advertising–obesity debate. Ehrenberg’s ‘‘Weak’’ Theory of Advertising For more than three decades, Ehrenberg and his colleagues have questioned the view that advertising works by persuading consumers. In a much-cited comment, he argued: ‘A minor actress pretending to drink a cup of Nescafe in a TV commercial may marginally encourage someone who usually buys another brand to do so again. But it is unlikely to make someone who usually buys another brand to switch to Nescafe. It is even less likely to persuade a non-coffee drinker to start drinking coffee.’ (Barwise & Ehrenberg, 1988, 167) Ehrenberg (1974) challenged hierarchy-of-effects models of advertising and their emphasis on persuading consumers to adopt new behaviors. Instead, he argued that because advertising is noticed primarily by users of the promoted brand, it reinforces existing behavior patterns and maintains a brand’s salience among its users, most of whom also regularly purchase competing brands. His model originally included three components: awareness, trial, and reinforcement; advertising’s primary role occurred in the reinforcement stage. (Barnard and Ehrenberg, 1997, extended the model by conceding that advertising could ‘‘Nudge’’ consumers’ behavior.) This model differs sharply from the traditional view of advertising as a persuasive force capable of instilling new behavior patterns in consumers, and led Ehrenberg to describe his approach as the ‘‘weak’’ theory. Ehrenberg’s model suggests advertising is a form of operant conditioning, and his views fit logically with behavior modification theory (Nord & Peter, 1980). At first glance, Ehrenberg’s view of advertising appears to support the advertis- ing industry’s contention that its promotions are unlikely to persuade people toAdvertising and Obesity 413 perform new behaviors, since Ehrenberg, like industry proponents, rejects the notion that advertising persuades. However, Ehrenberg’s argument that advertising maintains behavior should not be interpreted as minimising its potential influence on obesity. By supporting the continuation of unhealthy behavior patterns, advertis- ing reduces the likelihood that individuals will either recognise the behaviors as unhealthy or seek to change these. Interestingly, industry attempts to minimise the effects of ‘‘fast food’’ advertising have highlighted its potential to reinforce behavior. For example, Fraser (2003) stated: ‘‘So if television commercials promote Pepsi, fruit loops, burger rings and snickers bars they’re not leading kids into new and wicked temptations. They’ve always bought this kind of stuff.’’ Fraser’s comments imply that reinforcement is innocuous and support his contention that attempts to restrict it are unwarranted. By reminding users to consume ‘‘fast foods’’ and by providing extra incentives to do so, however, advertising may contribute to excessive consumption in a variety of ways. For example, bundling promotions combine several menu items and foster beliefs that ‘‘up-sizing’’ is both sensible (it represents better value) and normal (why else would super value combos exist?). Overall, advertising of fast foods maintains the impression that consumption of these products is consistent with a healthy diet, but offers little or no guidance about what is required to achieve a balanced and moderate food intake. Acceptance of Ehrenberg’s arguments raises the obvious question of how beha- vior develops, if not through advertising. As with the initiation of smoking, it is likely that unhealthy eating behaviors initially develop in an environment where that behavior is accepted, viewed as normal, or even promoted as desirable. Just as chil- dren whose family and peers smoke are more likely to develop a smoking habit than those from smoke-free environments, so children who regularly eat high-fat, high- salt, and high-sugar foods will come to view these as part of a ‘‘normal’’ diet. Although Ehrenberg’s model of advertising emphasises repeat purchase, which he views as critical to the long-term success of a brand, the ‘‘Trial’’ component recog- nises the potential for sales promotion activities to attract new users. Prominent sales promotions, such as price discounts, product bundling, and loyalty programs, stimu- late and reward purchase, and may encourage more frequent and heavier consump- tion. Similarly, invitations to ‘‘upsize’’ for a trivial increase in price, delivered at the point of purchase, actively promote larger portion sizes and higher energy intake. This aspect of Ehrenberg’s model fits logically with Nord and Peter’s (1980) descrip- tion of respondent conditioning, which occurs when a stimulus precedes a particular behavior and increases the likelihood of that behavior occurring. The relationship between the environment and behavior highlights the need for adults to shape the development of healthy eating habits in children. Parents’ task is complicated however, by the on-going presence of promotions that support quite different eating habits. Removal of fast-food advertising and sales promotions would eliminate environmental factors that support food consumption habits that, in excess, lead to obesity. Yet, just as removal of tobacco promotions has not eliminated smok- ing, removal of fast-food advertising will not eliminate obesity. To counter obesity, those responsible for health strategies need to develop programs that change indivi- duals’ environment so that healthier lifestyles become easier to follow. Both health lobbyists and advertising and food industry representatives recognise the need to change unhealthy eating behaviors, and both have developed initiatives to address this goal. For example, the advertising industry has proposed 414 J. Hoek and P. Gendall developing an education program and already has launched a campaign featuring ‘‘Willie Munchright,’’ a cartoon character owned by McDonald’s but used without branding to promote healthier eating habits. The industry’s reliance on advertising to promote healthy eating behavior, however, seems somewhat at odds with their argument that advertising does not cause behavior. While they assert that advertising does not persuade nonconsumers of fast food to begin consuming this type of food, they appear to believe it may persuade consumers to moderate their intake and begin a regular exercise program. According to Ehrenberg’s theory, such a campaign is highly unlikely to motivate people who do not eat moderately to change their behavior. Instead, it will reassure those who do maintain a careful diet that they have made sensible and healthy life- style choices. Similarly, advertising alone is unlikely to prompt individuals to adopt a regular exercise program, although it will remind those who do exercise of the benefits they will receive by continuing with this behavior. Although maintenance of beneficial behaviors is important, however, different interventions are required to change unhealthy eating and lifestyle habits. We examine these issues in the following section, where we analyse the New Zealand government’s Healthy Eating, Healthy Action Plan, and outline an alternative intervention agenda based on behavior modification theory (BMT). A New Intervention Agenda In discussing social marketing, Rothschild (1999) noted that interventions may occur at the individual, community, or social levels, and could be stimulated or reinforced by education, marketing, or the law. Like Ehrenberg, Rothschild’s approach also cor- responds to BMT, which suggests many marketing decisions could be simplified by analysing how environmental factors shape behavior (see also Nord & Peter, 1980). This perspective stresses the need to pay more attention to stimuli within consu- mers’ choice context. At present, less attention is paid to consumers’ environment than is devoted to their thought processes. For example, many education and social marketing campaigns provide information in the belief that this will increase aware- ness of an issue, improve attitudes toward the desired behavior, and eventually lead to the behavior itself. Such an approach relies on the view that changing consumers’ beliefs and attitudes will promote changes in their behavior. By contrast, behavior- ists eschew the need to understand consumers’ cognitive processes and focus instead on the environmental stimuli that prompt and reinforce their behavior patterns (Foxall & Greenley, 2000). Adopting a behavioral perspective implies that health-related interventions may occur at several levels. In the first instance, behavioral interventions may occur at an individual level; for example, offering an incentive, such as free nicotine patches or condoms, increases the proportion of individuals who decide to quit smoking or practice safe sex. The availability of specific stimuli such as these triggers behavior by introducing new factors to an environment. Once behavior has occurred, it can be maintained by applying reinforcers. These may be direct, such as the continued availability of the initial stimulus, or indirect, such as advertising that promotes the desired behavior. As Rothschild noted, interventions may also occur at a community level. Exam- ples of these include participation by schools in ‘‘healthier food’’ programs, a decision that may be influenced by policy changes that direct schools to establish specificAdvertising and Obesity 415 canteen guidelines. By limiting the availability of less healthy food choices, schools can directly influence what children who purchase food from school canteens may consume. Other initiatives include ‘‘walking bus’’ schemes designed to provide super- vised care as children walk to and from school. Although these interventions provide new opportunities for individuals to engage in healthier behaviors, however, they do not directly reinforce those individuals by rewarding them for making healthier choices. Behavior changes also may occur in response to policy developments, the third area of intervention Rothschild identified. Laws and policy initiatives constrain the behaviors a society may exhibit by controlling the ease with which these may be performed, the rewards that apply to them, and the disincentives used to discourage unwanted behaviors. For example, the decreasing tolerance of driving while under the influence of alcohol has arguably resulted from policy changes that have reduced the legal blood–alcohol limit, increased the level of enforcement and thus the likeli- hood of detection, and raised the fines applied to those convicted of drink driving offences. Similarly, both the penetration of smoking and the level of tobacco con- sumption appear likely to decrease following legislation that prohibits smokers from smoking in bars and restaurants (Longo, Johnson, Kruse, Brownson, & Hewett, 2001). Marketing campaigns that support the resulting new behaviors reinforce these legal interventions, maintain their salience, and support compliance. Implementation of policy creates the environment within which behavior occurs. As a result, it is logical to consider social and legal interventions, since these deter- mine many of the reinforcers that shape the behaviors of interest. Eggers and Swinburn (1997) also argued that initiatives designed to address obesity need to shift away from viewing obesity as an individual disorder to considering it as a ‘‘normal response to an abnormal environment’’ (p. 477). That is, they suggested researchers focus more attention on the range of advertising and promotional stimuli present within individuals’ consumption environment and that foreground less healthy eating behaviors. Although opponents of advertising restrictions have argued strongly that individuals should take more responsibility for their own behavior, Eggers and Swinburn point out that individuals’ ability to make healthy choices decreases when their choice environment actively promotes less health options. Yet despite the growing calls for greater attention to be paid to environmental factors, most behavior change programs begin with what is loosely described as social marketing. This type of marketing usually attempts to educate individuals, in the apparent belief that greater knowledge or awareness of an issue will lead to behavior change. Programs such as ‘‘Push Play’’ (which encourages people to exer- cise for at least 30 minutes each day) and ‘‘Five Plus’’ (which promotes consumption of five or more servings of fruit and vegetables each day) rely on individuals recog- nising the future benefits associated with these behaviors. A recent Cancer Society survey, however, found nearly half of New Zealand adults do not consume recom- mended quantities of fruit and vegetables, even though more than two thirds recog- nize the importance of these items in a healthy diet (Sullivan et al., 2004). These findings are consistent with Ehrenberg’s (1974) argument that advertising alone is insufficient to instill new behavior patterns and that, at best, it will only maintain the salience of existing behaviors. The New Zealand Cancer Society research also suggests that awareness and knowledge do not necessarily lead to behavior. Overall, these findings do not augur well for programs that rely heavily on educating people about the desirability of alternative behaviors. 416 J. Hoek and P. Gendall Obesity Reduction Plans Analysis of the goals set out in the New Zealand Ministry of Health’s Healthy Eating: Healthy Action Implementation Plan (HEHA Plan) suggests these empha- size education, awareness, and knowledge, while placing considerably less emphasis on the environmental factors that affect eating behavior (Ministry of Health, 2004). Reviews of other obesity management plans indicate that these also have education as a dominant goal, although many suggest regulatory changes that might be imple- mented (Bureau of Chronic Disease Prevention, 2001; CDC, 2005). While the HEHA plan represents an important statement about the New Zealand government’s recognition of obesity as a critical health issue, we suggest plans designed to reduce obesity will be more successful if they have an explicit behavioral orientation. This implies that policy interventions designed to create an environment where unhealthy eating behaviors become more difficult to perform and maintain logically precede education and awareness raising campaigns. In Table 1, we summarize the goals and objective of the HEHA Plan before suggesting how these might be better aligned with social marketing and advertising theories. Although the HEHA goals acknowledge the importance of environmental changes, the focus of these remains very much on individuals and on how they might be persuaded to adopt healthier behavior patterns. For example, the HEHA plan highlights the development of communication plans, training programs, and other measures designed to increase knowledge and disseminate information. While a more informed populace and more knowledgeable influencers may help increase awareness of the importance of healthy eating and exercise behaviors, this informa- tion alone is unlikely to stimulate behavior change that could have a material effect on obesity levels. As Ehrenberg (1974) suggested, advertising is not powerful enough to induce new behavior patterns, especially (as Rothschild, 1999, noted) when it offers no direct benefit to trigger or reinforce the new behavior. Reducing the level of obesity requires interventions that begin at a societal level to create an environment in which social marketing efforts are more likely to suc- ceed. Ehrenberg has argued that changes in awareness or attitudes are not necessa- rily predictive of behavior change and may even follow (rather than precede) behavior (Ehrenberg, 1974; Ehrenberg, Barnard, & Scriven, 1997). This reasoning implies that marketing will support existing behaviors, yet not be powerful enough to alter these or to promote the adoption of entirely new behaviors. To bring about more fundamental changes in behavior, it is thus necessary to consider the broader environmental factors that shape behavior. In particular, consumers’ environment should foreground healthy behaviors and reduce the ease of performing behaviors associated with less healthy outcomes. For these reasons, we propose inverting the traditional approach andbeginningwith changes to regulations and public policy, rather than with campaigns directed at individuals. Policy and Regulatory Interventions Given that advertising theory suggests sales promotions trigger and reinforce behavior, and social marketing theory proposes individuals exhibit higher levels of behavior when offered additional benefits, we suggest regulatory attention turn first to these activities. Specific initiatives could include regulating the development of merchandise based on children’s television programs or movies as gifts or compo- nents of continuity programs. Currently, many fast-food retailers pair movie-basedAdvertising and Obesity 417 Table 1.Healthy eating healthy action implementation plan objectives HEHA objectives Actions Build healthy public policy Adoption of WHO Global strategy; database of stakeholder groups; establish steering group across relevant sectors. Exploration of policy options; encouragement of sector links; review of nutrition and physical activity policies; Development of joint planning and policy processes Create supportive environmentsInvestigate advertising and social marketing options; Fruit in Schools pilot study; expand breakfast programs; encourage use of healthier cooking products among the food industry; monitor availability of healthy food choices; develop walking and cycling strategy; develop programs for older people and those with disabilities. Strengthen community actionSupport development of diverse community programs; ensure information shared. Develop personal skills Extend education and training programs and opportunities; enhance teachers’ ability to deliver curriculum; enhance knowledge of food industry and physical activity industry workers. Reorient health services Develop list of evidence-based weight loss programs; identify and fill gaps in these; develop training guidelines for obesity service providers; monitor and extend Green Prescriptions; integrate HEHA strategy into district planning; increase promotion of nutrition in primary care settings; ensure meaningful Maori participation. Monitor, research, and evaluateDevelop research agenda and link with relevant funding bodies; initiate research; monitor information on health status, nutrition, and obesity; improve evaluation of nutrition and physical activity programs. Communication Develop communication plan relating to nutrition and media strategy; evaluate plan; develop social marketing to facilitate behavior change; track effectiveness of campaign; develop HEHA brand. Workforce Assess needs of workforce, particularly Maori and Pacific workforce; develop training programs and strategies. Include nutrition and physical activity in relevant curricula. Increase capacity of Maori and Pacific health professionals. 418 J. Hoek and P. Gendall giveaways with specific products; this provides an incentive to purchase the meal item linked to the gift, and to continue purchasing until a complete collection has been acquired. Because each range is available for a limited time only, the promo- tions prompt frequent consumption as this ensures access to the full range of items (Schlosser, 2001). Although it is normally very difficult to change the rate at which consumers purchase a product (Ehrenberg, 1988), these promotions may shorten consumption cycles by applying time constraints that do not affect other purchase behaviors. Retailers bundle promotions, which means they combine together items on a menu and offer these at a reduced price. This may promote multiple purchases of an item where purchase of several items becomes better value than purchase of an individual item (e.g., $5 for 2 items instead of $3.95 each). Bundling may also cross-sell related products by offering a price discount when the items are purchased together (e.g., $5.95 for a hamburger, chips, and soft drink instead of a summed unit price of up to $2 more). Further encouragement to purchase multiple items occurs at the point of sale, where staff invite consumers to take advantage of the deals currently on offer. Use of sporting role models by fast-food manufacturers strengthens the associa- tion between healthy activities, such as exercise, and the consumption of foods high in fat, salt, and sugar. Because young people may identify strongly with role models, associations that pair ‘‘fast-food’’ items with individuals they esteem poses a risk that health messages relating to these foods will be discounted (Hoek, Gendall, & Stockdale, 1993). The differences between most young people’s energy requirements and those of high-performance athletes, such as Olympic Gold medalists Sarah Ulmer and Hamish Carter (both of whom have featured in McDonalds’ promotions) are never mentioned in promotions. Sponsorship’s pairing of role models’ attributes with brands may create the misleading impression that consumption of high-fat, high-sugar, and high-salt items is consistent with peak sporting performances. The frequency with which these sales promotions and sponsorships are used encourages regular purchases of ‘‘fast-food’’ items, provides on-going reinforcement of these purchases, and relies on associations that may mislead young people about the composition of a healthy diet. Regulating the range and types of sales promo- tions that can be used to foster sales of fast foods could remove powerful purchase incentives and rewards, thereby enabling other food options to assume a higher place in consumers’ choice hierarchy. Other policy changes could include regulation of the food options available through school canteens and the sponsorship–supply arrangements schools can enter into to supplement their operations grants. As noted, constraining food choice within schools modifies the behavior children can exhibit. At present, however, schools with insufficient funds enter into supply contracts with, for example, soft- drink manufacturers, who install vending machines and donate a proportion of sales revenue to host schools. These arrangements provide guaranteed access to a captive market and, because scholars authorize placement of these machines, they convey a clear message that schools approve of the food items sold. Regulations that limit both the type of food schools may sell and the sponsorship contracts they may enter into would also create an environment that fostered healthier food choices. In summary, the emphasis on regulatory and environmental change we propose would begin by exploring restrictions on the promotions used to support ‘‘fast-food’’ sales. More specific regulations could reduce the salience of these products and limitAdvertising and Obesity 419 the rewards currently provided to prompt or reinforce purchase. According to Ehrenberg and Rothschild’s reasoning, advertising restrictions would remove rein- forcers that promote and reward regular consumption of up-sized product options, and make this behavior appear consistent with a healthy diet. Stricter regulation of school supply arrangements would reduce opportunities for consumption and so make it easier for healthy eating habits to develop. Required modifications to man- ufacturing processes would ensure healthier food choices, irrespective of consumers’ willingness to seek these out. Changes such as these would promote healthier eating patterns, create an environment where community-level activities will be more likely to succeed, and ensure individuals would be more receptive to social marketing messages about healthy nutrition and exercise programs. Community-Level Interventions The HEHA Plan, and others like it, outline some excellent interventions operating at the community level, such as the ‘‘Fruit in Schools’’ program run successfully in late 2004. The key advantage offered by this program was its intrusiveness and explicit location within schools themselves. Children’s food choices expanded to include a new, low-risk and interesting option that many took the opportunity to try. This direct intervention provided a key opportunity to stimulate new behaviors and, through repetition, to encourage the establishment of a behavior pattern. The targetting of this particular program also recognised existing discrepancies in the availability of healthier food options, and thus contributed to the overall equity of the implementation program. The ‘‘Fruit in Schools’’ and other initiatives could succeed by offering new and different food choices, and also by reinforcing these through associations with posi- tive role models, prizes, and other reinforcers. The tactics used so successfully by fast-food manufacturers could increase the adoption and maintenance of healthier behaviors. Community-level interventions need to provide alternative choices and associate clear benefits or reinforcers with these. Simplifying the ease with which new behaviors can be performed, and ensuring these are more rewarding than alter- native behaviors, will help establish new patterns that advertising campaigns directed at individuals can reinforce. Individual-Level Interventions Policy environments that support community-level social marketing programs will also create the conditions where individuals are more likely to be responsive to education programs such as ‘‘Five Plus’’ or ‘‘Push Play.’’ In Table 2, we invert the traditional social marketing approach and outline an alternative program that begins with regulatory change and concludes with education campaigns aimed at individuals. Conclusions In addressing obesity, policymakers have directed their efforts primarily at creating more informed individuals, without first having created a regulatory environment that will support social marketing and education programs. Behavior modification theory and advertising theory suggest that social marketing and education 420 J. Hoek and P. Gendall campaigns will achieve limited results since they are rarely powerful enough to alter established behavior patterns. Both Ehrenberg’s ‘‘weak’’ theory of advertising and BMT suggest the key to behavior change lies in consumers’ environment. Using policy to decrease the visibility of less healthy foods, while also making these more expensive or more difficult to access, reduces the salience of these foods and dis- courages consumption. Overall, policy initiatives seem very likely to increase the probability that behavior change will occur. Although logic and theory support the introduction of additional regulatory measures, policymakers typically have two concerns about proposals designed to restrict marketing activities. First, they are sensitive to accusations of state matern- alism and, second, they are concerned that policy changes may not reduce unhealthy behaviors. Future research could explore both concerns. Analyses of public opinion could estimate the likely support for stricter policy measures. Recent studies suggest a public mandate does exist (King’s Fund 2004) although each jurisdiction contem- plating policy changes would wish to ascertain its own constituents’ opinions. Experimental work, such as stated choice preference experiments, could explore the attractiveness of specific promotional activities, such as bundling and the effect of celebrity endorsement, on choice behavior. Where these promotions significantly alter the overall utility of particular food items, voluntary restraint or further regula- tion would appear warranted. Such research could clarify both the support for regulatory intervention and the types of interventions most likely to change behavior, and would provide clear guidance to policymakers. Empirical evidence would complement the theoretical rationale for stricter regulation, which in turn would support social marketing and education initia- tives and increase the probability that these will support healthier eating behaviors. Table 2.Obesity prevention efforts Level Strategies Regulatory structure Regulate school sponsorship–supply arrangements Develop school food sale regulations (U.S. National School Lunchtime Program) Institute stricter food preparation standards Regulate the use of loyalty and bundling promotions Introduce more specific rules relating to youth role models Ensure full and meaningful disclosure of nutritional details Community level ‘‘Fruit in Schools’’ ‘‘Walking bus’’ ‘‘Good employer’’ Workplace exercise and fitness programs Heart Foundation ‘‘Best Fish and Chip’’ Competition Use of fruit rather than sweets as reinforcers in schools Support safe cycling and walking routes ‘‘5-2-1-GO’’ (U.S. SCHOOL-BASED food, television, and exercise program) Individual level ‘‘Push Play’’ ‘‘Five Plus a Day’’ ‘‘VERB’’—It’s what you doAdvertising and Obesity 421 References Ambler, T. (1996). Can alcohol misuse be reduced by banning advertising?International Journal of Advertising ,15 (2), 167–174. 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LITERATURE REVIEW (12-16 pages) This essay is basically synthesizing 10 sources to support the new research im proposing that needs to be done. The sources needs to be categorized into 3/4 subheadings
Influencing light versus heavy engagers of harmful behavior to curb their habits through positive and negative ad imagery JENNIFER L. BURTON 1*, DONNA J. HILL 2and AYSEN BAKIR 3 1 Phillips School of Business, High Point University, 833 Montlieu Avenue, High Point, NC 27262, USA2Foster College of Business, Bradley University, 1501 West Bradley Avenue, Peoria, IL 61625, USA3College of Business, Illinois State University, Campus Box 5590, Normal, IL 61790-5500, USA ABSTRACT Mass media advertising has increasingly been seen as an important vehicle to influence attitudes and behaviors on issues designed to en- hance the well-being of society overall. However, prior research shows mixed results on the ability of advertising to encourage substantial or long-term changes in self-destructive behavior. The current research provides a framework to reconcile previousfindings and demon- strates that different psychological processes are occurring when trying to convince light versus heavy engagers to curb their potentially harmful behaviors. Validated across two contexts (texting while driving and excessive gambling), the present study demonstrates that ads containing pos- itive imagery (as opposed to negative imagery) are more effective at influencing heavy engagers to limit their harmful behaviors. Heavy engagers in the harmful behavior seem to resist ads containing negative imagery and do notfind them to be more credible or involving. Instead, they are more influenced to curb their harmful behaviors after seeing positive imagery containing characters and situations to which they can relate. On the other hand, light engagers of harmful behavior are more likely to be persuaded to limit their behaviors after exposure to adver- tising containing negative imagery. The negative imagery evokes perceptions of ad credibility and encourages individuals to think about the advertised problem and consequences. Both credibility and ad involvement are shown to be important mediators of ad effectiveness for light engagers, whereas relatability was not a significant mediator for this group. Implications for the design of effective public service announce- ments targeted toward these separate groups are discussed. Copyright © 2015 John Wiley & Sons, Ltd. INTRODUCTION Mass media advertising (e.g., print, radio, and television) has increasingly been seen as an important vehicle to influence attitudes and behaviors on issues designed to enhance the well-being of society overall. Because of their demonstrated propensity to broaden awareness of important social issues and encourage pro-social behaviors, research on the impact of public service announcements has increased considerably in recent years (Keller and Lehmann, 2008). While public service announcements typically have honorable and socially beneficial objectives, prior research shows that they are often ineffective at encouraging substantial or long-term changes in self-destructive behavior (Midford and McBride, 2001; Foxcroftet al., 2003) and have the greatest impact on people less likely to engage in the harmful behavior (Kellyet al., 1996). One reason given for the ineffectiveness of advertis- ing to influence individuals engaging in harmful behavior is the third-person effect, where individuals feel that depicted consequences of a harmful behavior are more likely to happen to other people rather than themselves (Golan and Banning, 2008; Grier and Brumbaugh, 2007; Raghubir and Menon, 1998). Another reason for the ineffectiveness of ad- vertising to influence people potentially engaging in harmful behavior is the boomerang effect. The boomerang effect is when public service announcements cause an increased like- lihood of engaging in socially destructive behavior becausethe ad sensationalizes the experience for target audiences looking for ways to seek stimulation (Fishbeinet al., 2002a, 2002b; Zhaoet al., 2006). Our study reconciles some of the conflictingfindings on the effectiveness of ads designed to curb potentially harmful behaviors by suggesting that different psychological pro- cesses are occurring for individuals who are heavy versus light engagers in harmful behaviors. The current study uti- lizes a meditational approach to suggest that ads containing positive imagery will be more effective for individuals who are heavily engaged in the harmful behavior and ads contain- ing negative imagery will be more effective for individuals who are light engagers in the harmful behavior. We study three important mediators of ad effectiveness and test the no- tion that individuals who do not frequently engage in the harmful behavior experience higher levels of persuasion when negative ad imagery evokes perceptions of ad credibil- ity and encourages individuals to think about the issue and the associated consequences. On the other hand, we test the idea that positive ad imagery evokes high levels of relatability, which is an important factor in influencing heavy engagers of the harmful behavior to curb their bad habits. We examine these hypotheses in two separate contexts for gener- alizability: texting while driving (Study 1) and excessive gambling (Study 2). The results of this study have important implications for managers who use advertising to encourage positive social behaviors. The goals of many public service campaigns are often twofold: (1) to encourage heavy engagers to obtain help and curb their habit and (2) to encourage light and non-engagers from developing a bad habit in thefirst place. * Correspondence to: Jennifer L. Burton, Phillips School of Business, High Point University, 833 Montlieu Avenue, High Point, NC 27262, USA. E-mail: Jb[email protected] Copyright © 2015 John Wiley & Sons, Ltd. Journal of Consumer Behaviour,J. Consumer Behav.14: 237–247 (2015) Published online 7 April 2015 in Wiley Online Library (wileyonlinelibrary.com)DOI:10.1002/cb.1514 Oftentimes, these two goals are pursued simultaneously with the same advertising stimuli. We hypothesize that heavy ver- sus light engagers do respond differently to positive versus negative stimuli and exhibit different message processing strategies that influence persuasion. If this proves to be the case, advertisers would be more likely to affect social change by having separate campaigns targeted toward heavy versus light engagers of harmful behaviors. HYPOTHESES AND THEORETICAL DEVELOPMENT A main premise of this study is that individuals who fre- quently engage in a harmful behavior are more likely to curb their habit after viewing an ad containing positive imagery, while individuals who are light engagers of a harmful behav- ior are more likely to curb their habit after viewing an ad containing negative imagery. Numerous researchers have found differential effects of positive and negative stimuli (see Baumeisteret al., 2001; Rozin and Royzman, 2001 for reviews). For instance, meat products are described more favorably by consumers when they are advertised with a positive frame of reference (i.e., containing 75% lean beef) as opposed to a negative frame (i.e., containing 25% fat) (Levin and Gaeth, 1988). On the other hand, Meyerowitz and Chaiken (1987) report that public service announce- ments promoting breast self-exams were more effective with a negatively framed message. In the context of public service announcements designed to influence individuals to check their risk for heart disease, Maheswaran and Meyers-Levy (1990)find that negative messages are considered to be more informative and effective when individuals have the motiva- tion to engage in higher levels of message processing. Prior research provides some evidence to suggest that light engagers of a harmful behavior may be more likely to engage in higher levels of message processing. For example, Mandel and Johnson (2002) suggest that individuals with less experience and knowledge in a particular context (e.g., light engagers of harmful behavior) are more likely to rely on external sources of information in forming their overall evaluations. Additionally, these individuals are more likely to carefully assess and examine all presented informa- tion in making their decisions (Chiet al., 1982; Mitchell and Dacin, 1996) where they are prone to the bias of weighing negative information more than equally valenced positive information (Fiske, 1980; Maheswaran and Meyers-Levy, 1990). In the context of drugs, individuals who had the least experience with and intention to do drugs were more likely to believe in the negative consequences of drug use and less likely to believe that drug use had any positive consequences compared with heavy users (Fishbeinet al., 2002a, 2002b). Because of the importance of aligning the message with the attitudes and beliefs of the target audience, we predict that in- dividuals who do not frequently engage in harmful behaviors will be more persuaded by ads containing negative imagery. On the other hand, consumers with extensive prior knowl- edge and experience (e.g., heavy engagers of harmful behavior) are more selective in their information search (Bettman and Park, 1980) and focus on information that is consistent withtheir goals (Lewandowsky and Kirsner, 2000). This group is morelikelytorelyoninternalversusexternalinformation search in decision making (Mandel and Johnson, 2002), and exhibit a greater tendency to make quick decisions (Thunholm, 2005). Thesefindings suggest that heavy engagers in harmful behavior are more likely to use their prior knowledge and experience in forming judgments about their future behavior. They are also more likely to respond positively to imagery that represents their overall goals (i.e., the positive reasons why they engage in the harmful behavior). Indeed, prior research illus- trates that individuals who frequently use drugs are more likely to believe in the positive outcomes of drug use and less likely to believe in the negative outcomes associated with drug use compared with those non-users or infrequent users (Fishbein et al., 2002a, 2002b). Additionally, Wolburg (2006) shows that while non-smokers generally respond well to anti-smoking public service announcements, smokers generally responded with denial and even defiance. Research suggests that the best approach for targeting smokers is a message that is non- judgmental (McKenna and Williams, 1993) and includes pleasing elements such as humor or music (Grubeet al., 1996). Therefore, wepredict that ads featuring positive imagery will be more effective at persuading heavy engagers of harmful behavior to curb their habits. In summary, we predict that there will be a significant interaction between ad imagery (positive versus negative) and the extent of prior harmful behavior on the likelihood the ad influences individuals to limit their harmful behavior. Formally, H1A: The ad containing positive imagery will be more effective at influencing heavy engagers to limit their behaviors; and H1B: The ad containing negative imagery will be more effec- tive at influencing light engagers to limit their behaviors. The next set of hypotheses are based on prior research on the “ dual mediation”hypothesis that suggests that attitude toward the ad has both a direct relationship with attitude to- ward the brand and an indirect relationship through brand cognitions (MacKenzie and Lutz, 1989; MacKenzieet al., 1986). The only difference is that, in our case, we are not interested in attitude toward the brand but rather the extent to which the ad persuaded individuals to limit a potentially harmful behavior (i.e., texting while driving and excessive gambling). Therefore, we decided to concentrate on three as- pects of attitude toward the ad that a meta-analysis on public service announcements has shown to be important in gener- ating compliance with health recommendations: credibility, ad involvement, and relatability (Keller and Lehmann, 2008). These mediating variables are also expected to work differently for individuals who have high versus low levels of participation in the harmful behavior. We define credibility as the extent to which individuals find an advertisement to be believable, informative, persua- sive, and trustworthy. As previously mentioned, ads evoking negative imagery are generally considered to be more credible because individuals tend to weigh negative information more than equally valenced positive information in forming evalua- tions (Fiske, 1980). This tendency has also been shown in the 238J. L. Burtonet al. Copyright © 2015 John Wiley & Sons, Ltd.J. Consumer Behav.14: 237–247 (2015) DOI: 10.1002/cb context of public service announcements promoting choles- terol screening (Maheswaran and Meyers-Levy, 1990), breast self-examinations (Meyerowitz and Chaiken, 1987), and smoking cessation (Agostinelli and Grube, 2003). Addition- ally, prior research has shown credibility to be an important predictor of attitude toward the brand (MacKenzie and Lutz, 1989) and positive health behaviors in public service announcements (Keller and Lehmann, 2008). Therefore, we predict that the extent to which individualsfind the ad to be credible mediates the relationship between ad imagery (positive versus negative) and the likelihood the ad influences individuals to limit their harmful behaviors. Formally, H2: Individuals will perceive the ad with negative imagery to be more credible, influencing them to limit their harmful behaviors. In addition to credibility, the extent to which an ad generates issue involvement is also predicted to be an important deter- minant of an individual’s likelihood to curb harmful behav- iors. We define issue involvement as the extent to which an ad motivates an individual to think about the featured prob- lem (e.g., texting while driving and excessive gambling) and associated consequences. Prior literature suggests that negative content in public service announcements mobilizes and attracts physiological, cognitive, and social resources to a greater extent than does positive content in anti-piracy messages (Levinet al., 2007), as well as anti-verbal abuse, anti-smoking, anti-terrorism and, acquired immune deficiency syndrome prevention messages (Parryet al., 2013). The ability of these messages to mobilize individuals’physiolog- ical, cognitive, and social resources results in higher levels of issue involvement (Pratto and John, 1991). Research on persuasion suggests that higher levels of involvement lead to the formation of attitudes that are stronger, more stable, and persistent over time (Petty and Cacioppo, 1986). Addition- ally, a recent meta-analysis by Keller and Lehmann (2008) illustrates that emphasizing the consequences of harmful behaviors in public service announcements is an important aspect in generating compliance with health recommenda- tions. Therefore, we predict that the extent to which individ- ualsfind the ad to generate issue involvement mediates the relationship between ad imagery (positive versus negative) and the likelihood the ad influences individuals to limit their harmful behaviors. Formally, H3: Individuals will perceive the ad containing negative imagery as creating more issue involvement, thus influencing them to limit their harmful behaviors. Another important factor in generating persuasion is for the ad to contain characters and situations individuals can relate to (i.e., relatability). However, in this case, we believe that the ad containing positive imagery will be more relatable to individuals when it comes to persuading them to curb their texting while driving or excessive gambling habits. This pre- diction is based on research on public service announcements promoting safe sex where participants described the most persuasive messages as those featuring characters andsituations to which they could relate (Van Steeet al., 2012). Additionally, research on attitudes of smokers show that heavy smokers are much more likely to believe that their behavior is associated with positive outcomes and less likely to believe that their behavior could be associated with nega- tive outcomes (Fishbeinet al., 2002a, 2002b). Such tenden- cies lead to what is known as the third-person effect (Golan and Banning, 2008; Grier and Brumbaugh, 2007) that states that when individuals are confronted with negative situations in ads, they are more likely to think the negative conse- quences will apply to other people more than themselves. The third-person effect has been illustrated in public service announcement research in many contexts such as those soliciting charitable donations (Golan and Banning, 2008), promoting safe sex (Raghubir and Menon, 1998; Van Stee et al., 2012), and encouraging individuals to quit alcohol, tobacco, and gambling (Banning, 2001). Additionally, re- search has shown the third-person effect to be less pro- nounced when a message is positively framed (Golan and Banning, 2008) and the characters and situations are similar to the viewer and his/her experiences (Raghubir and Menon, 1998). For these reasons, we predict the following: H4A: Individuals will perceive the ad containing positive imagery to be more relatable than the ad containing negative imagery. H4B: The extent to which individualsfind the ad to be relat- able will predict the extent to which the ad influences them to limit their harmful behaviors. Previous research has shown that individuals display variation in their emotional responses to affect laden stimuli whether they are images (Larsen and Diener, 1987) or advertisements themselves (Moore and Harris, 1996). In general, advertising appeals that are self-relevant and activate an individual’sself- schema are considered more effective, and this effect is even stronger for advertisements featuring negative messages (Meyers-Levy and Peracchio, 1996). This is consistent with re- search by Wolburg (2006) that suggests that anti-smoking pub- lic service announcements are better received by non-smokers than smokers because the messages are more consistent with their current ideals and beliefs. It is also consistent with research by Van Steeet al. (2012) that illustrates that public service announcements featuring the negative consequences of unsafe sex practices are more effective when they feature characters and situations to which the viewers can relate. Public service announcement research across many con- texts such as smoking (Van Steeet al., 2012) and alcohol, tobacco, and gambling (Banning, 2001)finds that individuals may respond with denial or defiance when they are threatened by a message. In the context of drinking and driving public service announcements, Block (2005) demonstrates that indi- viduals react differently depending on whether they feel guilt or resonate with the message. This research has identified two paths explaining how individuals might deal with guilt. These two paths are described as“guilt reduction”and“guilt avoid- ance.”For example, we would expect the light engagers of harmful behavior to pursue a guilt-reduction strategy where an ad would generate feelings of credibility and involvementGenerating positive change through ad imagery239 Copyright © 2015 John Wiley & Sons, Ltd.J. Consumer Behav.14: 237–247 (2015) DOI: 10.1002/cb to motivate them to limit their texting while driving or gam- bling behaviors. This strategy is reflected in a number of public service announcement studies that show individuals tak- ing positive measures to prevent harm in the contexts of choles- terol screening (Maheswaran and Meyers-Levy, 1990), breast self-examinations (Meyerowitz and Chaiken, 1987), and smoking cessation (Agostinelli and Grube, 2003). On the other hand, we would expect the heavy engagers of harmful behavior to pursue a guilt avoidance strategy where individuals con- sciously try to avoid thinking about guilt-evoking incidents (Kubany and Watson, 2003) upon exposure to the ad featuring negative imagery. Thus, these individuals would not likely ex- perience the same levels of perceived credibility or ad involve- ment as the light engagers. The guilt avoidance strategy is one that is reflected in a number of studies that show denial or defi- ance when faced with guilt-provoking content in public service announcements dealing with quitting smoking (Van Steeet al., 2012) and alcohol, tobacco and gambling (Banning, 2001). Prior literature suggests that negative or positive appeals can be successful at achieving effective attitude change depending on the individual’s aroused level of emotional tension (Wheatley and Oshikawa, 1970). For example, if the individual’s emotional tension is stimulated by a negative appeal, the individual who is exposed to the message will try to reduce his or her anxiety level by looking for some type of comfort. Then, if the message in the ad is perceived to be offering some comfort, it may decrease the emotional tension for the individual and persuade the individual to follow a rec- ommended course of action (Wheatley and Oshikawa, 1970). This is similar to what Keller (1999) found with regard to safe-sex public service announcements. He found that threatening content in advertisements has facilitating effects of making the person wonder if he/she is vulnerable to the threat and think about whether the recommendations would protect that person. He also found that too much threat in advertisements has debilitating effects where the person doubts the effectiveness of the health recommendations and his/her ability to follow them (Keller, 1999). There- fore, individuals who are frequently engaged in harmful behavior might look for cues in the message that decrease the emotional tension for themselves. This, in turn, might de- crease their level of involvement in the ad and how credible they think the message is when the ad contains negative imag- ery. On the other hand, individuals who do not frequently engage in harmful behavior might not feel any guilt leading to higher perceptions of credibility and involvement because they do not need to reduce their emotional tension because of their exposure to the negative imagery. Therefore, it is hypothesized that H5: Individuals who frequently engage in the harmful behav- ior do not consider the ad containing negative imagery to be more credible or involving. However, they do consider the ad containing positive imagery to be more relatable. H6: Individuals who do not frequently engage in the harmful behavior consider the ad containing negative imagery to be more credible and involving. However, they do not consider the ad containing positive imagery to be more relatable.STUDY 1 Participants and procedure Study 1 was designed to test the aforementioned hypotheses by exposing individuals to advertisements designed to curb texting while driving behaviors. One-hundred eighty students from two Midwestern universities participated in this study in exchange for credit in their introductory business courses. A between-subjects design was used to test the degree to which positive and negative imagery used in the advertisements influenced individuals to limit their texting while driving behaviors. Subjects were randomly assigned to one of two conditions where we manipulated the extent to which the public service announcement featured positive or negative imagery. The ad featuring positive imagery showed a smiling young man and a smiling young lady driving their car while attempting to type out a text message on their cell phone. The positive im- agery was meant to express the positive reasons that people engage in the harmful behavior. The reason the positive imagery reflected the positive reasons people engage in the behavior as opposed to the positive benefits of not engaging in the behavior is because previous literature emphasizes the importance of highlighting situations and characters to which viewers can relate (Grubeet al., 1996; Van Steeet al., 2012). Also, the benefits of not engaging in harmful behaviors are similar to double negatives (e.g., not getting cancer and not getting into an accident) than actual positives. Finally, the main positive benefits of living long, healthy, and injury-free lives are often arbitrary and vary greatly by individual. The ad featuring negative imagery showed a dangerous crash with a person being run over and blood on the windshield. The imagery also showed a hand holding a cell phone to con- note that the driver was texting while driving to cause the accident. The negative imagery chosen was meant to express the potential negative consequences of texting while driving. We held the text of the two advertisements constant. The headline asked,“Do you text while driving?” The ad then proceeded to explain that over 500 000 people per year are killed or seriously injured because of texting while driving. The public service announcement then encouraged people to“learn the facts to prevent yourself from becoming one of the statistics.”The ad concluded by providing a website and toll-free number people could call for more information. Samples of the advertising stimuli used are provided in Appendix A. Prior to being exposed to the advertisement, individuals answered questions about the extent of their prior texting- while-driving behaviors. We measured frequency of texting while driving by asking how many times per month individ- uals engage in texting while driving behavior. Individuals could enter anywhere between 0 and 16 or more times per month. We also measured quantity of texting while driving behavior by asking how many texts they send while engaging in this behavior. Individuals could enter anywhere between 0 and 10 or more texts. We multiplied these measures together to obtain an estimated monthly quantity of texts sent while driving that ranged from 0 (14% of the sample) to 160 or more texts (7% of the sample). The median 240J. L. Burtonet al. Copyright © 2015 John Wiley & Sons, Ltd.J. Consumer Behav.14: 237–247 (2015) DOI: 10.1002/cb number of texts sent per month in our sample was 32.5 texts. Afterwards, individuals were exposed to the advertisement featuring positive or negative imagery depending on their condition. Finally, individuals answered questions regarding their assessments of the ad. Assessment measures included manipulation checks (e.g., extent to which the ad emphasized the positive and negative aspects of the behavior), mediation variables (e.g., measures of ad credibility, ad involvement, and ad relatability), and effectiveness variables (e.g., extent to which the ad influenced them to limit their behavior). Indi- viduals rated all assessment measures using 7-point scales. RESULTS First, we performed manipulation checks to ensure that our manipulation of positive versus negative imagery worked in the texting while driving context. Individuals rated the ad containing positive imagery as“emphasizing the positive as- pects of texting while driving”(M= 2.76) more than the ad containing negative imagery (M= 2.15;t= 2.15,p<0.05). Likewise, individuals rated the ad containing negative imag- ery as“emphasizing the negative aspects of texting while driving”(M= 6.34) more than the ad containing positive im- agery (M= 4.65;t= 6.79,p<0.01). Thefirst hypothesis predicted a significant interaction be- tween ad imagery and prior behavior where individuals who did not engage in much texting while driving would be more influenced by the ad containing negative imagery, and heavy engagers in texting while driving would be more persuaded by the ad containing positive imagery. To test thefirst hy- pothesis, we regressed the extent to which the ad influenced individuals to curb their texting while driving against ad imagery (positive versus negative), extent of prior behavior, and an interaction term (ad imagery x prior behavior). The regression equation was significant (F= 2.72,p<0.05) and showed a positive main effect of negative ad imagery on likelihood to curb texting while driving (t= 2.85,p<0.01). However, as predicted in H1A and H1B, the inter- action was significant (t= 1.82,p<0.07). Spotlight analysis was performed to test the slopes of the two contrasts as rec- ommended by Irwin and McClelland (2001) and Aiken and West (1991) when the moderating variable is continuous. Figure 1 shows the likelihood of individuals curbing their texting while driving behaviors after seeing the ad featuring positive and negative imagery for all levels of texting while driving behavior. Confirming H1A, individuals with the highest levels of texting and driving (160 or more texts per month) are more likely to curb their behavior after viewing the ad containing positive imagery (M= 4.41) than the ad containing negative imagery (M= 3.87). Individuals with the lowest levels of texting and driving (0 texts per month) are more likely to curb their behavior after viewing the ad with the negative imagery (M= 4.66) than the ad with the positive imagery (M= 3.73), confirming H1B. H2 predicted that perceived ad credibility would mediate the relationship between ad imagery and individuals’likeli- hood to curb their texting while driving. H2 was confirmed as full mediation was present. Results showed that the ad with negative imagery was considered to be more credible (i.e., believable, informative, persuasive, and trustworthy) (t= 2.08,p<0.05). This credibility led to increased likeli- hood to curb future texting while driving behaviors (t= 10.81,p<0.01). While the ad with negative imagery does predict likelihood to curb future behaviors (t= 2.08, p<0.05), this coefficient is no longer significant (t= 1.14, p= n.s.) with credibility in the regression equation indicating that full mediation has occurred. Indeed, a Sobel test (Baron and Kenny, 1986) confirms the presence of mediation (t= 2.04,p<0.05). As predicted in H3, ad involvement (i.e., the extent to which an ad encourages individuals to think about the issue and its consequences) also completely mediates the relation- ship between ad imagery and the likelihood individuals will limit their texting while driving behaviors. Ad imagery was shown to influence the level of involvement one feels while Figure 1. Interaction between ad imaginary and extent of prior behavior on individuals’likelihood to limit texting while driving. Generating positive change through ad imagery241 Copyright © 2015 John Wiley & Sons, Ltd.J. Consumer Behav.14: 237–247 (2015) DOI: 10.1002/cb viewing the ad (t= 3.07,p<0.01), which then leads to a greater likelihood to curb texting while driving behaviors (t= 16.47,p<0.01). While the ad containing negative imagery increases the likelihood individuals will limit their texting while driving behaviors (t= 2.39,p<0.05), this coefficient is no longer significant (t= 0.26,p= n.s.) when ad involvement is included in the regression equation. This complete mediation was also confirmed by a Sobel test (t= 3.02,p<0.01). H4A and H4B predicted that the ads containing positive imagery would be seen as more relatable (i.e., containing characters and situations individuals can easily relate to), and that relatability was also important in influencing indi- viduals to curb their harmful behaviors. These relationships were supported in the texting while driving context. Confirming H4A, individuals found the ad containing positive imagery to be much more relatable than the ad containing negative imagery (t= 2.23,p<0.05). In turn, the more individuals could relate to the ad, the greater the likeli- hood of them limiting their texting while driving behaviors (t= 7.62,p<0.01), confirming H4B. It is important to note that relatability did not mediate the relationship between ad imagery and likelihood to limit texting while driving. In- stead, the addition of relatability to the regression equation made the relationship between ad imagery and likelihood of limiting behavior stronger (t= 3.90,p<0.01), indicating that both influences are operating separately and simulta- neously. However, because the positive ad was generally seen to be more relatable, this relationship reduced the over- all effectiveness of the negative ad at influencing people to limit their harmful behaviors. At this point, we have demonstrated that perceived ad credibility, ad involvement and relatability have a positive relationship with individuals’likelihood to curb texting- while-driving behaviors after ad exposure. H5 attempts to explain why individuals who frequently engage in the harm- ful behavior are more likely to curb their behavior after being exposed to the ad featuring positive imagery. H5 says that in- dividuals who frequently engage in the harmful behavior will notfind the negative ad to be more credible or involving but willfind the positive ad to be more relatable. A median split was performed for this analysis where individuals who sent more than 32.5 texts per month while driving were consid- ered as“frequent engagers.”Multivariate regression was used to determine the relationship between ad imagery (positive or negative) and key dependent variables (i.e., ad credibility, ad involvement, and relatability). Results confirmH5 and show that frequent engagers do notfind the negative ad to be more credible (F= 0.78,p= n.s.) or involving (F= 1.78,p= n.s.) but dofind the positive ad to be more relatable (F= 10.96,p<0.01) (Table 1). A similar analysis was performed to confirm H6 with respect to light engagers. Results show that light engagers dofind the negative ad to be more credible (F= 3.80,p<0.05) and involving (F= 8.47, p<0.01) but do notfind the positive ad to be more relatable (F= 0.049,p= n.s.) (Table 1). Thesefindings explain why light engagers are more likely to curb their harmful behavior after being exposed to the ad with negative imagery. STUDY 2 Participants and procedure A similar study was conducted to test the six hypotheses in the context of excessive gambling to see if the results were generalizable to public service announcements designed to curb harmful behaviors in other contexts. One hundred eighty-one students from two Midwestern universities partic- ipated in the gambling study for credit in their core business courses. Once again, the text of the public service announcement remained constant and the experiment manipulated positive and negative imagery regarding the possible positive benefits and negative consequences of excessive gambling. The ads featuring positive imagery showed smiling people celebrat- ing and scooping up chips at a roulette game in a casino. The ads featuring negative imagery showed two men alone at a casino table with their heads in their hands showing frus- tration at having lost plenty of money. The headline of the ad stated,“6 million Americans have serious problems with gambling.”The ad then encourages people to obtain help by visiting a website or calling a toll-free number if gambling is a problem for them. The exact ad stimuli used in this study are shown in Appendix A. Similar to the texting while driving study, we collected information regarding the frequency and amount of gambling subjects perform in their daily lives. First, subjects indicated how many times they went gambling in a typical month (anywhere from 0 to 16 or more times per month). Next, subjects indicated how often they gambled on a typical gambling occasion (anywhere from 0 to 10 or more hours). We created an index to reflect how many hours individuals spend gambling in a month by multiplying these two values. Most individuals (73%) in our sample did not gamble. Table 1. Extent to which ad tonality (positive versus negative) predicts relatability, credibility, and ad involvement for individuals with high versus low instances of texting while driving High levels of texting while driving Low levels of texting while driving tFSig. Adj.R 2 tFSig. Adj.R 2 DV = relatability; IV = ad tonality 3.311 10.962p<0.001 0.098 0.222 0.049p= n.s. 0.01 DV = credibility; IV = ad tonality 0.886 0.784p= n.s. 0.002 1.95 3.803p<0.054 0.029 DV = ad involvement; IV = ad tonality 1.333 1.776p= n.s. 0.008 2.911 8.472p<0.005 0.074 Wilks’lambdaF= 8.030,p<0.001F= 3.714,p<0.014 DV, dependent variable; IV, independent variable; Sig, significance; Adj, adjusted 242J. L. Burtonet al. Copyright © 2015 John Wiley & Sons, Ltd.J. Consumer Behav.14: 237–247 (2015) DOI: 10.1002/cb Individuals who did gamble participated in the activity anywhere from 1.5 to 88 hours per month. Subsequently, participants were asked to view either the public service announcement featuring positive or negative imagery. Finally, individuals provided their assessments of the ad on a number of mediating (ad credibility, ad involvement, and ad relatability) and effectiveness variables (e.g., the extent to which the ad influenced them to limit their gambling behavior). RESULTS A manipulation check revealed that we had a successful ma- nipulation of positive versus negative imagery. Individuals rated the ad containing positive imagery as“emphasizing the positive aspects of gambling”(M= 4.78) more than the ad containing negative imagery (M= 1.64;t= 13.24, p<0.01). Similarly, the ad containing negative imagery was rated as portraying“the negative aspects of gambling” (M= 4.87) more than the ad containing positive imagery (M= 2.78;t= 7.59,p<0.01). A regression examining how ad imagery, prior gambling behavior and an interaction term influences people’s likeli- hood to limit their gambling behavior was significant (F= 3.87,p<0.01). There was a positive main effect of ad imagery on people’s likelihood to limit their behavior (t= 2.91,p<0.01), as well as a significant interaction between imagery and prior gambling behavior (t= 2.28, p<0.05). Similar to the texting while driving study, we performed a spotlight analysis (Aiken and West, 1991; Irwin and McClelland, 2001) that examined the effectiveness of each ad at the various levels of gambling people exhibited in our study (Figure 2). As predicted in H1A, individuals with the highest levels of gambling (88 hours of gambling per month) are more likely to curb their behavior after viewing the ad with positive imagery (M= 6.23) than the ad with negative imagery (M= 1.76). Individuals with the lowest levels of gambling (i.e., non-gamblers) are more likely to curb their behavior after viewing the ad with negative imagery(M= 2.28) than the ad with positive imagery (M= 1.72), confirming H1B. Full mediation was present when examining ad credibility as a mediator of the relationship between ad imagery and individuals’likelihood to curb their gambling behavior, confirming H2. The negative imagery in the excessive gambling ad led to stronger credibility perceptions (t= 4.02,p<0.01), which then led to an increased likelihood to curb gambling (t= 6.89,p<0.01). The negative relationship between ad imagery and likelihood to curb gambling behavior (t= 2.39,p<0.05) is no longer significant when credibility is added to the regression equation (t= 0.59,p= n.s.). Complete mediation for the gambling study was confirmed by a Sobel test (t= 3.47, p<0.01) (Baron and Kenny, 1986). Ad involvement was also a full mediator of the relation- ship between ad imagery and subjects’likelihood to curb their gambling behaviors, confirming H3. The excessive gambling ad with negative imagery also led to increased ad involvement (t= 2.32,p<0.05), which then led to individ- uals’increased likelihood to curb their gambling habit (t= 9.23,p<0.01). The direct relationship between negative imagery and the likelihood to limit gambling (t= 2.39, p<0.05) is eliminated (t= 1.28, p = n.s.) when ad involve- ment is included in the regression equation indicating the presence of complete mediation (Sobel test_t= 2.27, p<0.05) (Baron and Kenny, 1986). Participants found the ad containing positive imagery to be more relatable than the ad containing negative imagery (t= 2.53,p<0.05), which lead to increased likelihood to curb their gambling habit (t= 6.87,p< 0.01) confirming H4A and H4B. Consistent with Study 1, relatability did not mediate the relationship between ad imagery and the likelihood to limit excessive gambling. Adding relatability to the regression equation made the relationship between ad imagery and likelihood to limit gambling stronger (t= 4.17,p<0.01), indicating that both variables are independent and simultaneous predictors of subjects’inten- tions to limit their gambling. Because the positive ad was seen to be more relatable, this relationship reduces the Figure 2. Interaction between ad imaginary and extent of prior behavior on individuals’likelihood to limit gambling. Generating positive change through ad imagery243 Copyright © 2015 John Wiley & Sons, Ltd.J. Consumer Behav.14: 237–247 (2015) DOI: 10.1002/cb impact of the negative ad on subjects’likelihood to limit their gambling behaviors. H5 says that individuals who frequently engage in the harmful behavior will notfind the negative ad to be more credible or involving but willfind the positive ad to be more relatable. A median split was performed for this analysis where individuals who gambled more than 1.5 hours per month were considered“frequent engagers.”Individuals who gambled less than 1.5 hours per month were considered “light engagers.”Multivariate regression was used to determine the relationship between ad imagery (positive or negative) and key dependent variables (i.e., ad credibility, ad involvement, and relatability). Results confirm H5 and show that frequent engagers do notfind the negative ad to be more credible (F= 2.83,p= n.s.) or involving (F= 0.02, p= n.s.) but dofind the positive ad to be more relatable (F= 3.70,p<0.05) (Table 2). H6 posits that light gamblers are more likely tofind the negative ad to be more credible and involving but do not find the positive ad to be more relatable. H6 was confirmed, where light engagers dofind the negative ad to be more cred- ible (F= 13.74,p<0.01) and involving (F= 7.66,p<0.01) but do notfind the positive ad to be more relatable (F= 3.25,p= n.s.) (Table 2). Thefindings behind H5 and H6 explain why light gamblers are more likely to curb their behaviors after seeing the ad with negative imagery, and heavy gamblers are more likely to curb their behaviors after seeing the ad with positive imagery. DISCUSSION The current study helps reconcile previousfindings that show mixed results on the ability of advertising to influence indi- viduals to curb potentially harmful behaviors. Our research demonstrates that different psychological processes are at work when trying to convince light versus heavy engagers to curb their potentially harmful behaviors. Validated across two contexts (texting while driving and excessive gambling), ourfindings show that positive imagery (as opposed to neg- ative imagery) is more effective at influencing heavy engagers to limit their harmful behaviors. Heavy engagers in the harmful behavior seem to resist the negative imagery and instead rely on the ability to relate to the situation and characters presented in the ad containing positive imagery. This is consistent with research that suggests that individuals with more experience and knowledge about a domain aremore likely to be persuaded when the ad appeals to their higher level goals (Lewandowsky and Kirsner, 2000; Hong and Sternthal, 2010). Ourfindings show that persuasion is more likely to occur in heavy engagers even when the imag- ery is somewhat in conflict with the ultimate message of the ad, which is to encourage them to limit dangerous behaviors such as texting while driving and excessive gambling. On the other hand, light engagers of harmful behavior are more likely to be persuaded to limit their behaviors after ex- posure to the ad containing negative imagery. The negative imagery evokes perceptions of ad credibility and encourages individuals to think about the advertised problem and conse- quences. Both credibility and ad involvement are shown to be important mediators of ad effectiveness for light engagers, whereas relatability was not a significant mediator for this group. As individuals with less knowledge and experience with the harmful behavior, they are more likely to rely on ex- ternal sources in determining their attitudes (Mandel and Johnson, 2002) and carefully scrutinize the information con- veyed in the ad and use it in forming their attitudes (Chi et al., 1982; Mitchell and Dacin, 1996). Theoretical contributions A major contribution of this research is to reconcile prior research that shows mixed effectiveness of positive versus negative stimuli in public service announcements. For in- stance, Levin and Gaeth (1988) show that consumers respond better to messages regarding nutritional content when they have a positive frame of reference, but Meyerowitz and Chaiken (1987) show that consumers are more likely to per- form breast self-exams after exposure to messages with a neg- ative frame of reference. While Maheswaran and Meyers- Levy (1990) show that people are more likely to check their risk for heart disease with a negatively framed message, many other studies show that negatively framed public service an- nouncements lead to denial and defiance (Banning, 2001; Wolburg, 2006; Van Steeet al., 2012). The reason for the inconsistentfindings regarding positive and negative messages in public service announcements is that prior research does not consider an important moderator of these effects—the amount of experience an individual has performing these harmful behaviors. Therefore, negatively framed messages are more likely to work for those with little experience performing harmful behaviors, while positively framed messages are more likely to work for those with little experience performing harmful behaviors. Table 2. Extent to which ad tonality (positive versus negative) predicts relatability, credibility, and ad involvement for individuals with high versus low instances of excessive gambling High levels of gambling behavior Low levels of gambling behavior tFSignificance Adj.R 2 tFSignificance Adj.R 2 DV = relatability; IV = ad tonality 1.924 3.703p<0.06 0.053 1.803 3.252p= n.s. 0.017 DV = credibility; IV = ad tonality 1.682 2.828p= n.s. 0.037 3.711 13.744p<0.001 0.089 DV = ad involvement; IV = ad tonality 0.132 0.018p= n.s. 0.021 2.768 7.664p<0.006 0.048 Wilks’lambdaF= 2.457,p<0.075F= 9.741,p<0.001 DV, dependent variable; IV, independent variable. 244J. L. Burtonet al. Copyright © 2015 John Wiley & Sons, Ltd.J. Consumer Behav.14: 237–247 (2015) DOI: 10.1002/cb The third-person (Golan and Banning, 2008; Grier and Brumbaugh, 2007) and boomerang (Fishbeinet al., 2002a, 2002b; Zhaoet al., 2006) effects are often blamed for the in- effectiveness of public service announcements. However, prior research shows that the third-person effect is greater when consumers have more experience performing the harm- ful behavior (Wolburg, 2006), and the message is negatively framed (Golan and Banning, 2008). Taken together, these results suggest and our research confirms that positively framed messages will work better for individuals heavily engaged in harmful behaviors. Another major contribution of this study is to isolate the different psychological processes occurring in persuasion for these two important targets of public service announce- ments. While credibility, ad involvement, and relatability are generally perceived as important mediators of public service announcement effectiveness (see meta analysis by Keller and Lehmann, 2008), our research shows that these mediators work differently in determining the behavioral intentions of heavy versus light engagers of harmful behav- ior. Light engagers perceive the negative imagery as more credible and involving but do not perceive the positive im- agery as more relatable. On the other hand, heavy engagers perceive the positive imagery as more relatable but do not perceive the negative imagery as more believable or involving. Practical implications The researchfindings have very important implications for advertisers designing campaigns to curb harmful behaviors in our society. These public service campaigns are often de- signed by non-profit agencies, governmental bodies, and even advertising agencies looking to make a difference in the community through theirpro bonowork. First, these agencies must determine what the primary objective of their public service announcement campaign should be: (1) to de- terfirst-time behavior, (2) to limit the behavior of heavy users, or (3) a combination of both. Many agencies pursue both goals simultaneously with a single campaign, which the present research suggests may be ineffective. If the goal is to deterfirst-time behavior, then a campaign should feature a strong message featuring the negative consequences of the harmful behavior along with a solution on how to avoid the bad outcomes depicted. If the goal is to limit the behavior of heavy users, the campaign should feature characters and situations to which the heavy user can relate, along with a call to action that will convince these users to limit their harmful behavior. If the objective is to accomplish both, an agency should consider creating two separate campaigns and use effective media planning strategies to reach the heavy engagers with one campaign and light engagers with the other campaign. Limitations and future research As with any research, this study has some limitations that open the doors for potential future research. First, it is important to recognize that the current research focused on public service announcements designed to prevent or limit harmful behaviors. Therefore, it is important not togeneralize the results on the impact of positive and nega- tive imagery to other types of public service announce- ments such as those designed to solicit donations for important causes or encourage proactive health behaviors such as visiting a doctor or following a particular diet. Future research can use a similar experimental design to test the generalizability of these results to other types of public service announcements. Second, while the positive and negative imagery used in this study tried to emphasize positive and negative aspects of engaging in a harmful behavior, another interesting ave- nue would be to explore whether the positive imagery should depict the positive consequences of not engaging in a harm- ful behavior. We focused on the positive consequences of en- gaging in the behavior (which is a bit counter intuitive) mainly because prior research emphasizes the importance of characters and situations to which people can relate (Grubeet al., 1996; Van Steeet al., 2012). Examining which type of positive imagery would be more effective on light and heavy engagers of harmful behavior is an interesting di- rection for future research. Finally, while we establish the extent to which an individ- ual engages in a harmful behavior as an important moderator of the effectiveness of positive and negative imagery in pub- lic service announcements, future research should explore other potential moderators. Other potential moderators of public service announcement effectiveness could be individ- ual personality characteristics such as reactance or risk seek- ing or even individual experiences such as being or knowing a victim of such harmful behaviors. BIOGRAPHICAL NOTES Dr Jennifer L. Burtonis in herfirst year as a faculty member in the Department of Marketing at High Point University. Her main re- search interests are marketing communications, consumer decision making, and consumer affect. She has a PhD in Marketing from the University of Texas at Austin, MBA in Brand Management from Wake Forest University, and BA in Spanish and Criminal Jus- tice from Indiana University. Prior to entering academia, she worked for 6 years in product and marketing management in the telecommunication and industrial equipment industries for global companies such as MCI and Harris Group Incorporated. Dr Donna J. Hillis a Professor of Marketing, Emeritus at Bradley University where she taught Services Marketing, Marketing Research, Retail Management, and Professional Services Marketing. Her research has appeared in theJournal of Retailing,Journal of Service Research,Journal of Services Marketing,Journal of Consumer Policy, The Journal of Marketing Theory and Practice,The Journal of Applied Business Research,Journal of Marketing Management,Journal of Retailing and Consumer Services, andJournal of Consumer Satis- faction, Dissatisfaction and Complaining Behavior. She received her PhD in Marketing from Indiana University, MBA from Ball State University, and BA from Indiana University. Aysen Bakiris a Professor of Marketing at Illinois State University. She received her PhD from the University of Mississippi. Her primary research includes children’s advertising, gender roles, and cross-cultural consumer behavior. 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LITERATURE REVIEW (12-16 pages) This essay is basically synthesizing 10 sources to support the new research im proposing that needs to be done. The sources needs to be categorized into 3/4 subheadings
Drug information–seeking intention and behavior after exposure to direct-to-consumer advertisement of prescription drugs Yifei Liu, M.S. a,* , William R. Doucette, Ph.D. a, Karen B. Farris, Ph.D. a, Dhananjay Nayakankuppam, Ph.D. b aPharmaceutical Socioeconomics, S-532 PHAR, College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA bDepartment of Marketing, Henry B. Tippie College of Business, University of Iowa, Iowa City, IA 52242, USA Abstract Background:Concerns about direct-to-consumer advertisement’s (DTCA’s) in- formation quality have raised interest in patients’ drug information–seeking after DTCA exposure. Objective:To identify predictors of patients’ intentions and behaviors to seek drug information from physicians, pharmacists, and the Internet after DTCA exposure, using theories of planned behavior and self-efficacy. Methods:One thousand patients were randomly selected from 3,000 nationwide osteoarthritic patients. A self-administered survey examined predictors of intention including measurements of attitude toward behavior, subjective norm, perceived difficulty, self-efficacy, controllability, self-identity, intention, exposure to ads, and control variables. After 6 weeks, another survey measured respondents’ information- seeking behavior. For patients exposed to DTCA, 6 multiple regressions were * Corresponding author. Tel.:C1 319 335 7960; fax:C1 319 353 5646. E-mail address:[email protected](Y. Liu). 1551-7411/$ – see front matter 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.sapharm.2005.03.010Research in Social and Administrative Pharmacy 1 (2005) 251–269 performed for information-seeking intention and behavior for 3 information sources: physicians, pharmacists, and the Internet. Results:The response rates were 61.9% and 80.1% for the first survey and the second survey, respectively. Four hundred and fifty-four participants reported exposure to DTCA about arthritis prescription medicines in the previous month. Over 41% of the variance in intention and over 18% of the variance in behavior were explained by the regression procedures. The consistent positive predictors of intention were attitude toward behavior, self-identity, attitude toward DTCAs of arthritis medication, and osteoarthritis pain; while the consistent positive predictors of behavior were intention and osteoarthritis pain. The strongest predictors of intention were self-identity for physicians, subjective norm for pharmacists, and attitude toward behavior for the Internet. Perceived difficulty and self-efficacy did not predict intention, and self-efficacy and controllability did not predict behavior. Conclusions:DTCA-prompted drug information–seeking may be under patients’ complete volitional control. To promote information searching, efforts could be made to affect factors predicting intention. Interventions could address patients’ attitude toward behavior, the influence of their important others, and their role as information seeker, respectively, for information sources like the Internet, pharmacists, and physicians. 2005 Elsevier Inc. All rights reserved. Keywords:DTCA; Drug information; Self-care; Theory of planned behavior; Self-efficacy 1. Introduction The last decade is witness to rapid growth of direct-to-consumer advertisement (DTCA) of prescription drugs. The pharmaceutical industry’s annual investment in DTCA in the Unites States grew from $965 million in 1997 to $2.7 billion in 2001. 1,2 In 1999, it was estimated that on average Americans saw 9 prescription drug ads per day. 3In addition, approximately 86% of all US consumers recalled seeing or hearing a DTCA during a 6-month period in late 2001. 4 One concern with DTCA is that its information quality may be poor, especially regarding risks and benefits. 5-7 Between January 1997 and November 2002, the Food and Drug Administration issued 564 regulatory letters to pharmaceutical manufacturers, with regard to false or misleading DTCA. 6The main violations included minimizing the advertised drug’s risks, inadequate labeling information, misleading efficacy claims, and misleading superiority claims. Concerns regarding DTCA’s information quality raise interest in consumers’ drug information–seeking following exposure to DTCAs. That is, what types of consumers and to what extent 252Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 are consumers seeking additional drug information to supplement and perhaps clarify information included in DTCA? We know that around 40% to 50% of patients seek further drug information from any information source after DTCA exposure. 8Physi- cians are the most common information sources for patients, pharmacists are the second most common source, and the Internet is the fastest growing source. 8Despite the prevalence of consumers’ information-seeking after DTCA exposure, there has been little theory-guided investigation of it. The extant literature does not identify key influences on consumers’ information- seeking after viewing advertisements about prescription drugs. Further- more, no study has proposed or applied a theoretical model to address DTCA information–seeking from any information source. A theoretical approach is important to use because efforts to stimulate the performance of this behavior beyond 40% of exposed individuals may be inefficient and fail to overcome barriers until the causal factors are revealed. The objective of this study was to identify predictors of patients’ intentions to seek drug information and their self-reported drug in- formation–seeking behavior after DTCA exposure. We conducted this study in patients with osteoarthritis considering information-seeking from physicians, pharmacists, and the Internet, using the theories of planned behavior (TPB) and self-efficacy. 2. Theoretical approach Patients’ drug information–seeking after seeing/hearing DTCA can be regarded as a health behavior. One of the most influential theories to examine health behaviors is the TPB. 9According to TPB, the principal determinant of a person’s behavior is behavioral intention. 10,11 The individual’s intention to perform a behavior is determined by attitude toward performing the behavior and subjective norm. In addition TPB is used to explain behavior which is not under an individual’s complete volitional control by including the construct perceived behavioral control (PBC). 10,11 Perceived behavioral control is important in DTCA-prompted drug information–seeking because factors such as time, source availability, and patients’ inability to articulate questions and understand feedback may be barriers to this health behavior. 12,13 Another influential theory in the field of health behavior is self-efficacy theory. 9Its tenet is that psychological and behavioral change operate through the alteration of the individual’s self-efficacy. 14-16 Self-efficacy is ‘‘beliefs in one’s capabilities to organize and execute the courses of action required to produce given levels of attainment.’’ 17 This theory is important to DTCA-prompted drug information–seeking because low self-efficacy may be a barrier to this behavior. 253 Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 Self-efficacy is the original template for PBC and is most compatible with PBC. 11 Perceived behavioral control was theorized to account for situations in which people do not have full volitional control over the behavior of interest. 11But PBC was also defined as ‘‘the person’s belief as to how easy or difficult performance of the behavior is likely to be.’’ 18 However, perceptions of ‘‘under my control/not under my control’’ and ‘‘ease/ difficulty’’ are not necessarily the same. 19 There are 2 ways to measure PBC, indirect measures and direct measures.20 Perceived behavioral control has been directly measured in 3 ways including self-efficacy, perceived difficulty, and controllability. 19,21-29 It is found that self-efficacy and perceived difficulty predicted intentions as well as behaviors, and controllability predicted behaviors. 19,22,24,26,28,30 In this study, self-efficacy and perceived difficulty were hypothesized to impact intention. 19,21-28,30 Self-efficacy and controllability were hypothesized to impact behavior. 21-26,29,30 In addition to constructs from the TPB and self-efficacy, self-identity was added to the explanatory model in this study. Self-identity is the extent to which individuals perceive themselves to assume a particular societal role. 21 We added this concept because it provided additional explanatory power for intentions in previous studies using TPB. 31It may be especially important to consider in this context because patients might perceive themselves to have the role of information seeker due to influence of DTCA. Therefore, the final explanatory model included constructs from the TPB, self-efficacy, and self-identity (Figure 1). Based on the openness of TPB to include additional variables, 11 control variables were regarded as ‘‘individual difference Intention Perceived difficulty Controllability Self-efficacy (confidence) Subjective norm Self-identity Behavior H5 H3 H6H7 H8 H4H2H1* Attitude toward behavior Figure 1. Proposed model for consumer information search. *H1 means Hypothesis 1. In this figure, arrows represented the study hypotheses. Each hypothesis was positive unless otherwise indicated. Perceived difficulty was reversely measured as perceived ease (Appendix A), so H3 was also positive. 254Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 variables’’ to account for variance in intention and behavior due to differences in demographic and other characteristics among individuals. 32 3. Methods 3.1. Study design The study consisted of 2 self-administered mail surveys. Two surveys were conducted to establish temporal relationship between intention and behavior for causal explanation. The first 35-item survey assessed attitude toward behavior, subjective norm, self-efficacy, perceived difficulty, con- trollability, self-identity, intention, exposure to ads, and control variables. In the second 2-item mail survey, information-seeking behavior was measured for respondents to the first survey. The time interval between the 2 surveys was 6 weeks. 33,34 A pilot test of the first survey was conducted with 100 subjects randomly chosen from the sample frame. The results of the pilot test were used to refine sample size, study procedures, and the measurements. 3.2. Study population and sample Osteoarthritis is a common condition for DTCA-associated visits. 1,35 The study population comprised osteoarthritic patients. The sampling frame was a mailing list purchased from KM Lists Inc. of patients taking Celebrex , Tylenol , Ibuprofen, Advil , Motrin , and Aleve . A list of 3000 osteoarthritic patients was provided, with 500 patients per antiarthritis medication. The sample size, 1000, was estimated by the calculation method for simple random sampling. 36 The formula is nRz 2!(1 P)/ (3 2!P), where n is the sample size,zis the reliability coefficient (zZ1.96 for a 95% confidence level),3is set by investigator to make sure that sample estimatedshould not differ in absolute value from the true unknown population parameterDby more than3!D(3was set to be 0.15), andPis the proportion of respondents who would be prompted by DTCA to seek further information (Pwas 46%). 4,36 3.3. Measures and data collection Both surveys applied the tailored design method by Dillman 37 and included 4 contacts with subjects: a precontact letter, a survey package, a reminder card, and another survey package for nonrespondents. Each survey package included a personalized cover letter, a survey, and a stamped return envelope. All survey items were derived from reliable and valid multi- item instruments (Appendix A). 8,21-23,25-27,38,39 Direct measures for con- structs of the TPB such as attitude toward behavior, subjective norm, and 255 Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 PBC were used with 7-point response scales. 21-23,25-27 In most instances, concepts were measured with multiple items to improve reliability. All concepts were collected separately for the 3 information sources of interest in this study: physicians, pharmacists, and the Internet. Control variables were attitude toward DTCAs of arthritis medication, age, sex, ethnicity, education, use of antiarthritic medicines, use of gastric medicines, and osteoarthritis pain. 8,38,40-42 3.4. Data analysis Overall measures of the TPB constructs, self-identity, attitude toward DTCAs of arthritis medication, and osteoarthritis pain were calculated for each information source for each person exposed to DTCA by taking the mean of the corresponding items. The frequency, means, standard deviations, and bivariate correlations for measured variables were calcu- lated. Reliability analysis was performed for multiple-item measurements. There were 8 theory-driven hypotheses tested in this study (Figure 1). Each arrow in the model represents a specific hypothesis. For example, H1 (Hypothesis 1) stated that there was a significant positive association between attitude toward behavior and intention. Six multiple regressions were conducted for those exposed to DTCA to test the hypotheses and identify predictors of intention and behavior for each information source. Subjective norm, controllability, and self-identity had low item-item correlations (!0.7) (Table 1). To run the regression analyses with these variables, a single item with the largest variability was selected to capture more variance of intention and behavior (Appendix A). Cases with missing data were not included in the regression analyses. All analyses were conducted by Statistical Package for the Social Sciences (SPSS) 12.0 (SPSS Inc., Chicago, Ill). 4. Results Among the 1000 first surveys, there were 607 (61.9%) usable surveys returned, with 20 undeliverable or unusable surveys. Among the 607 second surveys, 486 (80.1%) usable surveys were returned. The average respondent was more than 45 years old, female, white, high school educated, and had regular Internet access (Table 2). Three quarters (454) of the respondents to the first survey were exposed to ads about arthritis prescription medicines in the previous month. Nearly 70% of first survey respondents took antiarthritic medications in the previous 2 weeks. Among those who took antiarthritic medicines, 15% took medications to relieve gastric pain by nonsteroidal anti-inflammatory drugs. 256Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 The participants exposed to DTCA who had a score above 4.0 on a 1 to 7 scale for measurement of intention were regarded as intenders, and those who had a score above 4.0 on a 1 to 7 scale for measurement of behavior were regarded as information seekers. Compared with the percentage of information seekers in national surveys (40%-50%), 8the percentage of intenders and information seekers was low (Table 3). In addition, respondents had low intention to seek information across information sources. All 6 regression models with participants exposed to DTCA were significant (Table 4), accounting for 41% to 50% of the variance in intentions and 18% to 20% of the variance in information-seeking behavior. For information-seeking from physicians, the significant positive predictors of intentions were attitude toward behavior, subjective norm, self-identity, attitude toward DTCAs of arthritis medication, and osteoarthritis pain; while the significant negative predictor was Internet access. Self-identity was the strongest predictor for intention. For behavior, the significant positive predictors were intention and osteoarthritis pain, and intention was the strongest predictor. Table 1 Reliability analysis of multiple-item measurements N items Internal consistency Behavior survey Behavior for physicians 2 0.825 Behavior for pharmacists 2 0.816 Behavior for the Internet 2 0.862 Intention survey Intention for physicians 2 0.810 Intention for pharmacists 2 0.770 Intention for the Internet 2 0.827 Attitude for physicians 2 0.842 Attitude for pharmacists 2 0.810 Attitude for the Internet 2 0.869 Subjective norm for physicians 2 0.380 Subjective norm for pharmacists 2 0.380 Subjective norm for the Internet 2 0.604 Perceived difficulty for physicians 3 0.772 Perceived difficulty for pharmacists 3 0.724 Perceived difficulty for the Internet 3 0.765 Self-efficacy for physicians 3 0.825 Self-efficacy for pharmacists 3 0.832 Self-efficacy for the Internet 3 0.896 Controllability for physicians 2 0.370 Controllability for pharmacists 2 0.435 Controllability for the Internet 2 0.723 Self-identity for physicians 2 0.517 Self-identity for pharmacists 2 0.490 Self-identity for the Internet 2 0.435 Attitude toward DTCAs of arthritis medication 2 0.748 Item-item correlation for 2-item measurements; Cronbach’safor 3-item measurements.257 Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 For information-seeking from pharmacists, the significant positive predictors of intention were attitude toward behavior, subjective norm, self-identity, attitude toward DTCAs of arthritis medication, and osteo- arthritis pain, with subjective norm being the strongest predictor. For information-seeking behavior, the significant positive predictors were intention and osteoarthritis pain, with intention being the strongest predictor. Table 2 Participants’ demographic characteristics Demographic characteristics Valid response (N) a Percent Age 18-24 11 1.82 25-34 23 3.80 35-44 72 11.90 45-54 167 27.60 55-64 171 28.26 O64 161 26.61 Total 605 100 Sex Male 165 27.18 Female 442 72.82 Total 607 100 Ethnicity White 555 91.89 Nonwhite 49 8.11 Asian 4 0.66 Latino 4 0.66 American Indian 7 1.16 Black 28 4.64 Other 6 1.00 Total 604 100 Education Below or some high school 37 6.12 Graduated high school 215 35.60 Some post high school 182 30.13 Graduated 4-year college 110 18.21 Masters, PhD or professional degree 60 9.93 Total 604 100 Access to the Internet No 168 28.00 Yes 432 72.00 Total 600 100 aValid response varied because of missing data. 258Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 For information-seeking from the Internet, the significant positive predictors of intention were attitude toward behavior, self-identity, attitude toward DTCAs of arthritis medication, and osteoarthritis pain, with attitude toward behavior being the strongest predictor. For behavior the significant positive predictors were intention and osteoarthritis pain, with intention being the strongest predictor. 5. Discussion In the proposed models, 41% to 50% of the variance in intention and 18% to 20% of the variance in information-seeking behavior were explained by regression models across information sources. This is consistent with previous research findings. On average, TPB accounted for 40% to 50% of the variance in intention and 19% to 38% of the variance in behavior in previous studies. 43 Predicting behavior appears more difficult because intention may change before performance of behavior. 43 For information-seeking from physicians, self-identity was the strongest predictor of intention. Individuals who view themselves as information seekers are more likely to have intentions to seek information from physicians. In DTCA, patients are encouraged to talk with their physicians about the advertised medication. In fact, physicians are the most common information source for patients. 8It is likely that patients’ roles as information seekers get strengthened through frequent interactions with physicians, and this role also stimulates them to intend to seek information from physicians. In addition, others’ expectations and appraisals with this information- seeking role may support a person’s self-identity about that role. 44 For information-seeking from pharmacists, subjective norm was the strongest predictor of intention. Pharmacists have a good reputation as health professionals, and informing patients about the benefits and risks of advertised drugs could be viewed as one part of pharmaceutical care. Their advice is also less costly to patients compared with obtaining advice from physicians. When patients ask their reference group about information sources, especially for drug costs, 41 pharmacists are typically the most likely source to be recommended. Table 3 Descriptive statistics of the dependent variables for participants exposed to DTCA Dependent variables N Item mean a Standard deviation % (O4.0) Intention for physicians 445 3.57 2.14 33.9 Intention for pharmacists 426 3.04 1.95 23.5 Intention for the Internet 405 3.08 2.06 24.2 Behavior for physicians 359 2.57 1.76 13.1 Behavior for pharmacists 352 2.48 1.66 12.8 Behavior for the Internet 338 2.48 1.84 14.5 a1 to 7 response scale.259 Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 For information-seeking from the Internet, attitude toward behavior was the strongest predictor of intention. Instead of contacting physicians and pharmacists, patients could search information anytime when they were on the Web. Actually, information-seeking from the Internet involves the least social interaction with others, which means more privacy for patients. In addition, most study subjects were over 45 years, and older patients have increasingly used the Internet for self-education. 45 Once patients regard information-seeking on the Internet as enjoyable, they are very likely to have the intention to perform the behavior. Table 4 Prediction of intention and behavior to seek drug information following DTCA exposure Intention Behavior Dependent variablePhysicians (nZ375)Pharmacists (nZ362)Internet (nZ341)Physicians (nZ311)Pharmacists (nZ294)Internet (nZ279) Regression model AdjustedR 2 0.504 0.479 0.406 0.180 0.188 0.200 df14, 360 14, 347 14, 326 12, 298 12, 281 12, 266 F 28.186 a 24.669 a 17.631 a 6.674 a 6.637 a 6.781 a Standardizedb Construct measurements Attitude toward behavior.146 a .192 a .286 a Subjective norm .253 a .366 a .027 Perceived difficulty .047 .056 .012 Self-efficacy .034 .001 .118 .077 .134 .045 Self-identity .269 a .164 a .258 a Intention .327 a .390 a .417 a Controllability .013 .065 .027 Control variables Attitude toward DTCAs of arthritis medication0.199 a 0.166 a 0.135 a 0.063 0.031 0.010 Age 0.022 0.037 0.074 0.022 0.004 0.041 Sex 0.009 0.034 0.018 0.063 0.038 0.055 Ethnicity (white or not) 0.019 0.012 0.039 0.032 0.001 0.040 Education 0.037 0.022 0.039 0.024 0.044 0.054 Arthritis medications use 0.004 0.016 0.058 0.057 0.007 0.088 Gastric medications use0.031 0.005 0.082 0.066 0.052 0.044 Osteoarthritis pain0.153 a 0.113 b 0.106 b 0.207 a 0.174 a 0.192 a Access to the Internet 0.080 b 0.059 0.065 0.062 0.006 0.089 Number of cases varied because of missing data. aSignificant at .01.bSignificant at .05. 260Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 Across information sources, attitude toward DTCAs of arthritis medication had a significant positive influence on intention. This variable was about the usefulness of information in DTCA (Appendix A). When patients think the information in DTCA is useful, they might want to confirm its usefulness by seeking more information from physicians, pharmacists, and the Internet. Although Fishbein and Ajzen 46 stated that attitude toward an object was a less powerful predictor for behavior than attitude toward the object-related behavior, this study suggests that attitude toward object could be categorized as one individual difference variable to account for more variance in intention under TPB. 32 Osteoarthritis pain had a significant positive impact on both intention and behavior. This finding suggests that DTCA has a role in a patient’s self- care activities if the patient has symptoms. When osteoarthritic patients feel pain, they are more likely to be driven by DTCA to seek drug information. Seventy-two percent of first survey respondents had Internet access, which is comparable to 75%, the percentage of Internet access in US homes. 47 Internet access had a negative effect on patients’ intentions to seek information from physicians. This suggests that the Internet could be a substitute for physicians as an information source, because it is less expensive and more convenient. However, there was no effect of Internet access on actually seeking information from physicians. In addition, the substitution effect contradicts previous research indicating that the Internet is complementary to physicians as an information source. 48 Future research is needed to better understand the relationship between the Internet and physicians as information sources. There was no significant relationship between intention and PBC measurements like self-efficacy and perceived difficulty. There was no significant relationship between behavior and PBC measurements such as self-efficacy and controllability. These findings suggest that information- seeking is a behavior under patients’ complete volitional control, which means that patients do not have barriers for the behavior. Another possible reason for these findings is that the barriers associated with information- seeking did not appear concrete or imminent to participants given the time interval between the 2 surveys. Intention was the strongest predictor for behavior for each information source. Because there were no apparent barriers for the behavior, it is likely that osteoarthritic patients will search for more information once they have an intention to do so. The participants exposed to DTCA in this study had low intentions to seek drug information after DTCA exposure. They also showed a favor- able attitude toward DTCAs of arthritis medication, with a mean of 4.78 on a 7-point scale. These findings indicate that they may believe that information quality of DTCA is good or may be unaware of risk information of cox-2 inhibitors or other nonsteroidal anti-inflammatory drugs. Actually, 20% to 50% of the public believes DTCA quality is guaranteed by regulation, and 33% are unaware of drug ‘‘brief 261 Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 summary’’ information, which includes risks and side effects. 49,50 In fact, promotion campaigns for Vioxx and Celebrex were warned by the Food and Drug Administration for providing incomplete, unbalanced, and misleading information. 51-53 Concerns about cardiovascular risk associated with cox-2 inhibitors were raised. 54 Yet, Merck omitted the increased cardiac danger in its DTCA promotion. 51 The issues of cardiovascular safety led Merck to withdraw the drug from the market on September 30, 2004. 55 Later, it was reported that patients taking large doses of Celebrex daily also had a 2.5 times increased cardiovascular risk compared with placebo users. Although Pfizer maintained Celebrex on the market, it stopped all DTCA of Celebrex .56 The consistent positive predictors of intention were attitude toward behavior, self-identity, attitude toward DTCAs of arthritis medication, and osteoarthritis pain, and the consistent positive predictors of behavior were intention and osteoarthritis pain. To promote information search, efforts could be made to affect factors predicting intention. Health professionals could personalize their service to make patients feel that the experience of information-seeking after DTCA exposure is pleasant. Health-related Web sites could make their sites more user friendly to allow patients to enjoy information searching on the Internet. Pharma- ceutical industry, health plans, and health professionals could encourage osteoarthritic patients to take the role as information seeker, especially those who suffer from pain. Particularly they could emphasize the message that ‘‘patients are drug information seekers’’ or ‘‘patients are expected to search for more information after seeing this ad.’’ Besides in DTCA, they could put the message where the patients have easy access such as Web sites, physician’s offices, and pharmacies. Future research to examine DTCA-prompted behaviors could borrow this study’s theoretical models as a framework. Self-identity should be highlighted because DTCA might give the public different societal roles. For example, driven by DTCA, besides the role of drug information seeker, consumers might also think they have the roles to ask about advertised medical conditions and request prescriptions. For studies to address DTCA-prompted drug information–seeking, the theory of reasoned action instead of TPB could be applied, because this behavior appears to be under patients’ complete volitional control. 6. Limitations Subjects were a convenience sample and were willing to be contacted by any party associated with KM Lists Inc. These patients might have different attributes from other osteoarthritic patients in the population, which limits the generalizability of the study results. First, these patients might be more open and more responsive to any contact. Second, affiliation with the list 262Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 company might give them more exposure to pharmaceutical commercials/ drug information. On one hand, they might have a more favorable attitude toward DTCA. Conversely, they might have already performed informa- tion-seeking and might not do it in the future. The 2-item measures of subjective norm, controllability, and self-identity were derived from previous multi-item instruments but exhibited low reliability in this study. Therefore, a single item with the largest variability was chosen to represent them in the regression analyses. However, this procedure raises concern about construct validity for these theoretical constructs, ie, the operationalization of the single item might not represent the corresponding construct well. Future studies measuring these constructs need to use more items from reliable and valid instruments. There were 2 other limitations in this study. First, the 2 surveys were self- administered, so there might be recall bias for some measurement items capturing events in the past, such as behavior, use of antiarthritic drugs, use of gastric drugs, and exposure to ads. Second, nonresponse bias might occur. Those who suffered from severe/extreme pain while filling out the surveys might have not responded. In addition, this study only focused on 3 information sources, physicians, pharmacists, and the Internet, while ignoring other information sources like relatives, friends, neighbors, nurses, and reference books. Those who depended on other information sources might not have responded, either. 7. Conclusions The TPB was useful in examining patients’ drug information–seeking from physicians, pharmacists, and the Internet after DTCA exposure. The strongest predictors of intention to seek information from various sources were self-identity with respect to physicians, subjective norm with respect to pharmacists, and attitude toward the behavior with respect to the Internet. The difference in findings reflected unique attributes of each information source in patients’ information-seeking. There were reportedly few barriers to performing the behavior. Intention was the strongest predictor of behavior. 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Construct measures Attitude toward behavior (1) ‘‘For me, trying to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources during the next six weeks is’’ (‘‘1Zunpleasant’’ and ‘‘7Zpleasant’’); (2) ‘‘For me, trying to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources during the next six weeks is’’ (‘‘1Zunenjoyable’’ and ‘‘7Zenjoyable’’). Subjective norm (1) ‘‘People who are important to me would disapprove/approve of my trying to get more information about a medication from each of the following sources during the next six weeks’’ (‘‘1Zdisapprove’’ and ‘‘7Zapprove’’); [Item used in intention regressions for the Internet] (2) ‘‘People who are important to me think I should/should not try to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources during the next six weeks’’ (‘‘1Zshould not’’ and ‘‘7Zshould’’). [Item used in intention regressions for physicians and pharmacists] 266Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 Perceived difficulty (1) ‘‘For me, during the next six weeks, trying to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources would be’’ (‘‘1Zextremely difficult’’ and ‘‘7Zextremely easy’’); (2) ‘‘If I wanted to, during the next six weeks, it would be easy for me to try to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources’’ (‘‘1Zstrongly disagree’’ and ‘‘7Zstrongly agree’’); (3) ‘‘If I wanted to, during the next six weeks, it would be difficult for me to try to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources’’ (‘‘1Zstrongly disagree’’ and ‘‘7Zstrongly agree’’). Controllability (1) ‘‘During the next six weeks, it is entirely up to me whether or not I try to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources? (‘‘1Zstrongly disagree’’ and ‘‘7Zstrongly agree’’); (2) ‘‘How much personal control do you feel you have over trying to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources during the next six weeks’’ (‘‘1Zno control’’ and ‘‘7Zcomplete control’’); [Item used in behavior regressions for physicians, pharmacists and the Internet] Self-efficacy (1) ‘‘If you wanted to, how confident are you that you will be able to try to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources during the next six weeks?’’ (‘‘1Znot very confident’’ and ‘‘7Zvery confident’’); (2) ‘‘If you wanted to, to what extent do you see yourself as being capable of trying to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources during the next six weeks?’’ (‘‘1Zvery incapable’’ and ‘‘7Zvery capable’’); (3) ‘‘If I wanted to, I believe I am able to try to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources during the next six weeks’’ (‘‘1Zdefinitely do not’’ and ‘‘7Zdefinitely do’’). Self-identity (1) ‘‘To what extent does trying to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources during the next six weeks affect you’’ (‘‘1Zdoes not affect’’ and ‘‘7Zdoes affect’’); [Item used in intention regressions for physicians and pharmacists] 267 Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 (2) ‘‘Quite frankly, I don’t care about trying to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources during the next six weeks’’ (‘‘1Zstrongly disagree’’ and ‘‘7Zstrongly agree’’); [Item used in intention regressions for the Internet] Intention (1) ‘‘I intend to try to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources during the next six weeks’’ (‘‘1Zdefinitely do not’’ and ‘‘7Zdefinitely do’’); (2) ‘‘I plan to try to get more information about a medication for an advertised antiarthritic prescription medicine from each of the following sources during the next six weeks’’ (‘‘1Zdefinitely do not’’ and ‘‘7Zdefinitely do’’). Behavior (1) ‘‘Within six weeks after completing the first survey, I got more information about a medication for an advertised antiarthritic pre- scription drug from each of the following sources’’ (‘‘1Zstrongly disagree’’ and ‘‘7Zstrongly agree’’); (2) ‘‘Within six weeks after completing the first survey, how frequently did you get more information about a medication for an advertised antiarthritic prescription drug from each of the following sources’’ (‘‘1Znever’’ and ‘‘7Zextremely frequently’’). Part 2. Control variables Attitude towards DTC arthritis medication ads ‘‘Advertisements for antiarthritic prescription medicines help me have better discussions with my health providers about my health’’ (‘‘1Zstrongly disagree’’ and ‘‘7Zstrongly agree’’); ‘‘Advertisements for antiarthritic prescription medicines help me make better decisions about my health’’ (‘‘1Zstrongly disagree’’ and ‘‘7Zstrongly agree’’). Arthritis medication use ‘‘In the past two weeks, did you take any medicine to relieve arthritis pain?’’ Gastric medication use ‘‘In the past two weeks, did you take any medicine to relieve stomach upset caused by medications like Naproxen, Ibuprofen, Diclofenac?’’ 268Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269 Access to the Internet ‘‘Do you have regular access to the Internet?’’ Osteoarthritis pain* ‘‘Please put the number in the blank to best describe the pain you currently experience in a typical day during that activity: (a) Walking on flat surface; (b) Going up or down stairs; (c) At night while in bed; (d) Sitting or lying; (e) Standing upright’’ (0Znone, 1Zslight, 2Z moderate, 3Zsevere and 4Zextreme). Note: *Pain of activities was measured by the 5-item subscale of The Western Ontario and McMaster University Osteoarthritis Index (WO- MAC). Part 3. Exposure to ads ‘‘In the past month, did you see or hear any advertisement for antiarthritic prescription drug?’’ 269 Y. Liu et al. / Research in Social and Administrative Pharmacy 1 (2005) 251–269
LITERATURE REVIEW (12-16 pages) This essay is basically synthesizing 10 sources to support the new research im proposing that needs to be done. The sources needs to be categorized into 3/4 subheadings
50 Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. ABSTRACT The effective media strategy in advertising is gradually becoming the premise of company that lives in the competition of marketing. Due to the rapid growth of new advertising media and technologies, it is possible for a firm to precisely target advertising to the potential consumer segment within a market. This research explores the extent to which an advertiser should regulate the quality of its targeting and effect on consum- ers’ surplus and social welfare. The authors present a theoretic model measuring the targeting quality of internet-based targeted advertising with two measures termed accuracy and recognition. Accuracy measures the possibility of correct prediction in the target segment, while recognition is defined as the probability that any member of the targeted segment is identified. The authors demonstrate, within a monopolistic framework, the online targeted advertising might lower or increase both consumers’ surplus and social welfare compared with mass advertising, which depends on different range of accuracy and recognition in the social media. The recognition of internet-based targeted advertising plays a positive role on equilibrium price, whereas the accuracy plays a negative role in the regulation of advertising intensity and equilibrium price. Therefore, it is believed that the accuracy and recognition of the online targeted advertising can be used as a lever for the strategic segmentation of a market. Bidirectional Role of Accuracy and Recognition in Internet-Based Targeted Advertising Jiang Zhao, School of Economics and Management, Southeast University , Nanjing, China Shu-e Mei, School of Economics and Management, Southeast University , Nanjing, China Wei-jun Zhong, School of Economics and Management, Southeast University, China Keywords: Accuracy, Internet-Based Targeted Advertising, Mass Advertising, Price Competition, Recognition 1. INTRODUCTION Advertising is one of the most critical marketing strategies for a firm, and the largest element of advertising spending is media purchasing (Aaker, 1968). The informative view of advertis – ing claims that in many markets, firms invest in advertising to create awareness for products, prices, attributes and special offers to otherwise uninformed potential consumers. Therefore, it is always a great challenge to buy the media effectively and not direct toward the “wrong people”. As a classic concern goes by John Wanamaker in 19 th century, “Half the money I DOI: 10.4018/jeco.2015010104 Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 51 spend on advertising is wasted and the trouble is I don’t know which half” (Dellarocas, 2012, p.1178). Traditionally, the objective in media planning is to minimize wasted advertising by reducing the quantity of advertising sent to the consumers who will probably never buy the product. However, throughout a variety of technological advances, the internet provides many firms with an unparalleled ability to precisely target advertising towards the po- tential consumer segment within a market. In particular, the targeting improves the quality of the match between the consumer and the advertisement message (Bergemann& Bonatti, 2011). Currently, within the internet-based tar- geting techniques including IP address tracking and the analysis of cookies, the consumers’ preference and potential demands can be eas- ily obtained across many different websites and search engines (Rutt, 2012). That means the firm can send the internet-based targeted advertising via online platforms to the potential consumers with great accuracy. For instance, social network websites, such as Google and Facebook, can roughly reveal an individual’s current interests by tracing his/her recent web- browsing activities, and then directly provide the advertisements of relevant products that might interest him/her. As reported in a previous study, a potential consumer cannot be an actual buyer unless the firm invests in advertising for the sales (Stahl, 1994). The effective media strategy in advertis – ing is gradually becoming the critical premise of the company that lives in the competition of marketing. However, due to the expensive spending on mass advertising through national TV or newspapers, firms are increasingly active in the use of internet-based targeted advertising while selling products to the loyal consumers (Iyer et al., 2005; Gal-Or et al., 2006).Given that advertisers are motivated to pursue the internet-based targeted advertising, the objec – tive of our study is to understand the following questions: when the firms have the ability to choose different targeting levels to different consumer segments, how they allocate their advertising? Whether the higher of targeting ability is, the better social benefits can obtained when compared to mass advertising? What is the primary role of targeting quality of internet- based targeted advertising on the products? For these purposes, we first present a model to analyze the role of recognition and accuracy of internet-based targeted advertising on firm’s equilibrium price and profit in monopolistic framework, and then develop the model on the optimization of the investment on the two measures of imperfect targeting. A first output of this paper is to discover the bidirectional role of the two measures of internet-based targeted advertising, and the others, the effect of targeted advertising is not always better than mass advertising, which depends on the optimal choice of targeting qualities. In fact, even in the monopolistic market, the informative advertising is used for the introduction of products’ characteristics so as to enlarge the potential market and avoid the potential rival’s entry in the market. For instance, Microsoft’s operating system is nearly occupied the total personal computer market in China, still quite a large number of advertisements are sent to the consumers in China every year. The model addressed in this article fits well with previous studies on the impact of informative advertising on product information and pricing. In particular, Butters (1977) first proposes a message-sending model in markets for ho – mogenous goods, where advertising provides information about the existence of products and their characteristics. Later, Grossman and Shapiro (1984) extend the Butter’s model to the markets with horizontal differentiation via a circle model, and show that the decreased ad- vertising costs may reduce profits by increasing the severity of price competition. The similar models are established by Stahl (1994), Bester and Petrakis (1995), Hamilton (2004) and Celik (2007). One of the assumptions in these papers is that the advertising is uniform throughout the market. Hernández-García (1997) compares the targeted advertising and mass advertising within a monopolistic framework, and considers that the targeting might lower both consumers’ surplus and social welfare. Then Roy (2000) Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. 52 Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 establishes a model, within a homogeneous market, firms can target consumers, and com- pete on prices after observing the competitor’s advertising. Moreover, an infinite number of equilibrium is generated, which depends on significant coordination between firms. Later, Esteban et al. (2001) consider different levels of advertising to be directed at different segments within a market, and argue that the monopolist will direct heavier advertising weights to the consumers who are willing to pay more for the product, in such a way that the overall level of advertising falls with targeting. By contrast, this paper proposes similar results with Iyer et al. (2005), who demonstrate that the use of internet- based targeted advertising increases the market price and leads to higher profits when compared with mass advertising. Similarly, Johnson (2013) examines how the increasing ability of firms target their advertisements to particular individuals influences market outcomes when consumers have access to advertising avoidance tools, and confirms that the firms generally ben- efit from increased targeting. All these results indicate that the targeted advertising is better than mass advertising in cost savings due to its accurate targeting ability. However, there are still some controversies on the role of targeting ability in the firms’ equilibrium prices and profits while adopting targeted advertising for the sales. Galeotti and Moraga-Gonzalez (2003) present a strategic game of pricing and targeted advertising, and prove that the market is segmented only from time to time and presents substantial price dis- persion across segments. Gal-Or et al. (2006) introduce a bidimensional descriptor to evaluate the quality of the targeting termed accuracy and recognition, and demonstrate that the adver – tiser should choose to reduce its investment in recognition and increase its investment in ac- curacy while facing a competitor that pursues a strategy to improve its recognition of potential customers. Recently, Ben Elhadj-Ben Brahim et al. (2011) construct a model in which two horizontally differentiated firms compete in prices and targeted advertising on an initially uniformed market, and they prove that firm’s equilibrium profits may be lower with targeted advertising relative to mass advertising when the firm can perfect differentiate between cus- tomers choosing a possibly different advertising intensity for each consumer type. Likewise, Esteves and Resende (2013) also suppose that when the firms have the perfect targeting ability, the overall welfare and consumer welfare falls when firms use targeted advertising instead of mass advertising. Obviously, the assumption of perfect targeting is an ideal condition. In most con- dition, the firm only has imperfect targeting quality due to the consumers’ imperfect in- formation. Therefore, in this article, we use the accuracy and recognition to describe the targeting quality of imperfect internet-based targeted advertising, which avoids some limits of aforementioned assumption on the perfect targeted advertising and reveals better on the features of internet-based targeted advertising. Fortunately, previous studies on targeted pricing show us some clues. Chen et al. (2001) prove that when individual marketing is feasible, but imperfect, improvements in targetability by either or both competing firms can result in win-win competition for both even if both players behave noncooperatively. Then Chen and Iyer (2002) demonstrate that low address- ability and high levels of market differentiation both help reduce price competition, which facilitates symmetric choice of addressability by the firms in equilibrium. Likewise, Esteves (2010) investigates the competitive and welfare effects of information accuracy improvements in markets where firms can price discriminate after observing a private and noisy signal about a consumer’s brand preference, and argues that the firms charge more to customers they believe have a brand preference for them, and the price has an inverted-U shaped relationship with the signal’s accuracy. In similar results, Shaffer and Zhang (2002) explore the competitive effects of one-to-one promotions in a model with two com – petition firms where the firms differ in size and consumers have heterogeneous brand loyalty. They suggest that the optimal way to manage customer churn is to engage in both offensive Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 53 and defensive promotions with the relative mix depending on marginal cost of targeting. Then, Chen Y et al. (2009) consider that dynamic targeted pricing can benefit competing firms, when they actively pursue customer recognition based on consumer purchase history. However, the dynamic targeted pricing may not benefit for a monopolist. In a recent study, Zhang and Katona (2012) analyze the strategic aspects of contextual advertising, considering an interme- diary who has access to a content base, sells advertising space to advertisers who compete in the product market. Their results indicate that the intermediary lowers the targeting ac- curacy such that the consumers see less relevant advertisements when competition is high. That gives us a hint that the accuracy of advertising might be used as a lever for price competition. In this study, we are focused on the dif- ference between the internet-based targeted advertising and mass advertising in a monopo- listic framework. The remainder of the article is organized as follows. Section 2 introduces a basic model of mass advertising and imperfect internet-based targeted advertising. Section 3-6 explores the bidirectional role of accuracy and recognition in the equilibrium price, regulation of advertising intensity, consumers’ welfare and social welfare. Section 7 investigates the optimization of imperfect internet-based targeted advertising with mismatch lose. Sec- tion 8 extends the analysis of the optimized investment on the accuracy and recognition of internet-based targeted advertising. Section 9 concludes. The Appendix collects some formal proofs and the definitions of all the symbols. 2. LITERATURE AND MODEL SETUP 2.1. A Basic Model of Mass Advertising and Imperfect Internet- Based Targeted Advertising The informative advertising is used to stimulate the consumer’s demands. Even in the monopo- listic framework, the advertising is used to build the brand image of the product for the demands of consumers, which could be made as a bar – rier for the entry of other potential firms. Therefore, in order to simplify the study, we develop a mass advertising model of a market with only one monopolist as previous reported (Hernández-García, 1997). Suppose the firm chooses a price p for the product, and the potential demands for the product can be defined as q x p = ( ), but this will never be realized until the consumers are informed of its existence by advertising. In this framework, we are aimed to study whether the shift from mass advertis – ing to internet-based targeted advertising can affect the monopolistic firm’s supply of the products. We assume that the mass advertising is sent to the customers randomly and all con- sumers have the same probability of φ receiv – ing an advertisement. Moreover, A ( ) is de- fined as the per capita cost needed to reach the fraction φ and the marginal cost of advertising is increasing with the number of consumers. In addition, the marginal cost of advertising is increasing with the number of consumers reached, i.e. A ( ) 0 and A ( ) 0. These assumptions are in accordance with previous reports (Butters, 1977; Grossman and Shapiro, 1984). In this situation, both the price and the level of advertising are obtained in the firm’s strategy space. Then, the firm produces the product at a constant marginal cost of c. The firm’s maximum profit with mass advertising r ( ) is defined as follows: Ma x p c xp A r = ( ) ( ) ( ) (1) The first order condition (FOC) of the profits on price p and the fraction are shown in the following equations: = + = r p p c x p x p 0 0 ; ( ) () ( ) (2) Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. 54 Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 = = r p c x p A 0 0 ; ( ) () ( ) (3) In order to evaluate the impact of advertis – ing on the reaching consumers more accu- rately, it requires that we look at a parametric example of the cost function A ( ) φ . The sim- plest example is a quadratic functional form, which equals to multiplication of constant a and square of fraction φ as previous reported (Bester & Petrakis, 1996): A a ( ) = 2 2 (4) We denote the optimal price termed pr * and optimal reaching fraction as * for mass advertising. The firm’s pricing strategy is de- scribed in Equation (2), which shows a simple inverse elasticity rule. Obviously, the optimal price of the product does not depend on the level of advertising. Therefore, a dichotomy between the pricing strategy and the advertising strategy is available. Under imperfect informa – tion, reducing the price increases the full infor – mation demands, however, the monopolist needs to cover the new segment of the market with additional advertisement so as to realize that sale. We assume that all consumers are hetero – geneous and they are located in a linear city in the presence of positive transportation costs. The length of the city which means the total demands of the consumers is normalized to 1. All of them derive the same gross surplus v from consumption and incur a transportation cost tper unit of distance. The utility function can be defined as following equation of U v p tx = , where x [ , ] 0 1 represents the physical distance between consumers lo- cated at the point and the monopolist. In fact, due to the normalized unit total demands, the value of physical distance x equals to the potential demands of x x p = ( ). Therefore, consumers’ potential demands, firm’s equilib – rium price and advertising intensity with mass advertising can be expressed in the following expressions. Moreover, the procedure of deriva – tion is expressed in Section 1 of the Appendix: x p v p t p v c v c at r ( ) , ( ) * * = =+ = 2 4 2 and (5) Here, the expression of s v c = repre- sents the social surplus gross of transportation costs (Hernández-García, 1997, p.134). That means: *=s at 2 4 (6) Then, we consider the description of the internet-based imperfect targeted advertising. We use a spatial analogy for the description of heterogeneity for the existing consumers lo- cated in a linear city. Each consumer will purchase only one unit of the products from the firm at a distance of x after receiving an ad- vertisement from the firm. Therefore, x is considered to be the marginal consumer. How- ever, due to the imperfect targeting ability, there is a probability of α committing a Type I error while sending advertising to the wasted popu- lation. That means when the firm aimed to provide internet-based targeted advertising to the objective consumers, only a segment of x ( )1 can be correctly recognized, and only this segmentation of consumers will purchase the product after receiving the advertising. Meanwhile, there is a probability of β com- mitting Type II error targeting the consumers for the firm purchasing the online advertising via social media organization such as Facebook, Google etc. It means the population of ( )1 x consumers that are misrecognized as the objec – tive consumer. However, all these consumers will not purchase any of the products after re- ceiving the advertising. Hereinafter, recognition Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 55 ( )R and accuracy ( )T are used for the better description of the quality of online targeting technology. The relationship between recogni – tion ( ) R and accuracy ( )T for a given adver – tiser is shown as follows: R = 1 (7) Tx x x = + ( ) ( ) ( ) 1 1 1 (8) In our assumption, all of the consumers derive the same gross surplus from consumption and incur a transportation cost t per unit of distance. Therefore, their utility function can be expressed as U v P tx = 0, which means only consumers with U 0 will pur – chase the product, so the monopolist’s potential sale at price p are given by the following expression for the internet-based targeted ad- vertising: x p v p t ( ) (9) Let ϕ considered as the fraction of con- sumers while receiving the advertisements from the firm. Then the firm’s profit using the online advertisement at the range of [ , ] 0 x with Type I and Type II error are presented in the follow- ing equation: Max p c x a x x t = + ( ) ( ) ( ) ( )   1 2 1 1 2 (10) Substituting the constraint condition of Equation (7) and (8) into the objective Func- tion (10), and the maximum profit of the firm while purchasing online targeted advertising to the potential consumers can be simplified as follows: Ma x p c xR a x R T t = ( ) 2 2 (11) The FOC of the profits on price p and the fraction yields (see Section 3 of the Ap- pendix): = + + [ ] + = t p R t p v c pRa tT 2 20 2 ( ) (12) That means: p v c a Tt*= + + 2 4 (13) = = t v p t R p ca T ( ) 0 (14) That implies: * ( ) = p c T a (15) Moreover, the second order condition of the profits on price p and the fraction implies the existence of the max value. Therefore, we demonstrate that fraction of advertising is correlated with the accuracy of social media. Here, we find that target – ing really raises the price of the product. When the price is decreased by the mo – nopolist, the dichotomy between pricing and advertising is broken by the accuracy of the targeting. As a result, the marginal cost of reducing the price can be increased by targeting accuracy. Then, our objective is to evaluate the mar – ket outcomes from a social perspective. In our Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. 56 Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 model, advertising is socially desirable, when the accuracy is increased, the market size might be changed. So the relevant issue is to analyze whether that internet-based targeted advertising for the firm in monopolistic framework is always socially optimal. In a previous study, Shapiro (1980) demonstrates that a monopolist using a random technology is always undersupplied by informative advertising. Next, we extend the result to the case of targeting with the welfare standard of consumers’ surplus plus producer surplus. From the spatial analogy as mentioned above, the total social surplus under targeting can be shown as follows: W st xxR a xR T t= ( ) 2 2 2    (16) The FOC for the socially optimal level of advertising is derived as follows: = = W s tx xR a xR T t 0 2 0 ; ( ) (17) Although the online targeting technology raises the price of the product, the monopolist has a higher incentive to provide internet-based targeted advertising than mass advertising. However, the targeting also plays distinct roles affecting welfare in opposite directions. First, the full information demand is reduced by the higher price, which decreases welfare. Secondly, the wasting of advertisement can be avoided by the online targeting, which increases welfare. In the following section, we are aimed to de- termine which effect is dominant and whether the bidirectional role is correlated with the two parameters of online targeting. 2.2. Role of Accuracy in the Regulation of Firm’s Equilibrium Price In order to evaluate the impact of targeting on social welfare, the equilibrium price of prod- ucts using mass advertising and online targeted advertising are compared from aforementioned equation (5) and (13), which indicated that the imperfect targeting might raise the equilibrium price of the product due to distinct accuracy. Indeed: P P v c a T v c a Tt r* * = + + + = 2 4 2 4 (18) So the monopolist has the ability to raise the equilibrium price above marginal cost by chang – ing the intensity of advertising and the accuracy. From the above results, we can conclude that the internet-based targeted advertising might benefits the monopolist, so the relevant issue is to analyze the implications of the different roles of targeting intensity for both consumers and society. In the following study, the role of accuracy and recognition in the regulation of advertising intensity, the demands of consum- ers, consumers’ surplus and the social welfare are described separately. Proposition 1: The accuracy of internet-based targeted advertising plays a negative role in the regulation of equilibrium price while compared with mass advertising. How- ever, the accuracy plays a bidirectional role in the regulation of advertising intensity when compared with mass advertising. Indeed, if T v p t ( ) / , the number of ads rise, whereas if T v p t > ( ) /, and then the num- ber of ads decreases. Proof: By contradiction. Let us suppose that T v p t > ( ) and * *< . This implies t h a t ( ) ( )( ) p c T a p c v p at > . I t means * *> , which contradicts with the aforementioned assumption. The level of advertising might be reduced because, although the targeting makes each advertising much more efficient depending on correct targeting. The wrong targeting not only induced a great cost loss, but also increase Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 57 consumers’ burden. Finally, the effect of online targeted advertising might be lower than mass advertising. 2.3. Bidirectional Role of Accuracy and Recognition of Internet- Based Targeted Advertising in the Demands of Consumers Next, we begin to analyze the different ways in which targeting affects consumers. First, when the accuracy and recognition is too large, that means the price of the product might rise to a high level, which reduces the number of consumers who buy the product. As the objec- tive of the targeting advertising is to obtain the potential consumers and reduce the waste of advertisements by accuracy and recognition, the two parameters of targeting on consumers demand needs to be studied. Then, the number of consumers who buy the products after receiv – ing the mass advertising and internet-based targeted advertising is compared. The original demands of consumers are described as x s atr = 3 2 8 / while the monopolist adopt- ing mass advertising for the sales. In addition, the demands of consumers while receiving the online targeted advertising can be expressed as follows: x R s t R p c T tat = 2 4 2 ( ) (19) Therefore, we can conclude Proposition 2 after the comparison of the demands of consum – ers with different advertising strategies. Proposition 2: The accuracy and recognition of internet-based targeted advertising plays a bidirectional role in the demands of consumers. The expression of: RT a ts as t a pc > ( ) / () 4 2 2 3 2 means the demands of consumers after receiv – ing internet-based targeted advertising might be lower than that of mass advertising. However, when: RT a ts a s t a pc < ( ) / () 4 2 2 3 2 the demands of consumers after receiving the online targeted advertising might be even higher. From the aforementioned analysis, it is clear that the monopolist benefits from the new advertising only in specific range, whereas the consumers are likely to be worse off. Then, we are determined to verify whether the targeting show similar results to consumers’ surplus. 2.4. Bidirectional Role of Accuracy and Recognition of Internet- Based Targeted Advertising in the Consumers’ Surplus Hereinafter, we compare the consumers’ surplus after the consumers receiving mass advertising from the monopolist and that incepting of in- ternet-based targeted advertising. It is known that the consumers’ surplus CS( ) can be depicted as the following expression of CS P P Q = ( ) / max * 2 . Therefore, the con- sumers’ surplus of online targeted advertising CS t ( ) and mass advertising CS r ( ) are com- pared. We can obtain the results as the follow- ing Proposition 3. Proposition 3: The accuracy and recognition of internet-based targeted advertising is cor – related with the consumers’ surplus, when: RT s ats atp ac s t p c s p c > + ( ) ( ) ( ) 8 4 4 2 2 the consumers’ surplus after online targeted advertising is higher than mass advertising. However, the opposite result of: RT s a ts atp a c s t p c s p c + ( ) ( ) ( ) 8 4 4 2 2 Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. 58 Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 will lead to a lower consumers’ surplus when compared with mass advertising. Proof: See following equations: CSvv c s at s at r= + = 1 2 2 8 32 3 2 3 2 ( ) CS vv c p cs t R p c T at t= + 1 2 2 4 24 ( )( ) Then CS t and CS r are compared in the following in-equation. If CS CS t r≥ , then: s at v v c p c s t R p c T at3 2 32 1 2 2 4 2 4 0 + × ( ) ( ) else if: CS CS t r< s at v v c p c s t R p c T at3 2 32 1 2 2 4 2 4 0 + > ( ) ( ) That’s the results. QED. From the analysis, we can conclude that the consumers’ surplus largely depends on accuracy and recognition of internet-based targeted advertising, which plays a bidirectional role in the regulation of consumers’ surplus. The too high accuracy and recognition might reduce the consumers’ surplus compared with mass advertising. 2.5. Bidirectional Role of Accuracy and Recognition of Internet-Based Targeted Advertising in Social Welfare In the following study, we examine whether the targeted advertising with different targeting quality is desirable from a social point of view. The results can be obtained from Proposition 4. Proposition 4: The targeting might not be socially desirable which depends on the product of accuracy and recognition of internet-based targeted advertising. When: RT s v p pc s v p > + 4 2 21 2 / ( )()( / ) the social welfare with imperfect internet-based targeted adverting is higher than mass advertis – ing, and the opposite results of: RT s v p pc s v p < + 4 2 2 1 2 / ( )()( / ) will lead to a lower social welfare when com- pared with mass advertising. Proof: The comparison between the levels of welfare under both mass advertising and internet-based targeted advertising is shown as follows: W s at r= 4 2 16 and: W s v p v pp cTR at t= + ( ) ( )( ) 2 2 1 2 When: RT s v p p cs v pW W t r > + > 4 2 2 1 2 ( ) ( )( ), However, when: RT s v p p cs v pW W t r < + < 4 2 2 1 2 ( ) ( )( ), Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 59 That also means too high accuracy and recognition of the online targeting might reduce the social welfare .QED. From the above results, we can realize that a more efficient targeting technology might not be always socially desirable, which is correlated with the accuracy and recognition. The intuition is as follows: Targeting raises the price of the good when the accuracy and recognition are upgraded. If the accuracy and recognition are too high, the cost of targeting might increase a lot, therefore, the firm must raise the price at a high level so as to make profits. Therefore, the targeting is really harmful for consumers. However, the process of advertising is becoming efficient by targeting when the accuracy and recognition is not too high. In this situation, the targeting generates substantial savings in cost and shows better marketing effect than mass advertising. Generally, we can conclude that if the accuracy and recognition are not too high, the monopolist can raise the price of the product by only a little and both consumers’ surplus and social welfare rise. By contrast, if the ac- curacy and recognition of the monopolist is too high, this positive effect might be weaken, and might lower the social welfare. Therefore, the monopolist should make its targeting accuracy and recognition in a specific range to pursue the optimized profit. The proper accuracy and recognition of targeting by the firm can be used as a tool for segmentation of a market. 2.6. Optimization of Imperfect Targeting with Mismatch Lose In the above model, we haven’t considered the loss of the firm while purchasing the social media and sending the targeted advertising to the wrong consumers. In fact, as there is a probability of committing Type II error in sending internet-based targeted advertising to the wrong consumers by the firm, all these consumers will never buy the product even receiving the advertising. However, these wrong consumers are considered as the firm’s poten- tial consumers, and these advertisements are wasted, which we call it mismatch lose for the firm. In our following model, we further con- sider the coefficient of the mismatch lose as c1 for one unit wrong consumer, therefore, the mismatch lose of the firm while purchasing the online advertising and sending to the consum- ers of ( ) 1 x at a probability of is expressed as c x1 1 ( )  , and then the profit of the firm is shown in the following expression: Max p c x a x x c x t = + ( ) ( ) ( ) ( ) ( )    1 2 1 1 1 2 1 (20) Substituting the constraint condition of (7) and (8) into the objective function of (20), and the max profit of the firm using internet-based targeted advertising can be expressed in the following equations: Ma x p c xR a x R T c T x R T t = ( ) ( ) 2 1 2 1 (21) The FOC of the profits on price p and the fraction yields: = + + + + = t p R p v c t a R tT c T R tT 0 2 2 1 0 2 1 [ ( )] ( ) (22) That means: p v c a T c T T v c T c a T* ( ) ( ) = + + + + + 2 4 1 2 2 1 1 21 1 (23) Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. 60 Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 The equation works when: aT c T T c T a 4 1 2 2 1 1 1 = = ( ) ( ) = = t p c xRaxR T 0 0 ( )   (24) That means: * ( ) = p c T a Likewise, the second-order condition of the profit is also available. Therefore, we continue to compare the targeting level, the demands of consumers, as well as the welfare. From the equation (24), we can c o n c l u d e t h a t t h e e q u i l i b r i u m l e v e l o f advertising will not be changed and isn’t correlated with mismatch lose. Proposition 5: The targeting level is cor – related with the accuracy of internet- based targeted advertising, but isn’t correlated with its mismatch lose .The optimized price arises with mismatch lose, and decreases with the improve – ment of accuracy. The minimum opti – mized price is: v c Tc a T + + 2 1 1 2 1( ) and the minimum optimized advertising level is considered as the following ex – pression of: 2 11c T a ( ) 2.7. Optimization of Imperfect Targeting after Investment on Accuracy and Recognition with Mismatch Lose In our model, when the firm chooses the online targeted advertising from the social media or – ganization for the marketing, the potential consumers might be changed into the actual consumers. Moreover, the accuracy and recog- nition of the internet-based targeted advertising might directly affect the firm’s profit and social welfare. If the accuracy and recognition of the internet-based targeted advertising are not well pursued, the effects of the internet-based tar – geted advertising might be less than mass ad- vertising. Therefore, the firm must make the decision simultaneously on the investment for a proper accuracy and recognition of the inter – net-based targeted advertising. Specifically, we assume that the cost of acquiring the accuracy and recognition is a quadratic function. Both k1 and k2 are constants in the function: f R T k R x k T x x ( , ) ( ) ( ) = + + 12 2 2 1 1    (25) The expression can be simplified in the following expression: f R T k R xk TRx ( , )= + 1 2 2 (26) Then, the monopolist’s profit with invest- ment on targeting qualities generates: Max p c xR a x R T c T x R T k R x k TRx t = ( ) ( )      2 1 2 1 12 2 (27) Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 61 The FOC yields: = + + + + + + = t p R p t a R T c T R T k R k TR 0 2 2 1 0 2 1 12 2 [ ( v c)] ( ) That means: p v c a T c T T k R k T v c T a c T kRTk T * ( ) ( ) = + + + + + + + + + 2 4 1 2 2 2 1 11 1 2 1 12 2 2 2 (28) = + + + + v c ac T k R ac T k T 2 2 2 2 1 2 1 1 2 The equation works only: a T c T T k R T k T T c T k RT k T a 4 1 2 2 2 1 1 122 1 122 = + + = + + ( ) ( ) (29) = = t p c xRaxR T 0 0 ( )   (30) That means: * ( ) = p c T a Likewise, the second-order condition of the profit is also existed. Moreover, we continue to compare the targeting level, the demands of consumers, as well as the welfare with the mass advertising. The same conclusions are also de- rived. From the equation (29), we can conclude that the level of advertising will not be changed and isn’t correlated with the targeting cost on the accuracy and recognition. From equation (28), we can conclude that the optimized price showed positive correlation with recognition of internet-based targeted advertising, but negative correlation with the accuracy of internet-based targeted advertising. That is why when the firm improves the targeting, both the recognition and accuracy will improved, which showed opposite effect to the firm. The higher recognition will enhance the equilibrium price, as well as the demands of consumers. However, the higher accuracy will decrease the equilibrium price, as well as the demands of consumers. The final effects derive the relative role of recognition and accuracy on the firm’s equilibrium price. Proposition 6: The targeting level is correlated with the accuracy of internet-based targeted advertising, but isn’t correlated with its mismatch lose .The optimized price arises with the recognized cost, and decreases with the improvement of accuracy. The minimum optimized price of the firm is considered as the following expression of: v c Ta c T kRTk T + + + + 2 1 1 2 1 122( ) and the minimum optimized advertising level can be expressed as: 2 1 1 122c T k RT k T a ( ) + + The recognition of internet-based targeted advertising plays a positive role in the regulation of advertising level, however, the accuracy of internet-based targeted advertising plays a nega – tive role in regulating advertising level. The final effects derive the dominate role of recognition and accuracy on the advertising level. Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. 62 Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 From the above model, it is clear that the ac- curacy and recognition of the online advertising play distinct roles in the regulation of optimized price. The recognition of internet-based targeted advertising plays a positive role in advertising level. That means a higher recognition on tar – geted advertising leads to a higher advertising level. However, the accuracy plays the opposite role in advertising level, and a higher accuracy might lead to a lower advertising level. The results reveal that when the firm decides to invest in the quality of advertising, the firm should invest the recognition and accuracy of advertising with different directions. 3. CONCLUSION In this article, we consider a model of monopolist purchasing the internet-based targeted adver – tising with different accuracy and recognition, which adds new insight into the impact of media proliferation sending to the potential consumers. Though the internet-based targeted advertising is proved to be beneficial for the efficiency of the firms and can reduce message wastage well, still much more accurate targeting does not mean better welfare for the society or company. We demonstrate that within a monopolistic frame – work, the targeted advertising might lower both consumers’ surplus and social welfare compared with mass advertising, which is correlated with accuracy and recognition. Therefore, different quality of targeting could greatly affect the firms’ equilibrium profits, sometimes, its effect might be worse than the mass advertising. Further, our results indicate that the accuracy and recogni – tion play the opposite role in the regulation of advertising level, which means the recognition plays a positive role in the regulation of equi- librium prices whereas the accuracy plays a negative role, and the final effects derive from one of the relative role. Therefore, we believe the accuracy and recognition of internet-based targeted advertising can be used as a lever for strategic segmentation of a market. Otherwise, it is clear that there are still some limits in the study of a monopolist model in the scope of our results, and therefore it needs some extensions for the analysis of targeting in a competitive framework in the further studies. However, the bidirectional role of accuracy and recognition of the online advertising suggest us that the pursuit of perfect targeting from social media organization might not be desirable, this partially explain the current controversies on whether the targeted advertising is always better than mass advertising. This will benefit from more clarifications of extensions for the affecting factors on targeting in a competitive framework in the future studies. ACKNOWLEDGMENT Financial support provided by National Key Technology Support Program (No. 2012BAH29F01), National Natural Science Foundation of China (No.71371050) and Re- search and Innovation Project for College Grad – uates of Jiangsu Province (No. CXZZ13_0137) are gratefully acknowledged. 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Management Science, 48 (9), 1143–1160. doi:10.1287/mnsc.48.9.1143.172 Stahl, I. I. II, & Dale, O. (1994). Oligopolistic pricing and advertising. Journal of Economic Theory, 64(1), 162–177. doi:10.1006/jeth.1994.1060 Zhang, K., & Katona, Z. (2012). Contextual advertis – ing. Marketing Science , 31 (6), 980–994. doi:10.1287/ mksc.1120.0740 Jiang Zhao is a PhD student. His current study is focused on electronic commerce. Shu-e Mei is a PhD supervisor. Her research fields include electronic commerce, technology innovation, and management information systems. Wei-jun Zhong is a PhD supervisor. His research fields include information security, electronic commerce, and management information systems. Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. 64 Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 APPENDIX The Procedure of Derivation in Equation (5) of the Model We arrive at the following equation: r p c v p t A p v cp vc A = = ++ ( ) ( ) ( ) ( ) ( ) 2 Therefore, the FOC yields: = + + = = < r r pp v c p 2 02 0 2 2 ( ) ; = = = < r r p cv p t a a ( ) ( ) ; 0 0 2 2 That means the firm’s optimal price and advertising intensity can be shown in the following expressions while sending the mass advertising to the consumers: p v c p v c pvc at v c v cv cr* * ;( ) ( ) = + = + + = + + + + 2 2 2 2 2 = vc at v c at ( ) 2 4 Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 65 Definitions and Implications Table 1 shows the function of each symbol in the model. Table 1. The definitions and implications of the symbols in the model Definitions of SymbolsImplications of the Symbols r t, Firm’s profit using mass advertising/internet-based targeted advertising * *, Firm’s optimized advertising intensity using mass /internet-based targeted advertising v Gross surplus t Transportation cost for each unit. a Advertising costs constant x xp , ( ) , The distance between the marginal consumer and the left firm; The potential demands with different price. A ( ) φ Total advertising cost Pr*,Pt * Firm’s optimized price using mass advertising /internet-based targeted advertising R Abbreviation of recognition, which indicates the probability that any member of the targeted segment is identified. T Abbreviation of accuracy, which indicates the possibility of correct prediction in the target segment. c1 The coefficient of mismatch lose Wr,Wt The total social surplus using mass advertising or internet-based targeted advertising. s The social surplus gross of transportation costs k1,k2 The constant coefficient of investment on recognition and accuracy Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. 66 Journal of Electronic Commerce in Organizations, 13(1), 50-66, January-March 2015 The Procedure of Derivation in Equation (13) of the Model Use the following equations to determine the procedure of derivation in the given model: t p c v p t R a v p tT R = ( ) ( ) ( ) 2 2 Therefore, the FOC yields: = ++ + = ++ + t pR t p v caR tT R t p v ca T 0 2 22 2 2 ; () () = = < 0 2 0 2 2 ; t p That means the firm’s optimal price can be shown in the following expression of: p v c a T t*= + + 2 4 while sending the online targeted advertising to the consumers.
LITERATURE REVIEW (12-16 pages) This essay is basically synthesizing 10 sources to support the new research im proposing that needs to be done. The sources needs to be categorized into 3/4 subheadings
http://hpq.sagepub.com/ Journal of Health Psychology http://hpq.sagepub.com/content/early/2013/10/21/1359105313504236 The online version of this article can be found at:   DOI: 10.1177/1359105313504236 published online 22 October 2013 J Health Psychol Michaela Dewe, Jane Ogden and Adrian Coyle packaging The cigarette box as an advertising vehicle in the United Kingdom: A cas e for plain     Published by: http://www.sagepublications.com can be found at: Journal of Health Psychology Additional services and information for         http://hpq.sagepub.com/cgi/alerts Email Alerts:   http://hpq.sagepub.com/subscriptions Subscriptions:   http://www.sagepub.com/journalsReprints.nav Reprints:   http://www.sagepub.com/journalsPermissions.nav Permissions:   What is This?   – Oct 22, 2013 OnlineFirst Version of Record >> at UNIV OF SURREY on November 6, 2013 hpq.sagepub.com Downloaded from at UNIV OF SURREY on November 6, 2013 hpq.sagepub.com Downloaded from at UNIV OF SURREY on November 6, 2013 hpq.sagepub.com Downloaded from at UNIV OF SURREY on November 6, 2013 hpq.sagepub.com Downloaded from at UNIV OF SURREY on November 6, 2013 hpq.sagepub.com Downloaded from at UNIV OF SURREY on November 6, 2013 hpq.sagepub.com Downloaded from at UNIV OF SURREY on November 6, 2013 hpq.sagepub.com Downloaded from at UNIV OF SURREY on November 6, 2013 hpq.sagepub.com Downloaded from at UNIV OF SURREY on November 6, 2013 hpq.sagepub.com Downloaded from at UNIV OF SURREY on November 6, 2013 hpq.sagepub.com Downloaded from Journal of Health Psychology0(0) 1 –9© The Author(s) 2013Reprints and permissions: sagepub.co.uk/journalsPermissions.navDOI: 10.1177/1359105313504236hpq.sagepub.com Introduction There is currently much debate concerning the impact of branded cigarette boxes on the uptake and maintenance of smoking. In April 2012, the UK government launched a consulta – tion on the introduction of plain packaging for all tobacco products which met with high levels of public support (Action on Smoking and Health, 2012a). It is argued by the proponents of plain packaging that even though tobacco com – panies have been restricted in their sources for advertising, the cigarette box has become iconic to each manufacturer and remains a vehicle for advertising and an object through which smok – ers express their identity (Action on Smoking and Health, 2010). In light of these debates, this article explores changes in advertising since 1950 in the United Kingdom and the strategies used by tobacco companies to promote their product, with a focus on the use of the box and the meanings associated with smoking. The possibility of branded cigarette boxes functioning to encourage smoking has been explicitly addressed in health interventions, most notably by the Australian government which The cigarette box as an advertising vehicle in the United Kingdom: A case for plain packaging Michaela Dewe, Jane Ogden and Adrian Coyle Abstract This research aimed to study tobacco advertising between 1950–2003 an d to evaluate the role of the cigarette box in advertising. Tobacco company advertisements ( n = 204) were coded for content and meanings used to promote their product. There was a significant shift from cigarettes being displayed to the cigarette box only. Changes in advertising and the meanings evoked were unrelated to changes in smoking behaviour. It is argued that the cigarette box has absorbed t he meanings associated with smoking and has become an effective vehicle for advertising. It is also argued that this can only be minimised with plain packaging. Keywords advertising, content analysis, plain packaging, smoking, tobacco University of Surrey, UK Corresponding author:Michaela Dewe, School of Psychology, University of Surrey, Guildford, Surrey GU2 7XH, UK. Email: [email protected] 504236 HPQ 0 0 10.1177/1359105313504236 Journal of Health PsychologyDewe et al. 2013 Article 2 Journal of Health Psychology 0(0) introduced compulsory plain packaging for tobacco products in December 2012. ‘Plain packaging’ requires the removal of branding including colours, imagery and logos and only allows the brand name to be printed on the ciga – rette box in a standardised font. In July 2013, the UK government announced a delay in imple – menting a plain packaging policy until the impact of the implementation of the Australian policy is known. Yet, recent research by Wakefield et al. (2013) has found that the introduction of plain packaging there has resulted in smo kers perceiv – ing their cigarettes as less satisfying and of lower quality than previously. The study also found that smokers were more likely to have thought about quitting in the last week and now rated quitting as a higher priority in their lives. The researchers argued that the early results sug – gested that plain packaging is having an effect and is associated with making smoking less appealing. Across its history, cigarette advertising – like the advertising of any product – has been oriented towards increasing the appeal and con – sumption of the product. Advertising per se has been defined as ‘any form of paid communica – tion by an identified sponsor aimed to inform and/or persuade target audiences about an organization, product, service or idea’ (Fennis and Stroebe, 2010: 2). There has been much work undertaken within psychology to under – stand how advertising functions. According to Fennis and Stroebe (2010), it operates in a com – plementary way on a societal/collective level, facilitating competition between brands, and on an individual level, endeavouring to persuade audience members. Persuasion can be seen here as ‘any change in beliefs and attitudes that results from exposure to a communication’ (Petty and Cacioppo, 1986: 5). There are sev – eral standard theories of persuasion that can be applied to advertising, including the cognitive response model (Greenwald, 1968; Petty et al., 1981), dual process models (Chen and Chaiken, 1999; Petty and Cacioppo, 1986) and the infor – mation processing model (McGuire, 1969). Ultimately persuasive advertising leads to the consumer forming positive associations about specific products or brands which promote consumption. The Framework Convention on Tobacco Control, an initiative of the World Health Organization (WHO, 2001), has defined tobacco advertising as any form of commercial and non-commercial communication with the aim or direct or indirect effect of promoting a tobacco product, including advertising which, while not specifically men – tioning the tobacco product, uses brand names, trademarks, emblems, or other distinctive fea – tures of tobacco products. (p. 4) Although tobacco advertising has been per – vasive in the Western world and far-reaching in its scope (Wakefield et al., 2005), since the 1990s, tobacco companies have been increas – ingly restricted in their potential advertising outlets. For example, in line with the UK Broadcasting Acts of 1990 and 1996, they were prevented from advertising on television and radio and since the Tobacco Advertising and Promotion Act in 2002, which came into effect in the United Kingdom in 2003, they have been unable to advertise via billboards or in print. Furthermore, from 2005, they were banned from advertising through either direct mail or sponsorship. Since this time, tobacco compa – nies moved their focus to ‘point-of-sale’ adver – tising to promote their products (Action on Smoking and Health, 2012b). This, however, has now also been limited following research demonstrating that adolescents were particu – larly susceptible to this approach and laws have been implemented in the United Kingdom, meaning that since April 2012, large stores can no longer have tobacco products on display (MacKintosh et al., 2012). These measures will be extended to smaller stores from 2015. With potential advertising outlets having been systematically limited over the past 20 years in the United Kingdom, the cigarette box has been left as the last significant vehicle for the promotion of smoking. Indeed, cigarette packaging has been recognised as a prominent Dewe et al. 3 form of tobacco marketing in the United Kingdom (Hammond et al., 2013). Research by Ford et al. (2012) has suggested that branded packaging is key at the point of sale and post- sale, influencing the perceived attributes of the product, and that it is an important promotional tool for advertisers. Furthermore, this research has suggested that the introduction of plain packaging for tobacco products in the United Kingdom would further restrict the capability of the tobacco companies to influence consum – ers through promotional activities using their boxes. Indications are that plain packaging of tobacco products leads to a significant reduc – tion in the positive associations with smoking such as glamour and sophistication (Hammond et al., 2013). The current research explores the associations with the cigarette box that were formed through its use in advertising which may have been carried forward by the box itself since the advertising ban. Supporters of the call for plain packaging argue that in line with the WHO definition cited earlier, cigarette boxes are a form of advertising and have been described as the principal way in which tobacco companies now advertise their products (Hammond et al., 2012), functioning as ‘silent salesmen’ (Mitchell and Studdert, 2012). In support of this, research has high – lighted a series of changes made by tobacco companies to the packaging used, including changes in size, design and whether the price is printed on the packets. Such changes have been argued to illustrate the use of the cigarette box to attract attention and promote the products they contain (Moodie and Hastings, 2011). Likewise, a review of internal tobacco industry documents indicated that following increasing legislation that has limited the possibilities for advertising, tobacco companies themselves view the packet as being crucial for creating a brand image and enhancing the impact of their brand where cigarettes are on sale (Wakefield et al., 2002). Furthermore, research indicates a rise between 2002 and 2006 in the number of adolescents who were aware of changes to the design of cigarette packets, suggesting that this age group may be vulnerable to this source of information (Action on Smoking and Health, 2010). This is of particular concern given that there are currently around 150,000 smokers aged 11–15 years in the United Kingdom with two-thirds of smokers starting before the age of 18 years (Action on Smoking and Health, 2012b). It is also argued that the compulsory introduction of plain packaging would remove this final outlet for the tobacco companies and that non-branded packaging would lower the appeal of cigarettes and cause a subsequent decrease in both smoking uptake and mainte – nance (Moodie and Ford, 2011; Thrasher et al., 2011). In contrast, the tobacco industry has argued that packaging has no impact on the consump – tion of their products. For example, an online campaign entitled ‘Hands off our packs! Say no to plain packaging’, run by the Freedom Organisation for the Right to Enjoy Smoking Tobacco (Forest, n.d.), has advanced several reasons why plain packaging should not be endorsed. First, it is said that plain packaging will have no impact on smoking prevalence. Second, it is said that to suggest that consumers select their cigarette brand on the basis of col – our is an insult to their intelligence. Third, it is contended that by removing the use of branding and trademarks for tobacco products, plain packaging will ‘eliminate the well known advantages trademarks create in a free market society’ (Philip Morris Limited, 2008: 31). In this debate about the impact of branded cigarette boxes and the (proposed compulsory) introduction of plain packaging, it is unclear what, if any, positive associations were formed in relation to the cigarette box through its use in cigarette advertising. This study addresses this and evaluates changes in advertising strategy between 1950 when the first research was pub – lished concerning the health effects of smoking (Doll and Hill, 1950) and 2003 when cigarette advertising in print and on billboards was banned in the United Kingdom. The research focuses on how the cigarette box has been used in cigarette advertising and what associations 4 Journal of Health Psychology 0(0) are created in relation to the box in order to dis – cern whether and, if so, how the cigarette box operates as a form of advertising for the tobacco industry. The study also explores the relation – ship between changes in the use of the cigarette box and its associated meanings and existing data on changes in smoking behaviour. Method A total of 40 UK tobacco print advertisements from each decade (1950s–2000s) were selected from an online advertising archive that con – tains over 1500 tobacco advertisements using a random number generator. The original sample contained both pro-smoking and anti-smoking advertisements. Of all, 36 were omitted from this analysis as they were anti-smoking adver – tisements, leaving a sample of 204 advertise – ments for analysis (39 from the 1950s, 38 from the 1960s, 33 from the 1970s, 38 from the 1980s and 28 from the 1990s and 2000s). A comprehensive coding framework was devel – oped and refined through analysis of a sub – group of advertisements to address aspects of content and meaning. The advertisements were grouped by the decade in which they were pub – lished and then analysed using content analysis (Rose, 2012), a method that has previously been suggested for analysing tobacco advertisements (Anderson et al., 2006). The advertisements were coded for their content in terms of whether they displayed a cigarette that was being smoked, whether they displayed a cigarette that was not being smoked and whether they displayed a cigarette box but no cigarette. They were also coded for how they promoted their product and the meanings being evoked. A total of 18 codes were used here: aroma, convenience, cost, fear, flavour, friend – ship, happiness, health, humour, image, lady – like, pleasure, popularity, promotions, quality, quantity, relaxing and size. In addition, changes in smoking prevalence data from 1950 to the present day were obtained from Cancer Research UK (2012) and were mapped onto the analytic outcomes. The results were analysed in terms of changes in content across the dec – ades, associations between changes in content and changes in smoking prevalence and changes in meaning across the decades. Results Changes in the content of advertisements across the decades (1950–2003) Changes in the content of advertisements from 1950 to 2003 are shown in Figure 1. Chi-square goodness-of-fit tests were con – ducted on the data. The results showed a sig – nificant association between decade and advertisements with a cigarette being smoked (χ2(5) = 39.953, p < .01) with percentages indi – cating that fewer advertisements used a ciga – rette being smoked to promote their product over time. There were, however, brief increases in the 1970s and 2000s (64.1% in the 1950s, 36.8% in the 1960s, 48.5% in the 1970s, 15.8% in the 1980s, 3.6% in the 1990s and 17.9% in the 2000s). The results also showed a signifi – cant association between decade and advertise – ments showing a cigarette not being smoked (χ2(5) = 56.468, p < .01). Figure 1 shows an overall decline in the use of a cigarette not being smoked over the decades apart from the 2000s which showed a brief increase (82.1% in the 1950s, 65.8% in the 1960s, 54.5% in the 1970s, 34.2% in the 1980s, 3.6% in the 1990s 0 10 20 30 40 50 60 70 80 90 1950s1960 s1970 s1980s1 990s2000 s Cigare e Smoked Cigare e No t Smoked Cigare e Box, No Cigare e Figure 1. Changes in the content on smoking advertisements from 1950 to 2003. Dewe et al. 5 and 21.4% in the 2000s). There was also a sig – nificant relationship between decade and whether advertisements showed a cigarette box but no cigarette ( χ2(2) = 22.399, p < .01). The percentages for ‘box only’ showed a more complex pattern but generally there was an increase across the decades, with a particular increase between the 1980s and 1990s and a decrease in the 2000s (7.7% in the 1950s, 5.3% in the 1960s, 15.2% in the 1970s, 13.2% in the 1980s, 42.9% in the 1990s and 32.1% in the 2000s). Changes in content of advertisements across the decades and smoking prevalence Changes in advertising content and smoking prevalence across the decades are shown in Figure 2. Smoking prevalence among females has consistently been lower than among males, but this gender gap has closed in recent years. Smoking prevalence declined slightly follow – ing the Tobacco Advertising and Promotion Act ban in 2003, but has levelled off since then, remaining stable for both males and females since 2006. Smoking prevalence declined most sharply between 1970 and 1990. There is no obvious association between changes in adver – tising strategy and smoking prevalence. Changes in the meanings of advertisements across the decades The percentages of meaning codes displayed by the advertisements in each decade are presented in Table 1. The results showed that overall, the four most common meanings were ‘quality’ (e.g. ‘555 cigarettes are the same superlative quality the world over’ and ‘A new cigarette gifted with Embassy quality’), ‘flavour’ (e.g. ‘Filters the smoke but not the taste’ and ‘Come to where the fla – vour is’), ‘pleasure’ (e.g. ‘Whatever the pleas – ure Player’s complete it’ and ‘The simple pleasure of Benson and Hedges Sovereign. Anytime’) and ‘cost’ (e.g. ‘Now! Benson and Hedges pleasure at every day prices!’ and ‘I like these better than Benson’s Hedges! Yes, Sir, at £3.99 we’re cuttin’ edge’). The four least com – mon codes were ‘fear’, ‘being ladylike’, ‘friendship’ and ‘convenience’. ‘Health’ was present in the top four codes in the 1980s. There was a general downward trend over time in the range and number of meaning codes present in the advertisements. Figure 2. Content of advertisements since 1950 and changes in smoking prevalence for men and women. 6 Journal of Health Psychology 0(0) Changes in the four most common codes (‘quality’, ‘flavour’, ‘pleasure’ and ‘cost’) are compared to the shift in the use of the cigarette box only in Figure 3. The results showed that over time, the use of the meanings associated with pleasure, cost and flavour declined. The invocation of quality in advertisements similarly declined but showed an increase in prevalence in parallel to the increased use of the box only rather than the cigarette. Discussion The findings from this study indicate that the tobacco companies increasingly used the ciga – rette box in their UK advertising until the Tobacco Advertising and Promotion Act ban in 2003, illustrated by the decline in the use of either a cigarette being smoked or not being smoked and the increase in the use of the box only. The results also suggest that this shift from cigarette to box was unrelated to smoking prevalence. Furthermore, the results indicate that the key meanings used in advertising across the decades were flavour, quality, pleasure and cost, with health being important in the 1980s, and that although an overall decline in their use was seen over time, the shift from cigarette to box only was reflected in an increased presenta – tion of images relating to quality. As noted earlier, proponents of plain packag – ing argue that the cigarette box is a key source of advertising and that the introduction of plain packaging would reduce smoking behaviour (Thrasher et al., 2011). This is refuted by tobacco companies for various reasons, includ – ing the contention that consumers do not make smoking choices on the basis of packaging (Philip Morris Limited, 2008). The results of this study indicate that the box is indeed a source of advertising and that this source was used for several decades before current restric – tions were introduced. Moreover, the results indicate that the tobacco companies are fully cognisant of the power of the cigarette box as a form of advertising as they used it to promote their product even when other advertising foci Table 1. The percentage counts of meanings evoked by smoking advertisements in each decade from 1950 to 2003. Meaning code 1950s 1960s 1970s 1980s 1990s 2000s Total Rank Aroma 0 7.9 9.1 0 3.6 0 20.6 12 Convenience 7.7 5.3 0 0 0 0 13 15 Cost 12.8 50 36.4 5.3 7.1 10.7 77.3 4 Fear 2.6 0 0 0 0 0 2.6 18 Flavour 38.5 34.2 39.4 28.9 3.6 7.1 151.7 2 Friendship 5.1 5.3 0 0 0 0 10.4 16 Happiness 7.7 2.5 0 2.6 3.6 10.7 27.1 11 Health 5.1 2.6 9.1 15.8 0 0 32.6 10 Humour 17.9 0 3 0 7.1 25 53 6 Image 2.6 5.3 6.1 0 0 0 14 13 Ladylike 0 2.6 3 0 0 0 5.6 17 Pleasure 43.6 34.2 15.2 2.6 3.6 0 99.2 3 Popularity 20.5 13.2 6.1 2.6 0 3.6 46 7 Promotions 0 21.1 12.1 2.6 0 7.1 42.9 8 Quality 66.7 50 18.2 2.6 21.4 3.6 162.5 1 Quantity 0 21.1 0 2.6 3.6 7.1 34.4 9 Relaxing 5.1 5.3 3 0 0 0 13.4 14 Size 17.9 18.4 15.2 18.4 0 7.1 77 5 Dewe et al. 7 were available to them. This research can be said to build on previous studies that have examined the use of branded packaging (Ford et al., 2012; Hammond et al., 2013) and pro – vides further evidence that the cigarette box is indeed an advertising vehicle in its own right. In addition, the results also indicate that the mean – ings associated with cigarettes were transferred from the cigarette onto the box in the years prior to the 2003 ban on print and billboard advertising, particularly those meanings associ – ated with quality. The downward trend in the number and range of meaning codes used in the advertisements throughout the decades can be interpreted as pointing to the key meanings that the tobacco industry wished to be associated with their products. Theories of persuasion provide insights into how changes in tobacco companies’ advertising foci may have oriented towards influencing consumption behaviour. At a very basic level, a strong case or argument in favour of a product needs to be created in order to be persuasive. (Potential) Consumers are more likely to be persuaded by advertising that focuses exclu – sively on the merits of a particular product (Fennis and Stroebe, 2010). The focus over time on specific key positive features that were ascribed to cigarettes can be seen as a refine – ment of persuasion endeavours. The focus on quality in association with the cigarette box functioned as a catch-all ‘bottom line’ argument for brands in the face of decreasing advertising possibilities in context and content. Furthermore, it has been claimed that a combination of infor – mation and image can increase the likelihood of an advertisement persuading an audience to purchase a product: an image can act as a reminder cue for positive ‘informational’ claims (Ajzen, 2005; Fishbein and Ajzen, 1975). In tobacco advertising, it is possible that the increased use of the cigarette box led to the box becoming a reminder cue for the positive claims that were included in the advertisement. With the increase in the use of the box in advertising, the positive associations from the advertise – ments became linked with the box itself and the box carried forward these associations. The shift from the cigarette to the box was not reflected in any obvious decline in smoking, suggesting that the box was as effective at pro – moting smoking as the cigarette itself. Figure 3. Percentages of the top four most frequently utilised meaning codes and the use of the cigarette box only. 8 Journal of Health Psychology 0(0) This provides some evidence in support of the call for compulsory plain packaging as the box cannot be considered a neutral object that has no impact on consumer choices. Instead the box can be viewed as a form of branded pack – aging that is oriented towards persuading the target audience to purchase the product. 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LITERATURE REVIEW (12-16 pages) This essay is basically synthesizing 10 sources to support the new research im proposing that needs to be done. The sources needs to be categorized into 3/4 subheadings
Challenges to attitude and behaviour change through persuasion LOUISE M. HASSAN 1* and NINA MICHAELIDOU 2 1 Bangor Business School, Bangor University, Bangor, LL57 2DG, Wales UK2School of Business and Economics, Loughborough University, Leicestershire, LE11 3TU, UK Persuasion generally refers to the formation or change in attitudes by individuals in response to processing information about the attitude object contained in the message, for exam- ple, advertisement for a product (Bohneret al., 2008). Per- suasion has long been studied and is central to the study of marketing and, specifically, consumer behaviour. Persuasion plays a key part in engendering attitudinal and behavioural change (e.g. Pettyet al., 2003; Petty and Cacioppo, 1981) and is therefore instrumental to the success of marketing communication and promotional campaigns. Billions of pounds are spent annually by advertisers (£16.1 billion in 2011) in an attempt to influence or change consumers’attitudes towards products, services and/or brands (Durani, 2012). Much of our current understanding of the effects of persuasion comes from work started in the 1980s by Petty and colleagues on the elaboration likelihood model (e.g. Pettyet al., 2003; Petty and Cacioppo, 1981), as well as work by Chaiken and colleagues on the heuristic-systematic model (e.g. Chaikenet al., 1989). Despite the vast body of research on attitude change theories and models, there is a clear need for further research on persuasion from different perspectives and contexts. This special issue aims to offer new insights and perspectives on attitude change through persuasion in the domain of consumer behaviour. In particular, we sought to extend both the theoretical and methodological approaches used to understand persuasion and its impact on attitude and behaviour, by seeking research that lies outside the traditional theories of persuasion or that utilises qualitative approaches that are much less applied in this research area. As a result, we have included articles that approach persuasion from less traditional routes and provide an innovative view on the role and impact of persuasion in addition to articles using experimental research approaches. The special issue arose in part because of the editors’roles as chairs of the Academy of Marketing Consumer Research Special Interest Group. We hosted a workshop at the University of Birmingham in December 2011 to generate interest and facilitate debate on this important topic. Some of the work presented at this workshop appears in this issue. Five articles spanning a range of topics have been selected. These include resistance to persuasion; product placement effects on persuasion and attitudes; attitudinal and emotional reactions to shock advertising; spurious tribal- ism and persuasion at a micro-social level; and the impact of analytical and imaginary information processing modes onattitude towards comparative advertisements. The special issue call generated a large number of submissions, and we would like to thank all those who contributed which enabled us to put together this special issue. Our thanks also go to the many reviewers, all those who submitted articles to the work- shop and the journal andfinally the authors for working hard on improving their articles at each stage of the review process. Thefirst article by Dursun and Tümer Kabadayi draws on the work of Ahluwalia (2000) to examine resistance to per- suasion in an anti-consumption context with consumers who possess negative attitudes towards frozen foods. The authors conduct experimental research in Turkey to investi- gate the role of initial attitude strength and persuasive message strength in triggering and/or hindering biased assimilation processes. Findings from this research extend our understanding of how consumers cope with positive product information, which influences their decision to resist products. The study’sfindings further show that consumers with strong or moderate attitudes respond differently to positive product information. The second article by Coker, Altobello and Balasubramanian examine the role of social context on attitudes towards product placements. Using quantitative research, the authors focus on prominent product placements, which they argue when executed carefully can enhance attitudes and be persuasive. They investigate the effect of viewing with friends on attitudes towards product placements in television shows. Findings from a laboratory experiment suggest that consumers’attitude to prominent product placements are more favourable if they are watching with friends as opposed to strangers. On the basis of their findings, the authors provide interesting suggestions with regard to communication and promotional campaigns that will enhance consumers’attitudes towards product placements viewed in social contexts. The third article by Parryet al. utilises focus groups to examine consumer reactions to shock advertisements. The research focuses on examining similarities and differences across the for-profi t and not-for-profit sectors and further examines the influences of gender and religion. Thefindings suggest that religion does affect how consumers emotional reactions to shock advertisements. Overall the use of shock advertisements is familiar to consumers, but consumers are inclined to accept their use more readily within a not-for-profit context than the for-profit context. Religious taboos or morally offensive images such as dead babies are not viewed positively by consumers and are deemed inappropriate themes for adver- tising. The fourth article builds on the literature on tribalism. Richardson uses literature insights in writing a conceptual * Correspondence to: Dr. Louise M. Hassan, Bangor Business School, Bangor University, Bangor, LL57 2DG, UK. E-mail: [email protected] Copyright © 2013 John Wiley & Sons, Ltd. Journal of Consumer Behaviour,J. Consumer Behav.12:91–92 (2013) Published online in Wiley Online Library (wileyonlinelibrary.com)DOI:10.1002/cb.1429 argument on the potential for persuasion among tribal mem- bers of the X factor TV brand. He delineates the process of persuasion by assessing both the role of the marketer and the need for linking values that bind together the tribal members. Without support from marketers, spurious tribalism may occur that undermines the ability of tribal members to persuade each other to engage in behaviours that are beneficial to the brand. Richardson closes with a need for empirical research to gain an enriched view on the propositions developed. Thefinal article by Kalro, Sivakumaran and Marathe exam- ines the roles of analytical and imaginary information proces- sing modes on individuals’attitudes towards comparative advertising formats. The authors focus on direct and indirect comparative advertising, suggesting that each may require a different information processing condition. Using an experi- mental design and smart phones as the product stimuli of the comparative ads, the authors’findings suggest that comparative advertising is more effective if direct comparisons are used un- der analytical processing, which is more suited for utilitarian products, whereas indirect comparisons are used under imagi- nary information processing conditions for hedonic products. BIOGRAPHICAL NOTES Louise Hassan, is a Reader in Marketing at Bangor Business School. Her research interests and activities are international in nature with a focus on transformative consumer research and social marketing. In particular, Dr Hassan is interested in understanding psychological processes underlying consumption decisions. Most of her research is undertaken within the contexts of smoking cessation and healthy eating. She is a co-investigator for the International Tobacco Control Evaluation project (ITC) and deputy chair of the Academy of Marketing Consumer Research Special Interest Group. Dr Hassan’s work has appeared in journals such as theJournal of Advertising,Journal of Business Research,Journal of Consumer Affairs,Psychology and Marketing,International Marketing Reviewand theEuropean Journal of Marketing.Nina Michaelidou, is a Reader in Marketing at Loughborough University School of Business and Economics. Her research interests lie in the area of consumer behaviour and specifically personality traits such as variety seeking and innovativeness, emotions and health behaviours as well as social media usage and consumers’responses to advertising appeals and promotions on social media. She is an associated editor for theJournal of Marketing Managementand the leader of the Academy of Marketing Special Interest Group on Consumer Research. Dr Michaelidou has published papers in various journals including theJournal of Marketing Management,European Journal of Marketing,Journal of Strategic Marketing,Journal of Business Research,Industrial Marketing Management,Food Policy,Journal of Consumer Affairs,International Journal of AdvertisingandJournal of Consumer Behaviour. REFERENCES Ahluwalia R. 2000. Examination of psychological process underly- ing resistance to persuasion.Journal of Consumer Research 27: 217–232. Bohner G, Erb H-P, Siebler F. 2008. Information processing approaches to persuasion: integrating assumptions from dual- and single-processing perspectives. In Crano WD, Prislin R (eds). Attitudes and Attitude Change. Psychology Press: New York; 161–188. Chaiken S, Liberman A, Eagly AH. 1989. Heuristic and systematic information processing within and beyond the persuasion context. In Uleman JS, Bargh JA (eds).Unintended Thought. Guilford Press: New York; 212–252. Durani A. 2012. AA reports UK ad spend lifted 2.7% in 2011. Media Week. Available at: http://www.mediaweek.co.uk/news/ 1126667/AA-reports-UK-ad-spend-lifted-27-2011/(accessed on 1 November 2012). Petty RE, Cacioppo JT. 1981.Attitudes and Persuasion: Classic and Contemporary Approaches. Dubuque, IA: Wm. C. Brown. Petty RE, Wheeler SC, Tormala ZL. 2003. Persuasion and attitude change. In Millon T, Lerner MJ (eds).Comprehensive Handbook of Psychology. John Wiley & Sons: New York; 353–382. 92Editorial Copyright © 2013 John Wiley & Sons, Ltd.J. Consumer Behav.12:91–92 (2013) DOI: 10.1002/cb Copyright of Journal of Consumer Behaviour is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use.