This is the accessible text file for GAO report number GAO-06-818
entitled 'ONDCP Media Campaign: Contractor's National Evaluation Did
Not Find That the Youth Anti-Drug Media Campaign Was Effective in
Reducing Youth Drug Use' which was released on August 25, 2006.
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Report to the Subcommittee on Transportation, Treasury, the Judiciary,
Housing and Urban Development, and Related Agencies, Committee on
Appropriations, U.S. Senate:
United States Government Accountability Office:
GAO:
August 2006:
ONDCP Media Campaign:
Contractor's National Evaluation Did Not Find That the Youth Anti-Drug
Media Campaign Was Effective in Reducing Youth Drug Use:
Youth Anti-Drug Media Campaign:
GAO-06-818:
GAO Highlights:
Highlights of GAO-06-818, a report to the Chairman and Ranking Member,
Subcommittee on Transportation, Treasury, the Judiciary, Housing and
Urban Development, and Related Agencies, Committee on Appropriations,
U.S. Senate
Why GAO Did This Study:
Between 1998 and 2004, Congress appropriated over $1.2 billion to the
Office of National Drug Control Policy (ONDCP) for the National Youth
Anti-Drug Media Campaign. The campaign aimed to prevent the initiation
of or curtail the use of drugs among the nation’s youth. In 2005,
Westat, Inc., completed a multiyear national evaluation of the
campaign.
GAO has been mandated to review various aspects of the campaign,
including Westat’s evaluation which is the subject of this report.
Applying generally accepted social science research standards, GAO
assessed (1) how Westat provided credible support for its findings and
Westat’s findings about (2) attitudes, beliefs, and behaviors of youth
and parents toward drug use and (3) youth self-reported drug use.
What GAO Found:
GAO’s review of Westat’s evaluation reports and associated
documentation leads to the conclusion that the evaluation provides
credible evidence that the campaign was not effective in reducing youth
drug use, either during the entire period of the campaign or during the
period from 2002 to 2004 when the campaign was redirected and focused
on marijuana use. By collecting longitudinal data—i.e., multiple
observations on the same persons over time—using generally accepted and
appropriate sampling and analytic techniques, and establishing reliable
methods for measuring campaign exposure, Westat was able to produce
credible evidence to support its findings about the relationship
between exposure to campaign advertisements and both drug use and
intermediate outcomes. In particular, Westat was able to demonstrate
that its sample was not biased despite sample coverage losses,
maintained high follow-up response rates of sampled individuals to
provide for robust longitudinal analysis, established measures of
exposure that could detect changes in outcomes on the order of
magnitude that ONDCP expected for the campaign and that could reliably
measure outcomes, and used sophisticated statistical methods to isolate
causal effects of the campaign.
Westat’s findings on the effects of exposure on intermediate
outcomes—theorized precursors of drug use—were mixed. Specifically,
although sampled youth and parents’ recall of campaign advertisements
increased over time, they had good impressions of the advertisements,
and they could identify the specific campaign messages, exposure to the
advertisements generally did not lead youth to disapprove of using
drugs and may have promoted perceptions among exposed youth that
others’ drug use was normal. Parents’ exposure to the campaign led to
changes in beliefs about talking about drug use with their children and
the extent to which they had these conversations with their children.
However, exposure did not appear to lead to increased monitoring of
youth. Moreover, the evaluation was unable to demonstrate that changes
in parental attitudes led to changes in youth attitudes or behaviors
toward drug use.
Westat’s evaluation indicates that exposure to the campaign did not
prevent initiation of marijuana use and had no effect on curtailing
current users’ marijuana use, despite youth recall of and favorable
assessments of advertisements. Although general trend data derived from
the Monitoring the Future survey and the Westat study show declines in
the percentage of youth reportedly using marijuana from 2002 to 2004,
the trend data do not explicitly take into account exposure to the
campaign, and therefore, by themselves, cannot be used as evidence of
effectiveness. In Westat’s evaluation of relationships between exposure
and marijuana initiation the only significant finding was of small
unfavorable effects of the campaign exposure on marijuana initiation
during some periods of data collection and in some subgroups.
What GAO Recommends:
Given that Westat’s evaluation stated the campaign did not reduce youth
drug use nationally, Congress should consider limiting appropriations
for the campaign, beginning in the 2007 fiscal year budget until ONDCP
provides credible evidence of a media campaign approach that
effectively prevents and curtails youth drug use. ONDCP’s written
comments on our report generally disagreed with the findings.
Specifically, ONDCP does not believe the Westat findings reflect the
campaign’s effectiveness. We believe the Westat study is sound.
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-818].
To view the full product, including the scope and methodology, click on
the link above.
For more information, contact Laurie Ekstrand, (202) 512-8777,
ekstrandl@gao.gov.
[End of Section]
Contents:
Letter:
Results in Brief:
Background:
Westat's Evaluation Design, Use of Generally Accepted and Appropriate
Sampling and Analytic Techniques, and Reliable Methods for Measuring
Campaign Exposure Produced Credible Evidence to Support Its Findings:
The Phase III Evaluation Provided Mixed Evidence of the Campaign's
Effectiveness on Intermediate Outcomes, but It Found No Effect of the
Campaign on Parental Monitoring of Youth:
The Phase III Evaluation Found No Significant Effects of Exposure to
the Campaign on Youth Drug Use Outcomes Other than Limited Unfavorable
Effects on Marijuana Initiation:
Conclusions:
Matter for Congressional Consideration:
Agency Comments and Our Evaluation:
Appendix I: Westat's Methods for Addressing Evaluation Implementation
Issues:
Appendix II: Comments from the Office of National Drug Control Policy:
Appendix III: GAO Contacts and Staff Acknowledgments:
Tables:
Table 1: Appropriations for the National Youth Anti-Drug Media
Campaign, Fiscal Years 1998 through 2006:
Table 2: NSPY Survey Rounds and Response Rates, Sampled and Surveyed
Youth:
Figures:
Figure 1: Data Collection Rounds and Waves of the NSPY:
Abbreviations:
CPS: Current Population Survey:
GRP: gross rating points:
MTF: Monitoring the Future:
NIDA: National Institute on Drug Abuse:
NIP: National Immunization Program:
NIS: National Immunization Survey of Children:
NLSY: National Longitudinal Survey of Youth:
NSDUH: National Survey on Drug Use and Health:
NRC: National Research Council:
NSPY: National Survey of Parents and Youth:
OMB: Office of Management and Budget:
ONDCP: Office of National Drug Control Policy:
PART: Performance Assessment Rating Tool:
PATS: Partnership for a Drug Free America's Attitude Tracking Survey:
PDFA: Partnership for a Drug Free America:
PME: Performance Measures of Effectiveness:
YRBSS: Youth Risk Behavior Surveillance System:
[End of section]
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed
in its entirety without further permission from GAO. However, because
this work may contain copyrighted images or other material, permission
from the copyright holder may be necessary if you wish to reproduce
this material separately.
United States Government Accountability Office:
Washington, DC 20548:
August 25, 2006:
The Honorable Christopher Bond:
Chairman:
The Honorable Patty Murray:
Ranking Member:
Subcommittee on Transportation, Treasury, the Judiciary, Housing and
Urban Development, and Related Agencies:
Committee on Appropriations:
United States Senate:
Congressionally mandated under the Treasury and General Government
Appropriations Act of 1998,[Footnote 1] the National Youth Anti-Drug
Media Campaign had the primary goals of preventing the initiation of
drug use--particularly the use of entry-level drugs marijuana and
inhalants--among the nation's youth and stopping youth that have begun
using drugs from continuing their use. Administered through the Office
of National Drug Control Policy (ONDCP) and implemented in three
phases, the campaign featured as its centerpiece a paid advertising
effort in which campaign funds were used to purchase media time and
space for advertisements that delivered anti-drug messages to the
campaign's target audience--youth aged 9 to 18 and their parents--
through strategic placement of anti-drug advertisements on television
and radio and in print media. In addition to the advertising, the
campaign included community outreach, work with the entertainment
industry to encourage the accurate depiction of the consequences of
drug use, outreach to faith-based organizations, and work with youth
organizations. The campaign's first two phases, which ran from January
1998 through the summer of 1999, were pilot phases that focused
primarily on informing the planning and development for phase III and
included a 12-city pilot (phase I) and nationwide advertising (phase
II). Phases I and II aimed to increase public awareness of anti-drug
messages. Phase III of the campaign, which began in mid-1999, continued
the nationwide advertising campaign begun during phase II and
integrated the advertising with outreach efforts. From fiscal year 1998
through fiscal year 2006, Congress appropriated over $1.4 billion to
support the campaign. For fiscal year 2007, the President's budget
requested $120 million for the campaign, an increase over the fiscal
year 2006 appropriation, to purchase additional media time and space to
increase the reach and frequency of the campaign's messages, which
would restore appropriations to their fiscal year 2005 level.
Congress first authorized funding for the campaign in fiscal year 1998
with the expectation that demonstrable changes in youth drug behaviors
would be apparent within 3 years, and Congress required ONDCP to assess
whether the campaign's efforts have been effective in changing the drug
use behaviors of America's youth. ONDCP also indicated that it
anticipated that it would take 2 to 3 years for the campaign to affect
drug use behavior, although ONDCP also indicated that it was with the
implementation of phase III of the campaign, beginning in mid-1999,
that ONDCP expected to see improvements in anti-drug attitudes that
would lead to decreases in youth drug use within 3 years. We previously
reported that ONDCP's evaluations of the first two phases of the
campaign produced inconclusive results because of various evaluation
implementation problems and limitations of the analyses used to support
findings about effects during these pilot phases.[Footnote 2] In
particular, we noted that the impact evaluations of phases I and II did
not adequately gauge the overall level of anti-drug awareness generated
by the campaign--the principal outcome measure for these two phases--
and we identified site selection problems, unknown parent response
rates, low school response rates, and data analysis issues contributing
to the inconclusive results.
To implement the phase III evaluation, ONDCP entered into an
interagency agreement with the National Institute on Drug Abuse (NIDA),
which in turn awarded contracts to Westat, Inc., through June 2005 for
$42.7 million to conduct the evaluation. Westat subcontracted with the
Annenberg School for Communication at the University of Pennsylvania,
and staff from Westat and Annenberg were coprincipal investigators for
the study.[Footnote 3] Westat's phase III evaluation covered the period
from September 1999 through June 2004 and studied the impact of the
effectiveness of the nationwide campaign in reaching its target
audience; affecting youth beliefs, attitudes, intentions, and behaviors
with regard to drug use; and affecting their parents' beliefs and
attitudes toward drug use and affecting parents' behaviors associated
with interacting with their children and monitoring their activities.
Westat evaluated the campaign using a longitudinal panel survey--the
National Survey of Parents and Youth (NSPY)--that aimed to measure the
campaign's effectiveness by assessing changes in various outcomes
within individuals over time in relation to their exposure to campaign
messages. Westat's evaluation assessed the effect of exposure to the
campaign on youth drug use and on several key intermediate outcomes--
such as youth and parent attitudes toward and beliefs about drug use
and parental involvement with their children--that were believed to
influence youth drug use. In conducting the evaluation, Westat
submitted several interim reports that were used in part to inform
decisions about the direction of the campaign. Westat submitted a draft
of the final evaluation report to NIDA in February 2005.[Footnote 4]
Both Congress and ONDCP recognized the need for a separate evaluation
of the campaign, because of limitations associated with existing
national surveys of drug use. Congressional conferees acknowledged
their intention to rely on the evaluation to gauge the impact of the
campaign, and also indicated that if the campaign failed to show its
effectiveness, they would be compelled to reevaluate the use of
taxpayer money to support it. ONDCP acknowledged that existing national
surveys of drug use would not be able to answer the critical question
of whether changes in drug use behavior and attitudes were the result
of the campaign. These surveys do not ask respondents about their
exposure and reactions to the messages of the campaign that can then be
linked to their drug-related attitudes and behavior. For example, in a
2001 report on youth drug use and the campaign, ONDCP officials noted
that while national surveys of youth drug use showed flattening or
declining youth marijuana use in 1999 and 2000 and these trends
suggested that the campaign may be having the desired impact, it was
necessary to await the results of the campaign's independent evaluation
before drawing any definitive conclusions regarding the campaign's
contribution to changes in youth drug use.
In a committee report for the fiscal year 2004 appropriations cycle,
the Senate Appropriations Committee directed us to review how
consultants were used in support of the media campaign.[Footnote 5]
This is the second of two reports responding to this mandate.[Footnote
6] The first report provided information concerning ONDCP's use of
consultants in the campaign. This second report addresses three
questions related to Westat's evaluation of phase III of the media
campaign: (1) How did Westat ensure that it could report credible
results in its evaluation of the campaign? (2) What did the evaluation
find about the effect of exposure to the campaign on key intermediate
outcomes that were intended to lower youth drug use? (3) What did the
evaluation find about the effect of exposure to the campaign on youth
drug use?
In addressing our objectives, a team of GAO social scientists reviewed
and assessed materials related to Westat's phase III evaluation,
applying generally accepted social science research standards,
including such elements as when and how the sample data were collected,
adjustments made to the sample to address nonresponse, how program
effects were isolated (i.e., the use of statistical controls), and the
appropriateness of outcome measures. The materials reviewed included
interim and final evaluation reports, documentation and analyses
provided by Westat to us in response to several sets of questions that
we submitted about the details of its methodology, documentation
pertaining to meetings of scientific panels that provided guidance on
the evaluation, and documentation prepared by ONDCP about the design
and implementation of the campaign. We conducted our work in accordance
with generally accepted government auditing standards from October 2005
through June 2006.
Results in Brief:
By collecting longitudinal data--i.e., multiple observations on the
same persons over time--using generally accepted and appropriate
sampling and analytic techniques, and establishing reliable methods for
measuring campaign exposure, Westat was able to produce credible
evidence to support its findings about the relationship between
exposure to campaign advertisements and both drug use and intermediate
outcomes. In implementing the study, Westat encountered problems that
are common to large-scale longitudinal studies, and it addressed those
using methods that are generally recognized as appropriate approaches
for the study implementation challenges Westat faced. Challenges that
Westat encountered were (1) lack of baseline data, which precluded
Westat from comparing postprogram outcomes to preprogram conditions,
and the redirection of the campaign; (2) sampling concerns,
particularly ensuring the coverage of eligible households with youth in
the targeted age range and ensuring that attrition over successive
survey cycles did not result in insufficient sample size to detect
campaign effects or in systematic bias within the sample; (3)
establishing measures that would allow for both the sufficient
detection of and the reliable measurement of exposure to the campaign
on NSPY survey respondents; and (4) disentangling causal effects of
exposure and drawing meaningful comparisons in the absence of ability
to employ an experimental design where NSPY respondents would have been
randomly assigned to various levels of exposure--the generally
preferred approach for assessing program effects, where possible. Our
examination of Westat's evaluation report and related documentation
leads us to conclude that it addressed each of these challenges
sufficiently to allow it to report credible findings about the effect
of campaign exposure on drug use and intermediate variables believed to
be precursors to drug use. Specifically, (1) several factors suggest
that the lack of baseline data was not fatal to the evaluation's
findings, and Westat was able to generate statistically significant
findings related to the redirected campaign; (2) Westat found no
evidence of bias in the NSPY estimates despite sample coverage losses,
and it also maintained high follow-up response rates of sampled
individuals to provide for robust longitudinal analysis; (3) the NSPY
sample could be used to detect changes in outcomes that were on the
order of magnitude of changes that ONDCP expected for the campaign, and
Westat demonstrated that its measures of exposure were valid and could
reliably predict outcomes, whether results of the associations between
exposure and outcomes were favorable or unfavorable to the campaign;
and (4) using sophisticated statistical methods, Westat matched
respondents on their underlying propensity to be exposed to campaign
advertisements and, by comparing differences in outcomes among groups
with different levels of exposure resulting from its matching methods,
isolated the effects of the campaign from other variables. (See
appendix I for further details.)
For intermediate outcome measures thought to influence the ultimate
target of the campaign, youth drug use--for example, recall and
identification of campaign messages, youth anti-drug attitudes, and
parents' beliefs and behaviors--Westat found favorable effects for some
measures and subgroups, as well as unfavorable effects and no
significant effects for others. In general, both youth and parents'
recall of specific campaign messages increased over the life of the
campaign. In addition, NSPY trend data showed some increasing trends in
anti-drug attitudes and beliefs as well as the proportion of youth who
reported never intending to try marijuana. However, cross-sectional and
longitudinal analysis provided no evidence that these trends resulted
from campaign exposure. Westat's analysis also indicated that among
current, non-drug-using youth, exposure to the campaign had unfavorable
effects on their anti-drug norms and perceptions of other youths' use
of marijuana--that is, greater exposure to the campaign was associated
with weaker anti-drug norms and increases in the perceptions that
others use marijuana. Data for parents in the NSPY on five intermediate
measures show some favorable effects of campaign exposure on parents'
behaviors and beliefs. However, for a major aim of the campaign,
affecting parental behaviors regarding monitoring their children's
whereabouts, activities, and friends, Westat found no evidence of a
significant effect. Moreover, where the data showed favorable
relationships between campaign exposure and parental beliefs and
behaviors, Westat did not find that these effects on parents ultimately
lead to corresponding changes in their children's beliefs and
behaviors.
Westat's evaluation found no significant favorable effects of campaign
exposure on marijuana initiation among non-drug-using youth or
cessation and declining use among prior marijuana users. Westat's NSPY
data did show some declining trends in self-reported lifetime and past-
month use of marijuana by youth over the period from 2002 to 2004 and
declining trends in youth reports of offers to use marijuana. Declining
drug use trends in the NSPY were consistent with trends in other
national surveys of drug use over these years. However, Westat
cautioned that because trends do not account for the relationship
between campaign exposure and changes in self-reported drug use, trends
alone should not be taken as definitive evidence that the campaign was
responsible for the declines. ONDCP has also acknowledged the
limitation of drug use trends for the purpose of demonstrating a causal
link between campaign exposures and declines in drug use trends.
Westat's analysis of the relationship between exposure to campaign
advertisements and youth self-reported drug use in the NSPY data for
the entire period covered by its evaluation--assessments that used
statistical methods to adjust for individual differences and control
for other factors that could explain changes in self-reported drug use-
-showed no significant effects of exposure to the campaign on
initiation of marijuana by prior nonusing youth. Westat's analysis
found significant unfavorable effects--that is, a relationship between
campaign exposure and higher rates of initiation--during one round of
NSPY data and for the whole period of the campaign among certain
subgroups of the sample (e.g., 12 ½-to 13-year-olds and girls). Westat
found no effects of campaign exposure on rates of quitting or use by
prior users of marijuana.
In light of the fact that the phase III evaluation of the media
campaign yielded no evidence of a positive outcome in relation to teen
drug use and congressional conferees' indications of their intentions
to rely on the Westat study, Congress should consider limiting
appropriations for the National Youth Anti-Drug Media Campaign
beginning in the fiscal 2007 budget year until ONDCP is able to provide
credible evidence of the effectiveness of exposure to the campaign on
youth drug use outcomes or provide other credible options for a media
campaign approach. In this regard we believe that an independent
evaluation of the new campaign should be considered as a means to help
inform both ONDCP and Congressional decision making.
We provided a draft of this report to the Director of ONDCP for
comment. In response, ONDCP provided written comments (reproduced in
appendix II), which stated that ONDCP was puzzled that we did not make
recommendations to it about how to improve the campaign. However, the
main purpose of our report was to assess Westat's evaluation rather
than to comment on how to improve the media campaign. In so doing, we
focused on Westat's methods. Our role was to inform Congress about the
reliability of Westat's evaluation so that Congress could decide the
extent to which it will continue to fund the campaign.
ONDCP expressed a number of concerns about our assessment of Westat's
evaluation and its implications concerning the effectiveness of the
campaign. Most importantly, it stated that the Westat study is ill
suited to assess impact and the study's findings are of limited
relevance. Our extensive review of the Westat study does not support
ONDCP's conclusion. Westat successfully addressed implementation
challenges and used sophisticated analytic techniques to develop its
findings. Another major issue ONDCP presents in its comments deals with
the fact that the campaign has made major changes since the Westat data
collection, rendering the study's findings irrelevant. Neither we nor
ONDCP has factual data upon which to base an assessment of the
effectiveness of the current campaign. However, other major efforts to
substantially change the campaign during the time frame of the Westat
data collection did not yield positive results. ONDCP raised a number
of other issues that are generally related to the issues discussed
above. These are addressed in the Agency Comments and Our Evaluation
section of this report.
Background:
The National Youth Anti-Drug Media Campaign:
As part of the Treasury and General Government Appropriation Act of
1998,[Footnote 7] the Drug Free Media Campaign Act of 1998 required,
among other things, the Office of National Drug Control Policy to
conduct a national media campaign for the purpose of reducing and
preventing drug abuse among young people in the United States.[Footnote
8] The National Youth Anti-Drug Media Campaign may be the most visible
federal effort devoted to preventing drug use among the nation's youth.
It aims to educate and enable America's youth to reject illegal drugs;
to prevent youth from initiating use of drugs, especially marijuana and
inhalants; and to convince occasional users of these and other drugs to
stop using drugs. Administered by ONDCP, and implemented in three
phases, the campaign has as its centerpiece a paid advertising effort
in which campaign funds were used to purchase media time and space for
advertisements that delivered anti-drug messages to the campaign's
target audiences--youth aged 9 to 18 and their parents and adult
caregivers--through strategic placement of anti-drug advertisements on
television and radio and in print media.
The campaign's first two phases were pilot phases that had as their
objectives developing advertising concepts, creating limited
advertisements, testing public awareness of the advertisements in 12
metropolitan areas, and eventually extending the pilot program
nationwide. Phase III of the campaign, which began in mid-1999,
continued the nationwide advertising campaign begun during phase II and
integrated the advertising with outreach efforts. In addition to the
advertising, the fully integrated phase III campaign included community
outreach, work with the entertainment and media industries to encourage
the accurate depiction of the consequences of drug use, outreach to
faith-based organizations, and work with youth organizations.
During phase III, ONDCP had overall responsibility for developing and
implementing the campaign, and to do so, it enlisted the support of
nonprofit organizations, trade associations, private businesses, and
federal agencies. Appropriated media campaign funds were to be used to
cover the costs of actually making the advertisements as well as the
costs for planning of purchase of media time and space. The campaign
also included public outreach and specialized communications efforts.
The purpose of public outreach and communications was to extend the
reach and influence of the campaign through nonadvertising forms of
marketing communications. Examples of these nonadvertising forms of
communication included submitting articles related to key campaign
messages such as effective parenting or the effects of marijuana on
teen health to newspapers and magazines; building partnerships and
alliances, for example, coordinating positive activities for teens with
local schools and community groups; creating Web sites and exploring
alternative media approaches; and entertainment industry outreach.
According to the campaign's communications strategy, youth aged 9 to 18
were segmented into three school and age risk-level categories: late
elementary school adolescents, aged 9 to 11; middle school children,
aged 11 to 13; high school youth, ages 14 to 18. The campaign
originally targeted youth aged 9 to 18 with a focus on middle school
age adolescents (roughly 11-to 13-year-olds); its secondary focus was
on high school-aged youth (approximately 14 to 18 years of age). In
2001, the campaign shifted its creative focus to 11-to 14-year-olds in
order to more effectively reach youth at the time they are most at risk
for trying drugs. In 2002, the campaign altered its target age group to
focus primarily on 14-to 16-year-olds. For all age groups, the
communications strategy identified the primary focus of the campaign as
at-risk nonusers and occasional users of drugs. For all groups, it was
designed to give consideration to differences arising from gender,
race, ethnicity, and regional and population density factors.
From fiscal year 1998 through fiscal year 2004, Congress appropriated
$1.225 billion to support the campaign (table 1).
Table 1: Appropriations for the National Youth Anti-Drug Media
Campaign, Fiscal Years 1998 through 2006:
Fiscal year: 1998;
Final appropriations (in millions of dollars): $195.
Fiscal year: 1999;
Final appropriations (in millions of dollars): $185.
Fiscal year: 2000;
Final appropriations (in millions of dollars): $185.
Fiscal year: 2001;
Final appropriations (in millions of dollars): $185.
Fiscal year: 2002;
Final appropriations (in millions of dollars): $180.
Fiscal year: 2003;
Final appropriations (in millions of dollars): $150.
Fiscal year: 2004;
Final appropriations (in millions of dollars): $145.
Fiscal year: 2005;
Final appropriations (in millions of dollars): $120.
Fiscal year: 2006;
Final appropriations (in millions of dollars): $100.
Fiscal year: Total, 1998 through 2006;
Final appropriations (in millions of dollars): $1,445.
Fiscal year: Total, 1998 through 2005;
Final appropriations (in millions of dollars): $1,345.
Fiscal year: Total, 1998 through 2004;
Final appropriations (in millions of dollars): $1,225.
Sources: Appropriations Acts from various years.
Note: Appropriated amounts are prerescission amounts. For example,
rescissions were 0.38 percent in fiscal year 2000, 0.22 percent in
fiscal year 2001, 0.65 percent in fiscal year 2003, and 0.59 percent in
fiscal year 2004.
[End of table]
For fiscal year 2007, the President's budget requested $120 million for
campaign activities. The 2007 request represents an increase of $21
million above the fiscal year 2006 budget authority. The additional
resources were requested to help to purchase additional media time and
space to increase the reach and frequency of the campaign's messages.
Planning and the Underlying Logic of the Campaign:
According to ONDCP, its planning for the campaign's communications
strategy included reviews of published studies on the etiology and
prevention of adolescent drug use, drug prevention campaigns, other
public health campaigns, and general consumer marketing campaigns
targeting youth and their parents. ONDCP also supplemented its research
evidence with an extensive expert consultation process that included
input from over 200 experts in academia, civic and community
organizations, government agencies, and the private sector. A campaign
design expert panel that included experts in the fields of drug use and
prevention, public health communication, advertising, market research,
consumer marketing, and public policy met over a 4-day period during
the fall of 1997 and played a key role in integrating diverse sources
of information and guiding the development of the communications
strategy for the campaign.
The planning process resulted in a statement of ONDCP's communications
strategy for the campaign, which described the premises of the
campaign. Among these were the following: First, that the media can
influence people in a variety of ways, such as informing and alerting
them to important developments and shaping subsequent actions;
satisfying leisure time needs, thereby influencing individuals' views
and beliefs about the world; and stimulating interest in commercial
goods and services, thereby influencing where and how people shop.
Second, that media messages have more potential to reinforce rather
than to alter existing attitudes and beliefs. Third, to the extent that
youth attitudes, beliefs, and intentions toward drug use vary with
their age, the potential of a media campaign to influence drug use may
be directly related to the age of the youth. Fourth, the campaign had
to be sustained over time and to have a significant media presence, and
its central messages have to be repeated often and in a variety of
ways. Citing research showing that attitudinal and behavioral change
took time to occur, ONDCP reported that it expected to observe
"improvements in anti-drug attitudes that would lead to decreases in
youth drug use within three years" of the implementation of phase III
of the campaign. Fifth, as parents and adult caregivers play a vital
role in youth drug use behaviors, and by also targeting parents, the
campaign would aim to affect the nature of their interaction with their
children, thereby strengthening their children's capacity to resist
using illicit drugs.
The campaign focused on primary prevention--that is, preventing those
who did not use drugs from starting to use drugs. According to ONDCP, a
media campaign that focused on primary prevention targets the
underlying causes of drug use and therefore has the greatest potential
to reduce the scope of the problem over the long term. Further, a
primary prevention campaign also has greater potential to affirm and
reinforce anti-drug attitudes of nonusers than to persuade experienced
users to change their behaviors, and a primary prevention campaign
would also, over time, lessen the need for drug treatment services.
With a focus on young, non-drug-using adolescents, an expectation
underlying the campaign's potential success was that as these young,
non-drug-using adolescents aged, the campaign's messages would
intervene, retard the development of more pro-drug attitudes, and
enable adolescents to continue to maintain their preexisting anti-drug
attitudes. By maintaining these attitudes, or preventing the
development of pro-drug sentiments, the campaign would affect drug use
rates by lowering the rate at which youth initiated drug use,
particularly the use of marijuana or inhalants.
The campaign was designed to have a significant and sustained media
presence. During planning, ONDCP acknowledged that the campaign would
have to be sustained for a period of time sufficient to bring about a
measurable change in the beliefs and behaviors of youth in the target
audience. On the basis of the experiences of successful social
marketing campaigns, ONDCP reported that it expected that changes in
awareness or recall of the campaign would be detectable within a few
months of the start of the campaign, that changes in perceptions and
attitudes would be detectable within 1 to 2 years of the start of the
campaign, and that changes in behavior would be detectable within 2 to
3 years.
Campaign Activities during Phase III:
From mid-1999, the start of phase III, through June 2004, the end of
the phase III evaluation, campaign activities included extensive media
dissemination of campaign messages to a national audience of youth and
parents; an interactive media component, which involved using content-
based Web sites and Internet advertising; use of experienced
individuals and organizations with expertise in marketing to teens,
advertising and communications, behavior change, and drug prevention to
inform the campaign strategy and implementation; use of multicultural
initiatives that focused on sufficiently exposing campaign messages to
African Americans, Asian Americans, Pacific Islanders, Hispanic
Americans, American Indians, and Alaskan Natives; and the
implementation of the integrated social marketing and public health
communications campaign through the creation of partnerships with
civic, professional, and community groups and outreach to media,
entertainment, and sports industries. Through the partner
organizations, the campaign attempted to strengthen local anti-drug
efforts, and through outreach, it encouraged the news media to run
articles that conveyed campaign messages. Youth and parent exposure to
campaign messages could come from the direct, paid and donated
advertising or from content delivered by news media and entertainment
industries through the outreach efforts. Additional opportunities for
exposure to anti-drug messages could be enhanced through personal
involvement with organizations that became partners as a result of
campaign outreach or by interaction with the campaign's Web site.
Further, youth exposure to anti-drug messages could also occur through
interactions with friends, peers, parents, or other adults that
occurred directly from either campaign ads or outreach efforts.
Campaign Themes and Messages:
Campaign messages for both youth and their parents and caregivers were
to focus on common transitions--such as the transition from elementary
to secondary school--and common situations--such as the amount of time
spent in settings without adult supervision--that were believed to
heighten adolescents' vulnerability to drug use initiation. In
addition, messages were to focus on altering mediating variables--such
as beliefs and intentions--that were known to have a significant impact
on adolescent drug use. Finally, campaign messages were designed to
create a "brand identity" in the minds of target audience members and
through brand identity position campaign messages as credible and
important. Throughout phase III, themes such as parents as "The Anti-
Drug" and the "My Anti-Drug" theme for youth were designed to promote
identification and positive associations with the campaign's messages.
While they evolved throughout the campaign, the central strategic
messages or themes for youth focused on resistance skills and self-
efficacy to refuse drugs, normative education and positive messages,
negative consequences of drug use, and early intervention. Resistance
skills and self-efficacy advertisements were designed to enhance the
personal and social skills of youth that promote lifestyle choices and
to help build youth's confidence that they could resist drugs.
Normative education themes attempted to instill the beliefs that most
young people do not use drugs or convey messages that "cool people
don't use drugs," while positive message themes reinforced the idea of
positive uses of time as alternatives to illicit drugs. Negative
consequences themes aimed to enhance youth perceptions that drug use is
likely to lead to a variety of negatively valued consequences, such as
loss of parental approval, reduced performance in school, and negative
social, aspirational, and health effects. Negative consequences themes
were the primary focus of the Marijuana Initiative, which was
introduced during 2002. An early intervention theme sought to motivate
youth to intervene with friends who they perceived as having problems
with drugs or alcohol and tried to convince youth of their ability to
take action and to give them the tools and skills they needed to
intervene.
For parents, the campaign's themes included messages that every child,
including their own, was at risk of doing drugs; that they can learn
parenting skills to help them help their children avoid drugs; that
they need to be aware of the harmful effects of drugs including
marijuana and inhalants; and, as part of the Early Intervention
Initiative, that it was important that they intervene at the earliest
possible opportunity in their child's life if their child was using
drugs or alcohol.
Design of the Evaluation, Interim Evaluation Reports, and Redirection
of the Campaign:
ONDCP recognized the need for a separate evaluation of the campaign and
for ongoing reporting of evaluation results. The need for a separate
evaluation stemmed in part from the limitations of existing national
surveys that monitor drug use, such as Monitoring the Future, which
provides data on drug use by high school students, the National
Household Survey on Drug Abuse,[Footnote 9] and the Youth Risk Behavior
Survey, which addresses health risk behaviors including drug use. These
recurring surveys provide very little information with which to
evaluate the impact of the campaign, because they were not designed to
evaluate it. As ONDCP has written, these surveys contain no questions
about target audience exposure and response to the campaign, and as a
result, any changes in attitudes, beliefs, and behaviors toward drug
use could not be associated directly with the campaign. By comparison,
ONDCP acknowledged that it was using the Westat evaluation to assess
the extent to which changes in anti-drug attitudes and beliefs or drug-
using behavior can be attributed to the campaign, as opposed to other
socioeconomic factors. In addition, ONDCP indicated that for the
campaign, data from Westat's evaluation would enable ONDCP to assess
whether the campaign is working.
The primary tool of the Westat evaluation was the National Survey of
Parents and Youth. The NSPY is a longitudinal panel study of children
and their parents' exposure and response to the campaign. The NSPY was
designed to collect initial and follow-up data from nationally
representative samples of youth aged 9 to 18 and from the parents of
these youth. The sample was designed to represent youth living in homes
in the United States and their parents. Data collection began in
November 1999 and was conducted over four rounds--each of which was
about 1 year apart from the next round--in nine waves of interviews. An
interview wave refers to the fielding of a survey round to a specific
subsample in the NSPY. An interview round refers to the completion of
interviews with the entire sample. Data for each of the nine waves were
collected using a laptop computer and a combination of computer-
assisted interview technologies. To collect sensitive data, audio
computer-assisted self-interview technology was used, allowing
respondents to self-administer the questionnaire in total privacy. The
final wave of data collection was completed in June 2004 (fig. 1).
Eligible youth and parents were to be interviewed four times.
Figure 1: Data Collection Rounds and Waves of the NSPY:
[See PDF for image]
Source: Adopted from Westat, 2005, Vol. 2: Appendices.
[End of figure]
The evaluation aimed to assess whether exposure to the campaign
affected the self-reported knowledge, attitudes, beliefs, and drug use
of youth. Because the campaign reached out to all youth nationwide, the
evaluators could not assess its effects using experimental methods, in
which some subjects are randomly assigned to the intervention and
others are randomly assigned to control groups that were not exposed to
the intervention. Westat's evaluation was designed to take into account
the variation in self-reported exposure to the campaign messages and to
assess how this variation in exposure was correlated with outcomes that
the campaign intended to affect. To attribute changes in drug use
attitudes and behaviors to the campaign, the evaluation was designed to
assess exposure to the campaign and to compare differences in outcomes
for groups of persons that were exposed to varying levels of the
campaign's messages, and to use statistical controls to account for
individual-level differences among survey respondents.
Westat's evaluation assessed youth self-reported drug use and
intermediate outcomes--such as youth and parent attitudes and beliefs
toward drug use and parental involvement with their children--that were
believed to influence youth drug use. The evaluation of phase III
addressed issues related to (1) whether the campaign was reaching its
target populations, (2) whether the desired outcomes moved in favorable
or unfavorable directions, (3) whether the campaign was influencing
changes in the desired outcomes, and (4) what could be learned from the
overall evaluation to support ongoing decision making for the campaign.
These issues led to the five major objectives for the evaluation:
* to measure changes in drug-related knowledge, attitudes, beliefs, and
behavior in youth and their parents;
* to assess the relationship between changes in drug-related knowledge,
attitudes, beliefs, and behavior and self-reported measures of media
exposure, including the salience of the measures;
* to assess the association between parents' drug-related knowledge,
attitudes, beliefs, and behavior and those of their children;
* to assess changes in the association between parents' drug-related
knowledge, attitudes, beliefs, and behavior and those of their children
that may be related to the campaign; and:
* to compare groups of people with high exposure to other groups with
low exposure.
Westat submitted semiannual and special topic reports to NIDA, as the
findings from these interim evaluation reports were to be used to
support ongoing decision making for the campaign. Westat submitted the
first semiannual report in November 2000. By December 2003, Westat had
submitted six additional reports, four of which were labeled as
semiannual reports, and the other two included a special report on
historical trends in drug use and a 2003 report of findings.[Footnote
10] Westat submitted its first draft of its final report to NIDA in
February 2005.
In addition to Westat's evaluation of the relationship between exposure
and outcomes, Westat also prepared a report on the environmental
context of the campaign.[Footnote 11] In May 2002, Westat reported
findings from this qualitative study of views of representatives from
major national organizations and state prevention coordinators about
the messages conveyed by the campaign and the role of the campaign as
an organizing partner in helping to bolster local substance abuse
prevention efforts. According to Westat, representatives felt that the
campaign's messages reinforced their own messages that encouraged youth
to find healthy alternatives to drug use and to raise public awareness
of the issue of illicit drugs among youth. Westat also reported that
representatives were less enthusiastic about the role of the campaign
as an organizational partner in helping with local substance abuse
prevention efforts.
In November 2002, Westat submitted its fifth semiannual report to NIDA.
In it, Westat reported that it found little evidence that the campaign
had direct, favorable effects on youth self-reported drug use between
2000 and 2002. Specifically, Westat reported:
"There is little evidence of direct favorable Campaign effects on
youth. There is no statistically significant decline in marijuana use
to date, and some evidence for an increase in use from 2000 to 2001.
Nor are there improvements in beliefs and attitudes about marijuana use
between 2000 and the first half of 2002. Contrarily, there are some
unfavorable trends in youth anti-marijuana beliefs. Also there is no
tendency for those reporting more exposure to Campaign messages to hold
more desirable beliefs."[Footnote 12]
Westat further reported that there were unfavorable delayed effects of
campaign exposure on subsequent intentions to use marijuana and on
other beliefs. By delayed effects, Westat referred to the relationship
between exposure to the campaign measured in one survey round having an
effect on intentions or beliefs outcomes at a subsequent survey round.
For parents, Westat reported that the evidence was consistent with
favorable campaign effects, as it found that there were favorable
changes for three of five parents' belief and behavior outcome
measures. However, Westat also reported that it found no evidence for
favorable indirect effects on youth behavior as the result of their
parents' exposure to the campaign.
Congressional appropriators expressed concerns about the findings of
Westat's fifth semiannual report. In the conference report for fiscal
year 2003 omnibus appropriations, the conferees reported that they were
"deeply disturbed by the lack of evidence that the National Youth Anti-
Drug Media Campaign has had any appreciable impact on youth drug
use."[Footnote 13] The conferees further acknowledged that while the
evaluation conducted under NIDA's auspices showed "slight and sporadic
impact on the attitudes of parents, it has had no significant impact on
youth behavior." The conferees further acknowledged that while other
surveys of youth drug use--such as Monitoring the Future, a survey of
high school youth--showed recent declines in drug use, "the NIDA study
was undertaken to measure the specific impact of the Media Campaign,
not simply to gauge general trends," and the conferees stated that they
"intend to rely on the scientifically rigorous NIDA study to gauge the
ultimate impact of the campaign" and to reevaluate the use of taxpayer
money to support the campaign if the campaign continued to fail to
demonstrate its effectiveness.
In 2002, the strategy for the campaign was redirected. In the spring,
the target age group of the campaign became 14-to 16-year-olds--youth
who have higher rates of marijuana initiation than younger youth--from
its original targeting of 11-to 13-year-olds. The shift to teens in the
14-to 16-year-old range aimed to allow the campaign to more effectively
reach youth during the time at which they are most at risk for trying
drugs. ONDCP also required more rigorous copy test procedures of all
television advertisements before they were aired, and ONDCP increased
its oversight in guiding the development and production of
advertisements. In October 2002, ONDCP launched a new initiative called
the Marijuana Initiative. This initiative contained more focused
advertising to address youth marijuana use. In a hearing before the
House Committee on Government Reform, ONDCP announced that it would
reverse the ratio of campaign advertising expenditures directed to
adults and youth, respectively. Previously, about 60 percent of
expenditures were directed to adults and 40 percent toward youth.
Finally, during February 2004, it expanded the campaign's
communications goals to include the Early Intervention Initiative. This
intervention was targeted toward both parents and teen friends, and
ONDCP intended to use parental and peer pressure to stop drug and
alcohol use among teens.
Assessment of the Campaign by the Office of Management and Budget and
ONDCP's Current Approach:
To strengthen the linkages between resources and performance envisioned
in the Government Performance and Results Act of 1993 (GPRA),[Footnote
14] the Office of Management and Budget (OMB) developed the Program
Assessment Rating Tool (PART) to bring performance information into the
executive budget formulation process. PART is designed to determine the
strengths and weaknesses of federal programs by drawing upon available
program performance and evaluation data so that the federal government
can achieve better results. The PART therefore looks at factors that
affect and reflect program performance, including program purpose and
design; performance measurement, evaluations, and strategic planning;
program management; and program results. Because the PART includes a
consistent series of analytical questions, it allows programs to show
improvements over time and allows comparisons between similar programs.
OMB's PART rating of the campaign addressed issues related to its
purpose and design, strategic planning, program management, and program
results and accountability. OMB indicated that the purpose was clear--
giving ONDCP a 100 percent score on this factor--and it rated the
campaign's planning and management with scores of 67 percent and 70
percent, respectively. In its assessment of ONDCP's strategic planning,
OMB noted that in response to its 2002 PART review, ONDCP revised the
campaign's logic model and significantly changed its long-term and
annual performance measures.
However, OMB's assessment rating for the campaign was "results not
demonstrated." OMB indicated that its assessment of the campaign's
progress toward both the long-term goals and annual performance goals
will be reviewed against the results of the NIDA-managed evaluation.
OMB noted that while there is no federal program closely comparable to
the campaign, evaluations of other health behavior change efforts found
short-term effects after exposure to media. While acknowledging that a
final assessment of the effects of the campaign awaited the final
report from the NIDA-managed evaluation, OMB also indicated that
"outcome data from the evaluation suggest little or no direct positive
effect on youth behavior and attitudes attributable to the campaign to
date. Perhaps some positive effect on parental attitudes/behavior but
that has not yet translated into an effect on youth."
ONDCP has credited the campaign, along with a variety of collective
prevention efforts, with contributing to "significant success in
reducing teen drug use, as evidenced by the 19 percent decline from
2001 to 2005." It has introduced a new youth brand approach to connect
youth with aspiration themes. ONDCP also has indicated that while it
awaits our formal assessment of the evaluation, that it will use
existing national surveys to evaluate the campaign and suspend its
request for proposals for a new evaluation contract. Specifically,
ONDCP indicated that it would use the MTF survey to track improvements
in perception of the risk of drug use--a predictor of lower drug use by
youth--and it would use a special analysis of the PATS survey--the
Partnership for a Drug-Free America's Attitude Tracking Survey--data on
anti-drug messages. According to the 2005 data from MTF, there were no
significant 1-year declines in marijuana use for youth in any grade
levels, and while gradual declines in the upper grades continued,
declines halted for youth in the 8th grade. Additionally, for 8th
graders, perceived risk of marijuana use held steady, while for youth
in 10th and 12th grade, there was an increase in perceived risk of
marijuana use.
Recent Research on the Effects of the Campaign in Local Settings:
Two recently released studies have reported that exposure to the
campaign was associated with changes in past-month marijuana use under
certain conditions for certain groups of students exposed to the
campaign. In one of the studies,[Footnote 15] 45 South Dakota high
schools and their middle-school feeder(s) were randomly assigned to
three groups: (1) a basic prevention curriculum, (2) a group given this
curriculum with booster lessons, and (3) a control group. All schools
were exposed to the campaign during the fall of 1999 and spring of
2000. This permitted the researchers to test for a synergistic effect
between exposure to the campaign's anti-drug messages and participation
in the school-based drug prevention curriculum. The sample of about
4,100 youth were asked how often they had seen anti-drug advertisements
in recent months in five media outlets that were used by the campaign,
and the researchers measured exposure to the campaign that indicated
whether or not the adolescents reported seeing ads at least one to
three times per week in any of the five media outlets. Consistent with
Westat's fifth interim report, the evaluation of the South Dakota drug
prevention curriculum found no direct effects of exposure to the
campaign on its sample of adolescents' use of illegal drugs. However,
the evaluation also found that marijuana use in the past month was
significantly less likely among adolescents who received both the
curriculum with booster lessons and weekly exposure to the campaign's
messages. In other words, neither the enhanced curriculum nor the
campaign alone had a substantial effect on marijuana use in the absence
of the other. In addition, this evaluation's measure of exposure was
based on weekly exposure, suggesting that the synergistic effect of the
campaign observed in these South Dakota schools was based on the
delivery of repeated messages.
The second study used monthly random samples of 100 youth from the
enrollment lists of 4th to 8th graders in the public schools in the
spring of 1999 in two moderate-sized communities--Fayette County
(Lexington), Kentucky, and Knox County (Knoxville), Tennessee--over 48
months from April 1, 1999, through March 31, 2003.[Footnote 16] The
study period included advertisements aired under the campaign's
Marijuana Initiative. Students in the samples aged over time and were
13 to 17 years of age at the beginning of the Marijuana Initiative.
Youth in the samples were measured on marijuana use during the past 30
days, as well as on their attitudes toward marijuana. Exposure to
television and radio advertisements was measured by self-reported past-
month exposure. The study found that among high-sensation-seeking
youth--that is, youth who desire novel, complex, and intense sensations
and experiences and who are willing to take social risks to obtain
them--exposure to the first 6 months of the campaign's Marijuana
Initiative led to reductions in marijuana use. The study's authors
reasoned that the effects that they found for the Marijuana Initiative
were consistent with an approach termed SENTAR (for sensation-seeking
targeting), in which high-sensation-seeking youth are targeted with
high sensation value messages to prevent risky behaviors.
Westat's Evaluation Design, Use of Generally Accepted and Appropriate
Sampling and Analytic Techniques, and Reliable Methods for Measuring
Campaign Exposure Produced Credible Evidence to Support Its Findings:
Westat was able to produce credible evidence to support its findings
about the relationship between exposure to campaign advertisements and
both drug use and intermediate outcomes by employing a longitudinal
panel design--i.e., collecting multiple observations on the same
persons over time--using generally accepted and appropriate sampling
and analytic techniques and establishing reliable and sufficiently
powerful measures of campaign exposure. Westat encountered various
challenges and threats to validity that are commonly associated with
large-scale longitudinal studies, including lack of an opportunity to
use experimental methods, lack of baseline data, and changes in
campaign focus that were not timed with data collection; issues with
ensuring adequate sample coverage and controlling for sample attrition
over time; establishing measures that were sufficient to detect and
reliably measure campaign effects; and disentangling causal effects
without being able to employ an experimental design where subjects
would have been randomly assigned to different levels of exposure. Our
review of Westat's evaluation report and associated documentation leads
us to conclude that the design and methodology used in its evaluation
responded appropriately to these challenges, resulting in credible
findings.
Although Elements of the Campaign Limited Choices of Evaluation Designs
and Affected Data Collection, Westat's Design Was Rigorous and Provided
a Means to Test for Campaign Effects:
The nationwide scope of the campaign precluded Westat from using
experimental methods or obtaining baseline data, and the timing of the
introduction of some new campaign initiatives limited some of the data
available to evaluate them. However, Westat's longitudinal panel survey
design provided a framework for developing strong evidence of within-
respondent changes in outcomes over time as a result of exposure to the
campaign. The consensus of a scientific panel convened by NIDA in
August 2002 to review the evaluation was that Westat's use of a
national probability sample to study change arising from the campaign
was preferable as the "gold standard" to a study based on other
alternatives, such as in-depth community-based studies of the
mechanisms of change and campaign effects. Additionally, the
theoretical underpinnings of behavioral change through advertising,
along with statistically significant outcomes in some but not all
groups, suggest that the absence of baseline data and introduction of
new campaign initiatives did not invalidate the evaluation's findings.
Finally, despite the introduction of new campaign initiatives that were
not timed with data collection cycles, Westat was able to assess change
in the NSPY data and generate statistically significant findings using
these data.
Westat's longitudinal panel design was based on the premise that
effects of exposure to the campaign on outcomes could be measured and
detected within individuals over time, after controlling for various
other factors that could have influenced outcomes. The design called
for measuring the same respondents up to four times to assess how the
natural variation in exposure to the campaign correlated with campaign
outcomes. Westat's approach--an exposure (or dose)-response model--is
based upon a premise that respondents' recall of advertisements
(exposure or dose) is related to outcomes (response). In two recent
studies of the effects of the campaign on specific groups of youth in
local areas, an exposure-response approach has been shown to be an
effective method for detecting effects of the campaign in reducing
youth drug use in local settings. One of the studies reported a
synergistic effect of exposure to the campaign and a classroom-based
drug prevention curriculum among 9th grade students in 45 South Dakota
high schools. The other study reported reductions in drug use during
the period of the redirected campaign among high-sensation-seeking
youth in schools in Knoxville, Tennessee, and Lexington, Kentucky. To
assess the possibility of preexisting differences between groups of
exposed youth and parents that might explain both the variation in
exposure to the campaign and variation in outcomes, Westat included in
the NSPY structured interview many questions on personal and family
history, and it used the responses to control statistically for
differences in attributes of respondents in order to attempt to isolate
the relationship between exposure to the campaign and outcomes.
The absence of baseline data--that is, precampaign data on outcomes--
was beyond Westat's control, as phase III of the campaign began before
the first wave of data collection for the phase III evaluation began.
The lag between the start of phase III of the campaign in mid-1999 and
the completion of the evaluation's first round of data collection--
around mid-2001--leaves open the possibility that there were effects of
the campaign that occurred very early on in the campaign, prior to when
Westat began data collection. Several factors suggest that the absence
of pre-phase III baseline data was not fatal to the evaluation's
findings. First, if there were effects of the campaign that could not
be detected because of the absence pre-phase III baseline data, those
effects must have occurred very rapidly and then endured throughout the
remainder of the campaign, from 1999 through 2004. However, rapid
changes in youth drug use were not observed in MTF data; rather, the
overall trend in MTF past year drug use was flat between 1998 and 1999.
Second, rapidly occurring effects were not expected by ONDCP in
designing the campaign. As we reported in 2000, and as ONDCP wrote in
2001, ONDCP believed that it would take 2 to 3 years for changes in
drug use to be evident as a result of the campaign.[Footnote 17]
Another campaign design factor that affected Westat's evaluation was
the implementation of new campaign initiatives, such as the Marijuana
Initiative, which were implemented at times that officials at ONDCP
considered to be important, and therefore they may not have coincided
with planned data collection for the evaluation, nor should they
necessarily have done so. For example, the Marijuana Initiative was
implemented in October 2002, and the NSPY data available to evaluate
outcomes during it were limited to three complete survey waves. For its
longitudinal analysis of change during the Marijuana Initiative, Westat
was limited to data from two survey waves. Despite these limitations,
the evaluation produced data that enabled Westat to detect effects
during the period of the Marijuana Initiative.
Sample Coverage Issues Did Not Invalidate Westat's Assessment of the
Effectiveness of Exposure to the Campaign on Intermediate and Drug Use
Outcomes:
During the enrollment phase of the NSPY, Westat experienced sample
coverage problems, in that it enrolled--or rostered--a smaller
percentage of households with youth in the targeted age range than
would be expected based on comparable Current Population Survey (CPS)
estimates--the data that Westat used to develop its expectations about
the percentage of households having youth in the targeted age ranges.
Coverage refers to the extent to which a sample is representative of
the intended population on specified characteristics, and it is
important because the omission of segments of the intended population
from a sample--or undercoverage--can lead to biased results, in that
omitted segments may differ in some important respect from those
segments included. Westat estimated the extent of undercoverage in the
NSPY to be about 30 percent as compared to the CPS estimates, and
according to Westat and NIDA, the undercoverage arose during the stage
of sampling in which Westat was developing rosters of households that
were believed to contain youth in the target age range. At this stage,
the survey rostering process required entry into the household, which
may have led respondents in potentially eligible households to refuse
to participate.
Our review of Westat's documentation leads us to conclude that there
was no evidence of biased results due to undercoverage and that the
sample was sufficiently reliable both for the purposes of estimating
changes over time in individual outcomes and for assessing the
effectiveness of exposure to the campaign on outcomes. Westat's
comparisons of the estimated population characteristics of the NSPY--
such as race and ethnicity of head of household and race and ethnicity
of youth in households--with the estimated population characteristics
from the CPS show that they are generally similar. That is, the
distributions of characteristics of eligible households with youth
included in the NSPY were broadly consistent with a variety of
corresponding distributions from the 1999 CPS. These comparisons
suggest that the NSPY estimated population by race and ethnicity was
similar to that of CPS. Westat also used multivariate modeling
techniques to develop weighting adjustments, and it developed weights
to adjust its sample for nonresponse that were reasonably effective in
reducing nonresponse bias.
An additional test for bias in a sample is to compare estimates derived
from it with estimates on the same variable derived from another
sample. If the NSPY results were biased, then one would expect that
estimates derived from it would differ from estimates derived from
unbiased samples. For example, if eligible households refused to
participate in the NSPY because they contained teens with drug issues
and as a result avoided participation at a higher rate than did
households containing teens without drug issues, then these higher
refusal rates by households containing teens with drug issues would
lead to NSPY estimates of the percentage of youth reporting that they
used drugs that were lower than those obtained from other, comparable
national surveys. According to data provided by NIDA officials and our
review of Westat's final report, estimated self-reported drug use rates
from the NSPY are comparable to estimates derived from other major
surveys of drug use, such as the National Survey on Drug Use and
Health. For example, in the NSPY, rates of past-month marijuana use
among 12-to 18-year-olds were 7.2 percent in 2000, 8 percent in 2001,
8.9 percent in 2002, and 7.9 percent in 2003. These rates were similar
to those reported for 12-to 17-year-olds in the National Survey on Drug
Use and Health (NSDUH) of 7.2 percent in 2000, 8 percent in 2001, 8.2
percent in 2002, and 7.9 percent in 2003. If youth with known drug use
problems consistently opted out of both the NSPY and the NSDUH--a
hypothesis that is not testable with the available data--then the
estimates from both the NSPY and the NSDUH of the true prevalence of
youth drug use would be biased underestimates.
Sample Attrition across NSPY Interview Rounds Was Sufficiently Low to
Allow for Reliable Assessments of the Effect of Campaign Exposure on
Outcomes:
As the NSPY was a longitudinal survey--in which eligible sample
respondents were re-interviewed up to three times after their
enrollment interviews--attrition was a concern with which Westat had to
contend. If comparatively large numbers of sample respondents were not
retained across successive rounds of the survey, the capacity of the
NSPY to provide data to assess changes in outcomes in response to
exposure over time would be greatly diminished. Further, if attrition
was specific to certain groups, then the NSPY estimates would also be
biased.
For the purpose of estimating within-respondent changes in outcomes in
response to changes in exposure across sample periods--the main use of
the NSPY data--Westat achieved follow-up longitudinal response rates of
between 82 percent and 94 percent for waves 4 through 9, the follow-up
waves to the first three enrollment waves. The longitudinal response
rate consists of two elements: (1) the percentage of prior survey
respondents that are tracked and for whom eligibility is determined and
(2) the percentage of those eligible that actually complete an
interview. Across the three follow-up survey rounds, Westat tracked and
determined the eligibility to participate in a follow-up survey of
between 92 percent and 96 percent of the youth and parents who
completed a survey in the prior round. Of these, Westat obtained
consent and completed extended interviews with between 94 percent and
96 percent of youth and parents for whom eligibility for a follow-up
survey had been determined.
In our view, Westat's follow-up response rates resulted in a sample
that was sufficient to provide reliable findings about the effects of
exposure on outcomes. In addition, Westat's nonresponse adjustment
methodology compensated for effects of differential response rates
related to the percentage of persons in certain age groups, of certain
races and ethnicities, of those that owned homes versus rented, those
that were U.S. citizens versus noncitizens, and those with incomes
below the poverty level.
The NSPY Data Could Be Used to Detect Reasonably Small Effects, and
Westat's Measurement of Exposure and Outcomes Were Valid and Could
Detect Effects, if They Occurred:
The NSPY sample could be used to detect changes in outcomes that were
on the order of magnitude of changes expected by ONDCP for the
campaign, and its measures of exposure were valid and reliably
predicted outcomes. In early meetings on the design of the evaluation
of the media campaign, ONDCP officials reported that it had a specific
Performance Measures of Effectiveness system and that the campaign was
embodied within the first goal of the National Drug Strategy, which was
to "educate and enable America's youth to reject illegal drugs as well
as the use of alcohol and tobacco." Under this goal, ONDCP's proposed
targets for reducing the prevalence of past-month use of illicit drugs
and alcohol among youth from a 1996 base year--by 2002, reduce this
prevalence by 20 percent, and by 2007, reduce it by 50 percent. ONDCP
officials identified other specific targets, again from the base year
1996--by 2002, increase to 80 percent the proportion of youth who
perceive that regular use of illicit drugs, alcohol, and tobacco is
harmful; and by 2002, increase to 95 percent the proportion of youth
who disapprove of illicit drug, alcohol, and tobacco use. To achieve a
goal of 80 percent of 12th grade youth who perceive that regular use of
marijuana is harmful would require increasing the 1996 baseline
percentage of youth perceiving marijuana as harmful from 60 percent, as
measured by MTF, or by about 3.3 percentage points per year from 1996
to 2002. Westat's sample could be used to detect this amount of annual
change in youth attitudes.
In order to detect changes in outcomes due to exposure to the campaign,
it also was necessary that Westat accurately measure and characterize
exposure to the campaign. Westat provided evidence for the validity of
its measures of self-reported exposure, and the evidence suggests that
the measure of exposure was both valid and reliable. To measure
exposure to the campaign for both youth and parents, NSPY interviewers
asked respondents about their recall of anti-drug advertisements
(general exposure) and their recognition of specific current or very
recent television and radio advertisements (specific
exposure).[Footnote 18] To facilitate measures of recall, respondents
viewed television and radio advertisements on laptop computers. Youth
and parents were only shown or listened only to advertisements targeted
to their respective groups. In addition, both youth and parents were
asked some general questions about their recall of advertisements seen
or heard in various media, including television, radio, newspapers,
magazines, movie theaters, billboards, and the Internet.
Westat's assessments of the validity of its measure of exposure to
campaign advertisements confirm that the NSPY data were able to measure
exposure. First, Westat examined respondents' recall of campaign
advertisements using "ringer" television advertisements--
advertisements that never had appeared. According to Westat's analysis
of ringer advertisements, youth were more likely to recognize an
advertisement as a campaign advertisement when presented with an actual
campaign advertisement than a bogus one. For example, a far lower
percentage of respondents (11 percent) claimed to have seen a ringer,
or bogus, advertisement than the percentage who claimed to have seen
the broadcast advertisements (45 percent), particularly the
advertisements that were delivered with high frequency. The result held
for youth and for parents.
Second, comparing data on advertisement time purchases with self-
reported exposure to these advertisements in the NSPY, Westat found a
high correlation between advertising and exposure. Specifically, on the
basis of analysis of individual advertisements' gross rating points
(GRP)--a measure of the underlying reach and frequency of each
advertisement--and self-reported exposures by respondents, Westat found
a high correlation between GRPs purchased by the campaign and self-
reported exposure to advertisements among youth. The correlation for
parents was somewhat smaller, but was also significant. Third, Westat
also compared self-reported exposure with recall of the correct brand
phrase and found a strong association between self-reported exposure
and correct recognition of the brand phrase. This is further evidence
for the validity of its measures of self-reported exposure.
Westat measured a variety of outcomes for youth and parents and took
steps to ensure that the measures were consistent with existing
research. The youth questionnaires included numerous questions that
were designed to measure exposure to the campaign advertisements and
other anti-drug messages. The youth question areas included exposure
propensity to media; current and past use of tobacco, alcohol,
marijuana, inhalants, and Ecstasy; past discussions with and
communication of anti-drug messages from parents and friends;
expectations of others about respondent's drug use; knowledge and
beliefs about the positive and negative consequences of drug use;
exposure to campaign messages; family and peer factors; personal
factors; and demographic information. Westat used separate
questionnaires for youth of different ages; one questionnaire was used
for children (aged 9 to 11) and another one was used for teens (aged 12
to 18).
Westat's Analytic Methods Aimed to Isolate Causal Effects of the
Campaign and Did So Using Sophisticated Techniques That Enhanced the
Strength of Its Findings:
In it analysis, Westat used three types of evidence to draw inferences
about the effects of the campaign: (1) trend data--data that describe
increases or decreases in drug use and other outcomes over time; (2)
cross-section analysis--measures of association between exposure to
campaign messages and individual drug use beliefs, intentions, and
behaviors, at the time data were collected; and (3) longitudinal
analysis--measures of association, for youth and parents who were
observed at two points in time, between exposure to campaign messages
at the earlier time on outcomes at the later time.[Footnote 19] Westat
indicated that trends over time, by themselves, could not be used to
provide definitive support for campaign effects. Rather, the trends
needed to be supported by measures of association. Westat also
indicated that measures of association, whether cross-sectional or
longitudinal, needed to control for variables that could influence
outcomes independently of the campaign or otherwise confound the
association between exposure and outcomes. Cross-section association
between exposure and outcomes measured at the same time would provide
stronger evidence of campaign effects than would trend data alone,
provided that controls for other variables were introduced into the
associational analyses. However, even if cross-section associations
between exposure and outcomes hold after controlling for the effects of
other variables, as Westat pointed out, there may remain an alternative
explanation for cross-section associations: For example, an outcome--
like perceptions of others' use of drugs--may be the cause of exposure
rather than an effect of it. Westat's longitudinal analysis attempts to
address the ambiguities that exist with cross-sectional associations.
With longitudinal data, if, after controlling for other confounding
variables, exposure measured at an earlier time is associated with an
outcome at a later time, the inference made is that the causal
direction is from exposure to outcome, since an effect cannot precede a
cause in time.
As the campaign was implemented nationally and it was therefore not
possible to assign youth and their parents randomly to treatment and
control groups, a major threat to the validity of the conclusions from
the evaluation is that the observed correlations between exposure to
the campaign and self-reported attitudes and behaviors could reflect
preexisting differences among individuals in their underlying
susceptibility to campaign messages. The evaluation's associations
between exposure to the campaign and self-reported initiation of
marijuana use took into account statistically the individual
differences in attributes among youth who were exposed to various
levels of campaign messages, and they adjusted for the influence of
other variables that could determine marijuana initiation--called
confounder variables. As such, Westat's evaluation of the associations
between campaign exposure and marijuana initiation have accounted for
individual differences among youth and can be viewed as comparisons of
outcomes for statistically similar individuals. Further, the
statistical test Westat used in assessing the relationship between
exposure and initiation did not rely upon assumptions of linearity
between levels of exposure and initiation. Instead, it tests for an
ordered relationship between exposure and an outcome such as marijuana
use initiation.
Westat used statistical methods to address the possibility that
preexisting differences between individuals could have caused both
reported levels of exposure and respondent outcomes, and its use of
these methods contributed to the validity of its findings about the
effects of the campaign on outcomes. If, independently of the campaign,
individuals differed in their underlying tendencies to accept and
recall campaign messages, and if the individuals who were more likely
to recall advertisements also were those who were more likely to
respond to advertisements, then, absent efforts to address this
confounding factor, the findings about the evaluation would be
questionable. This type of bias is often called a selection effect. If
selection effects occurred in the campaign, then both exposure and
reported changes in attitudes and behaviors could reflect underlying
beliefs that were not affected by the campaign, despite the presence of
statistical correlations between self-reported exposure and changes in
attitudes and behaviors.
To control for selection effects and the many factors that could have
influenced both exposure and outcomes independently of, or in
conjunction with, the campaign, Westat used propensity scoring methods.
These methods limit the influence of preexisting differences among
exposed groups by controlling for a wide range of possible confounding
variables. Propensity score methods are used to create comparison
groups that are similar on measured and potentially confounding
variables but that differ on their levels of treatment. In the
evaluation of the campaign, the comparison groups were similar on
confounding variables but differed on their level of exposure to
campaign messages. Propensity score methods replace a set of
confounding variables with a single function of these variables, which
is called the propensity score. In Westat's analysis, an individual's
propensity score is considered to represent an individual's probability
of being assigned to a particular level of exposure to the campaign,
conditional upon the individual's values of the confounding variables.
By including relevant, potentially confounding variables and matching
individuals on their propensity scores, Westat was able to minimize
bias due to selection effects. The comparison groups that Westat
created by using propensity score methods can be considered as
statistical analogues to randomly assigning individuals to different
levels of exposure. After creating these groups, Westat then analyzed
outcomes among the groups having different propensities to be exposed
to campaign messages.
Our assessment of Westat's methods leads us to conclude that Westat
took reasonable steps to develop valid propensity models, and as a
result of its models, its analysis identified the effects of the
campaign, net of other factors included in its propensity score models.
First, rather than simply compare individuals who were exposed to
campaign messages with those who were not exposed, Westat estimated and
compared groups of individuals with different levels of exposure, where
the number of exposure groups was measured alternatively as a three-or
four-level variable--e.g., low, medium, or high exposure.[Footnote 20]
Second, for the results of propensity methods to be valid, it is
important that the propensity scoring models include all relevant
variables that could otherwise explain differences in both exposure and
outcomes, as evaluators can adjust only for confounding variables that
are observed and measured. If an important variable is omitted from the
propensity model, the results of analyses may be affected. Westat's
models included many relevant and potentially confounding variables.
For example, in the youth models, the propensity score models included
measures of demographic attributes, educational attainment and
educational aspiration, family and parent background, parental
consumption of television and other media, income and employment,
reading habits, Internet usage, location of residence in an urban area,
among other variables. Third, for propensity models to remove the
effects of confounding variables from the association between exposure
and response, it is necessary that the population means of the
confounder variables not vary across exposure levels. If a confounder
is successfully balanced, then it will have the same theoretical effect
across all exposure levels. After estimating models, Westat also
assessed and demonstrated the balance of variables in its propensity
models.
The Phase III Evaluation Provided Mixed Evidence of the Campaign's
Effectiveness on Intermediate Outcomes, but It Found No Effect of the
Campaign on Parental Monitoring of Youth:
Westat reported mixed evidence about the effectiveness of the campaign
on intermediate outcome measures--such as recall and identification of
campaign messages, youth anti-drug attitudes, and parents' beliefs and
behaviors--that were thought to be causal factors influencing youth
drug use, the ultimate target of the campaign. Most parents and youth
recalled exposure to campaign anti-drug messages, and for both groups,
recall increased during the September 1999 to June 2004 period covered
by the phase III evaluation. For current, non-drug-using youth--whose
resistance to initiating marijuana use the campaign intended to affect-
-although NSPY data showed some favorable trends in anti-drug attitudes
and beliefs and in the proportion of youth who said that they would
definitely not try marijuana, there was no evidence that exposure to
the campaign influenced these trends. Conversely, among current, non-
drug-using youth, evidence suggested that exposure to the campaign had
unfavorable effects on their anti-drug norms and perceptions of other
youths' use of marijuana--that is, greater exposure to the campaign was
associated with weaker anti-drug norms and increases in the perceptions
that others use marijuana. On three of five parent belief and behavior
outcome measures--including talking with children about drugs, doing
fun activities with children, and beliefs about talking with children-
-the evidence pointed to a favorable campaign effect on parents.
However, while there was mixed evidence on the effect of the campaign
on parents' beliefs and attitudes about monitoring children's
behaviors, there was no evidence to support a claim that the campaign
actually affected parents' monitoring behaviors--an area of the
campaign's focus for parents--and there was little evidence for
favorable indirect effects on youth behavior or beliefs as the result
of parental exposure to the campaign.
Youth and Parents' Recall of Campaign Advertisements Increased over
Time, Their Impressions of the Advertisements Were Favorable, and They
Could Identify the Campaign Brand:
According to Westat, the campaign purchased enough advertising time
over the 58-month period from September 1999 to June 2004 to achieve an
average exposure of 2.5 youth-targeted ads per week for youth and an
average of 2.2 parent-targeted advertisements per week for parents.
Westat's estimates include campaign advertisements intended for either
all youth or all parents, but they do not include exposure of youth to
parent advertisements or parents to youth advertisements, nor do they
account for separate advertising targeted to specific race-or ethnicity-
defined audiences.
Using exposure indexes, Westat measured trends in general and specific
exposure to campaign advertisements. The general exposure index was
based on questions that asked about exposure to anti-drug messages in
recent months through a variety of channels, including movies,
television, radio, and billboards, and was not limited to campaign
advertisements.[Footnote 21] The specific exposure index was based on
recall of specific advertisements broadcast during the 60 days prior to
the respondent's interview, and was limited to advertisements that
targeted the respondent. For example, for youth, only youth
advertisements were sampled to measure specific exposure. Youth aged
12½ to 18 and their parents reported increasing levels of recall of
specific but not general exposure to campaign advertisements over time.
For both parents and youth, there was a sharp increase over time in the
recall of specific exposure of television ads across the campaign.
Westat speculated that the increase in specific recall may have arisen
from better-placed, more memorable, or longer-aired advertisements
rather than only to an overall increase in television advertisements.
However, recall of all general anti-drug advertising was fairly stable
over time, as there was no overall detectable change in reported
general exposure over the course of the campaign.
Beginning in 2001, when the evaluation started to measure brand phrase
recall, and continuing through 2004, the evidence indicates that youth,
in particular, exhibited increases in brand phrase recall. Advertising
campaigns may use a brand phrase to provide a recognizable element, and
to the extent that the brand is recognized and positively regarded, its
familiarity may lead to a positive response to a new advertisement or
increase the perception that each advertisement is part of a larger
campaign. The campaign included both a parent and a youth brand. Brand
messages may have involved a series of phrases or the portrayal of an
activity or lifestyle as positive (e.g., participating in team sports)
to set up the brand phrase of "The Anti-Drug." Westat reported that the
evidence from the NSPY shows that the greater the exposure to media
campaign advertising, the more likely respondents were to recall the
brand phrase. In addition, the more that respondents recalled specific
ads, the more likely they were to recognize the brand phrase, although
over time even those with less exposure had learned the brand phrase.
Overall, youth reported favorable impressions of the subset of campaign
television advertisements that they were asked to evaluate, and their
favorable impressions increased over time. Responses to the
advertisements--whether they were attention getting, convincing, or
said something important to the respondent--were positive among both
youth and their parents. Parents' evaluations of the advertisements
were generally more positive than those of youth, and parents' positive
views also increased over time.
In addition to distributing messages directly in media advertisements,
the campaign aimed to reach its target audiences indirectly through
other institutions and routes, such as community groups, in-school and
out-of-school anti-drug education, and discussions among youth and
parents, and youth and friends, concerning drug use and the drug
advertisements. The NSPY data indicated that the campaign's messages
were not accompanied by similar increases in exposure to messages from
other sources. Both youth and parents reported receiving anti-drug
messages from other sources, but they did not consistently report
increases in exposure to messages from these sources. For example, from
the 2000 to 2004 samples, the percentages of youth reporting receiving
in-school drug education messages and attending out-of-school drug
education both declined.
Westat Found That the Campaign Generally Had No Effect on the Attitudes
of Youth Not Using Marijuana toward Its Use but That Exposure to the
Campaign Was Associated with Unfavorable Effects on Youth Perceptions
of Others' Use of Marijuana:
Westat generally found no significant effects of campaign exposure on
the cognitive outcomes of adolescent nonusers of marijuana--i.e.,
development of anti-drug attitudes and beliefs. For current nonusers,
the evaluation reported on four cognitive measures and a fifth measure
of their perceptions of others' use of marijuana. Three of the four
measures--attitudes and beliefs about the consequences of marijuana
use; perceived social norms or pressures from parents, friends, and
peers about infrequent or regular marijuana use; and perceived self-
efficacy to avoid using marijuana, or their confidence to turn down use
of marijuana under various circumstances--were premised to affect the
fourth--youth intentions to use marijuana at all during the next year.
The fifth outcome, perceptions of other youths' use of
marijuana,[Footnote 22] was included to examine whether exposure to the
campaign was leading to increased perception among youth that others
use marijuana, and whether this perception, in turn, affected their own
behaviors.
Westat reported that the evidence from the analysis of trend data from
2000 to 2004 for two of the youth cognitive measures--attitudes and
beliefs about the consequences of marijuana use and intentions to use
marijuana--showed significant increases in youth believing that
marijuana use had negative consequences and significant increases in
the percentage of youth that reported that they had no intention to use
marijuana. However, evidence from both cross-section and longitudinal
associations between exposure and these two cognitive outcomes did not
substantiate that the favorable trends arose from exposure to the
campaign. Specifically, the cross-sectional associations between both
general and specific exposure to the campaign and intentions not to use
marijuana show no significant favorable effects of exposure on this
outcome. None of the cross-section associations between either general
or specific exposure and intention to use marijuana are significant,
and none of the longitudinal associations between specific exposure and
intentions are significant. Two of the longitudinal associations
between general exposure and intentions are significant, but the
direction of the effect is unfavorable, in that greater exposure led to
declines in intentions not to use marijuana. The evidence from the
associational analyses between exposure and attitudes and beliefs about
the consequences of marijuana use generally did not show an effect of
the campaign. While there was one significant cross-section association
between general exposure and attitudes and beliefs about consequences
during the final two waves of survey data, there were no significant
cross-section associations between specific exposure and attitudes and
beliefs about consequences, nor were there any significant longitudinal
associations with either general or specific exposure.
The associational analysis also produced some evidence of unfavorable
effects of exposure on social norms--i.e., social pressures from
parents, peers, and other important persons about marijuana use.
Westat's cross-section associations showed no significant effects of
exposure on social norms, but its longitudinal associations showed that
across all survey rounds, there was a significant relationship between
specific exposure and weaker social norms. Westat's analysis of
associations between exposure and perceptions of others' use of
marijuana also produced significant results. Cross-section associations
between specific exposure and perceptions of others' use were
significant, as were longitudinal associations of this relationship. In
other words, among youth who reportedly did not use marijuana at the
time of their interview, there was a significant effect of specific
exposure on the perception that others used marijuana, and the
direction of the effect was unfavorable--that is, those reporting
higher exposure to anti-drug ads were more likely to believe that their
peers used marijuana regularly. A significant and unfavorable
relationship between specific exposure and perceptions of others' use
of marijuana was obtained for the data covering the entire period of
the evaluation as well as for the period of the redirected campaign,
from 2002 to 2004.
The Evaluation Reported Favorable Effects of the Campaign on Three
Parent Outcomes but Not on Parental Monitoring:
A theme of the campaign was to encourage parents to engage with their
children to protect them against the risk of drug use, and parent
skills were a focus of parent advertising almost since the start of the
campaign. The campaign encouraged parents to monitor their children's
behavior by knowing where they were and with whom, and to make sure
that they had adult supervision. It also encouraged parents to talk
with their children about drugs and to a lesser degree to engage in fun
activities with their children. The evaluation observed five outcomes
for parents, and for four of the five found significant and favorable
effects of exposure to the campaign. For three outcomes--parent-child
conversations about drugs (talking behavior), parents' beliefs and
attitudes about talking with their children about drugs (talking
beliefs), and parents' engagement with their children in in-home and
out-of-home activities (fun activities)--both cross-section and
longitudinal associations between exposure and outcomes were generally
significant and favorable to the campaign. For parents' beliefs and
attitudes toward monitoring their children's behaviors, Westat reported
favorable trend and cross-sectional associations but no significant
overall longitudinal effects of either general or specific exposure on
this outcome. For the fifth outcome, parent monitoring behaviors--that
is, parents' knowing or having a pretty good idea about what their
child was doing or planned to do--the evidence did not support a
finding of an effect of the campaign. There were no significant
favorable trends in parents' reports of monitoring behaviors, and there
were no significant cross-section or longitudinal associations of
either general or specific exposure on monitoring behaviors.
No Evidence of Favorable Effects of the Campaign on Youth Outcomes
through Campaign Effects on Parental Outcomes:
Despite evidence of some favorable parental outcomes for the campaign,
Westat found no significant evidence for the overall evaluation that
these favorable parent outcomes affected youth attitudes and behaviors
toward drug use. Specifically, for the entire period covered by the
evaluation, Westat found no evidence of overall, indirect campaign
effects on parents leading to changes in marijuana use, intentions to
use marijuana, social norms, self-efficacy, or cognitions among youth
who were not marijuana users. Westat found that there were some
significant indirect effects of parental specific exposure on some
youth outcomes for some subgroups. For example, parental specific
exposure was favorably associated with intentions to use marijuana for
14-to 18-year-olds and for boys, and it was also associated favorably
with attitudes and beliefs about the consequences of marijuana use for
Hispanics. Westat also found significant but unfavorable indirect
effects of parents' general exposure on subgroups of youth in other
youth outcomes. For example, parental general exposure was unfavorably
associated with youth social norms for 14-to 16-year-olds and for
girls.
The Phase III Evaluation Found No Significant Effects of Exposure to
the Campaign on Youth Drug Use Outcomes Other than Limited Unfavorable
Effects on Marijuana Initiation:
Westat reported that the NSPY data showed some declines in self-
reported lifetime and past-month use of marijuana by youth over the
period from 2002 to 2004, and these trends in NSPY were consistent with
trends in other national surveys of drug use over these years. Westat
also reported that the NSPY data showed declining trends in youth
reports of offers to use marijuana. However, Westat cautioned that
because trends do not account for the relationship between campaign
exposure and changes in self-reported drug use, drug use trends alone
should not be taken as definitive evidence that the campaign was
responsible for the declines. On the basis of the analysis of the
relationship between exposure to campaign advertisements and youth self-
reported drug use in the NSPY data--assessments that used statistical
methods to adjust for individual differences and control for other
factors that could explain changes in self-reported drug use-
-for the entire period covered by its evaluation, Westat found no
significant[Footnote 23] effects of exposure to the campaign on
initiation of marijuana by prior nonusing youth. The only significant
effect indicated in Westat's analysis of the relationship between
campaign exposure and self-reported drug use was an unfavorable effect
of exposure on marijuana initiation--that is a relationship between
campaign exposure and higher rates of initiation--for one round of NSPY
data and similar unfavorable effects of campaign exposure on marijuana
initiation among certain subgroups of the sample (e.g., 12½-to 13-year-
olds and girls). Westat found no effects of campaign exposure on rates
of quitting or use by prior users of marijuana.
Westat Tracked Trends in Marijuana Use from Several Sources and
Reported That the Trend Data by Themselves Were Insufficient to
Demonstrate Effects of Exposure to the Campaign:
Westat tracked trends in self-reported use of marijuana by youth and
trends in youth reports of offers to use marijuana for the period from
2000 to the first half of 2004 to determine if there were significant
declines. Westat also assessed these trend data for changes occurring
since 2002, or during the period of the redirected campaign. Westat's
trend analysis was designed to provide supportive but not definitive
evidence for campaign effects.
In its trend analysis, Westat compared trends in self-reported drug
use--lifetime, past year, and past month--in the NSPY with trend data
on self-reported drug use from three other nationally representative
surveys of drug use--Monitoring the Future, the Youth Risk Behavior
Surveillance System (YRBSS), and the National Survey on Drug Use and
Health.[Footnote 24] Both MTF and YRBSS are school-based surveys, and
NSDUH is a household survey that provides estimates of drug use by the
civilian, noninstitutionalized population of the United States aged 12
years and older. Methodological differences between the school-based
surveys--MTF and YRBSS--and the household surveys--NSPY and NSDUH--have
been shown to account for the some of the differences in estimates of
marijuana use.
According to Westat's analysis, the surveys of self-reported marijuana
use show some similarities and differences in trends depending upon the
measure, age group, or subperiod covered within the longer 2000 to 2004
period. For example, the MTF data generally show declines in lifetime,
past-year, and past-month self-reported drug use for 8th, 10th, and
12th graders over the years from 2000 to 2004, although only some of
the year-to-year differences in the MTF self-reported drug use data
were statistically significant. Nonetheless, for the subperiod from
2002 to 2004, MTF data show statistically significant declines in past-
year and past-month use for 8th graders and past-year use for 10th
graders, and the NSPY data also show statistically significant declines
in past-month use from 2002 to 2004 for youth aged 12½ to 18 years old
and for 14-to 18-year-olds. On the other hand, the MTF data suggest a
decline in past-year and past-month use by 10th graders from 2000 to
2002, but the NSPY data suggest an increase in past-month marijuana use
during this period.[Footnote 25] Further, the data from NSDUH for 2000
and 2001 also show statistically significant increases in lifetime,
past-year, and past-month marijuana use among youth aged 12 to 17,
statistically significant increases in lifetime and past-year marijuana
use for youth aged 16 to 17, and a statistically significant increase
in past year use for youth aged 14 to 15. The pattern of increase in
NSDUH data from 2000 to 2001 is consistent with the 2000 to 2002
increases in past-month use in NSPY, but they differ from the MTF
trends over this period.
All four surveys generally show declines in marijuana use beginning in
2002, but not all of the declines are statistically significant. Both
MTF and NSPY show some statistically significant declines since 2002,
and while NSDUH and YRBSS show declines, the declines were not
statistically significant. These declines starting in 2002 coincide
with the redirected campaign and the introduction of the Marijuana
Initiative.
Despite the concurrence of the trend data from all sources for the 2002
to 2004 period, Westat concluded that the existence of declining trends
in self-reported drug use by themselves do not provide definitive
evidence that the campaign caused the declines because factors other
than the campaign also could affect behavior. For example, changes in
high-school completion rates among youth could affect drug use
behaviors, as high school dropouts may have more involvement with drugs
than youth who stay in school. Additionally, declines in self-reported
drug use that began before the initiation of phase III of the campaign
could not have been caused by the campaign. The declines reported in
MTF began prior to the start of phase III of the campaign; therefore,
factors other than the campaign had to have been responsible for the
start of the decline occurring in these data. Further, ONDCP also has
acknowledged the limitations of trends in the national surveys for
determining whether changes in drug use were the result of the
campaign. ONDCP's Office of Programs, Budget, Research and Evaluation
wrote about the MTF, YRBSS, and NSDUH:[Footnote 26]
"They provide policy makers with broad indicators of the success of
policy…However, they will not be able to answer the critical question
of whether these changes were the result of the Media Campaign. These
surveys do not ask respondents about their exposure and reactions to
the messages of the Media Campaign that can then be linked to their
drug-related attitudes and behavior."[Footnote 27]
Westat Reported That Trends in Marijuana Offers Declined over Time, but
Factors Other than the Campaign Contributed to Changes in Offers:
Westat assessed trends in youth reports of receiving offers of
marijuana--whether anyone had ever offered youth marijuana and the
frequency of offers within the past 30 days. Marijuana offers are
closely related to marijuana use, and the campaign aired messages that
encouraged resistance to offers of marijuana. Over the 2000 to 2004
period, Westat found significant increases in the percentage of youth
reporting that they had never received offers, and it also found
significant decreases in the percentage of youth reporting that they
had received offers in the prior month. Westat also found significant
changes in offers over 2002 to 2004, during the period of the
redirected campaign, and these changes were generally consistent with
the trends for the overall 2000 to 2004 period. Further, on the basis
of longitudinal analysis of the relationship between offers in one
period and marijuana use in the subsequent period among youth who were
nonusers in an initial survey round--an analysis that assesses whether
offers precede use or are simply a correlate of it--Westat found that
youth who reported having received a marijuana offer at one period were
much more likely--between three and seven times more likely, depending
upon age group--to have initiated marijuana use at a following period
than nonusing youth who reported never having received such an offer.
However, as Westat reported, while the findings on offers are
favorable, they cannot be ascribed to the campaign because they may be
caused by other factors, as the analysis of the relationship between
offers and use did not take into account other factors that could
affect use.
On the Basis of Its Analysis of the Association between Exposure and
Drug Use Outcomes, Westat Found No Evidence That Exposure to the
Campaign Affected Initiation or Cessation of Marijuana Use:
From its longitudinal analysis of associations between exposure and
initiation of marijuana use, Westat found no evidence that increased
exposure to the campaign reduced youth's initiation of marijuana use.
Westat's longitudinal analysis assessed the effects of exposure at one
survey wave on marijuana initiation at a subsequent survey wave,
controlling for potential confounding variables that could affect the
exposure initiation relationship. Westat assessed the effects of two
types of exposure on initiation of marijuana use--general exposure and
specific exposure. General exposure represents the sum of recalled
exposure to anti-marijuana advertising in four types of sources of
advertisements--television and radio, movies and videos, print media
including newspapers and magazines, and outdoor media. Specific
exposure represents the sum of recalled exposure to youth-targeted
individual campaign television advertisements that had been aired in
the 60 days prior to an interview.
Westat found no significant effects of the level of general exposure on
marijuana use initiation, either over the entire period of the campaign
or between subperiods as defined by survey rounds.[Footnote 28] Westat
also found no overall effects of levels of specific exposure on
marijuana initiation during the entire period of the campaign, but it
found one significant association between specific exposure and
marijuana use initiation that occurred in the data from wave 7 and its
wave 9 follow-up, or during the period of the Marijuana Initiative.
Wave 7 was the first complete survey wave covering exposure to the
Marijuana Initiative. The significant association from this analysis
was that higher levels of specific exposure were associated with higher
levels of initiation of marijuana use among previously nonusing youth.
Westat also examined the longitudinal relationships between exposure
and initiation for nine subgroups of youth (two sexes, three race/
ethnicity groups, two risk groups, and two nonoverlapping age groups).
For several subgroups, it found significant associations between
specific exposure and marijuana initiation. These associations were in
a direction that was unfavorable to the campaign, in that greater
specific exposure was associated with higher levels of initiation. The
subgroups for which these unfavorable associations were most pronounced
included 12½-to 13-year-olds, girls, African Americans, and lower risk
youth.
On cessation and reduction of marijuana use, Westat assessed two
outcomes among current marijuana users: the rate at which they quit
using marijuana and their frequency of use. The frequency of use
measure allowed for campaign effects to be observed if users did not
quit but reduced their use of marijuana. Westat estimated that the quit
rate--the percentage of prior-year users reporting that they no longer
used marijuana--among prior-year users of marijuana was 24.8 percent.
However, it found no statistically significant association between
general exposure and quitting or between specific exposure and
quitting. It also found that among adolescent marijuana users, the
frequency of use--increase, decrease, or no change--was not affected by
exposure to the campaign.
Conclusions:
A well-designed and executed multiyear study of the impact of the ONDCP
anti-drug media campaign on teen initiation of drug use, or cessation
of drug use, shows disappointing results for the campaign. The study
provides no evidence that the campaign had a positive effect in
relation to teen drug use, and shows some indications of a negative
impact. Some intermediate outcomes, such as parents talking with
children about drugs, and doing fun activities with their children,
showed positive results in that the media campaign encouraged parents
to adopt these behaviors. However, other intermediate outcomes, such as
parents' monitoring of their children's behavior, were not shown to be
affected by the campaign. Moreover, the evaluation did not provide
evidence that intermediate outcomes that showed positive results
translated into greater resistance to drugs among the teenage target
population.
Unfavorable preliminary findings from the evaluation were reported by
Westat in 2002. Beginning in 2002, ONDCP took a number of steps that
were intended to strengthen the power of the campaign to achieve
positive results. These steps included more rigorous ad copy testing
and a concentration on anti-marijuana messages. However, the post-2002
results yielded no evidence of positive impacts and some evidence of
negative and unintended consequences in relation to marijuana use.
Specifically, exposure to advertisements during the redirected campaign
was associated with higher rates of marijuana use initiation among
youth who were prior nonusers of marijuana.
Most parents and youth recalled exposure to the campaign messages and,
further, they recognized the campaign brand. Thus, the failure of the
campaign to show positive results cannot be attributed to a lack of
recognition of the messages themselves. This raises concerns about the
ability of messages such as these to be able to influence teen drug
attitudes and behaviors. It raises questions concerning the
understanding of the factors that are most salient to teens' decision
making about drugs and how they can be used to foster anti-drug
decisions.
Westat's evaluation is centered on this particular configuration of a
media campaign as it was presented from 1999 to 2004, and its results
pertained to the campaign nationwide. It cannot be construed to mean
that a media campaign that is configured differently from this one
cannot work. Nor should its results be construed to mean that in some
locations, for some groups of youth, the campaign did not have an
effect on drug use. However, substantial effort and expertise were
brought to the task of designing the advertisements from the outset,
and the 2002 redirection of the campaign placed even greater emphasis
on copy testing and enhanced ONDCP oversight. This casts some doubt on
the notion that a better media campaign can lead to positive results.
It is also important to note that two recent smaller studies in three
locations have provided evidence of a limited effect of the campaign
for some youth, and it is quite possible that additional analyses of
the NSPY data using different methods or measures may find other
effects of the campaign, at least for some adolescents, than have been
produced by Westat's evaluation team. The data from the evaluation have
only recently been made available to academic and other researchers,
and while the analyses undertaken by Westat are, as we have noted
elsewhere, appropriate and thorough, they are not exhaustive.
It is heartening that surveys intended to measure teen drug use, such
as Monitoring the Future, are showing declines in marijuana use in
recent years. Indeed, NPSY also shows some evidence of a decline in
drug use among teens. However, Monitoring the Future and other surveys
of teens concerning drug use are not linked to exposure to the media
campaign, and NPSY shows no relationship between anti-drug media
campaign exposure and favorable drug outcomes for teens. This seems to
indicate that other unidentified factors, other than the anti-drug
media campaign, are affecting drug use decisions among teens.
Although ONDCP has pointed to declines in teen drug use and credited
the campaign along with other prevention efforts as contributing to
significant success in reducing teen drug use, trend data derived from
the Monitoring the Future survey that show declines in teen marijuana
use from 2001 to 2005 do not explicitly take into account exposure to
the campaign, and therefore, by themselves, cannot be used as evidence
of effectiveness. ONDCP has indicated in the past, and we concur, that
because these surveys cannot link their results with the media
campaign, they do not measure campaign effectiveness. The evaluation of
the media campaign reinforces the lack of linkage between the media
campaign and teen drug use behavior.
It is important to note that virtually all social science research is
imperfect. Attempting to systematically observe and document human
behavior in real-world settings is a daunting task given the extremely
wide variation in both humans and settings. We believe that the
evaluation of the ONDCP media campaign is credible in that it was well
designed given the circumstance of the campaign, and appropriately
executed.
Matter for Congressional Consideration:
In light of the fact that the phase III evaluation of the media
campaign yielded no evidence of a positive outcome in relation to teen
drug use and congressional conferees' indications of their intentions
to rely on the Westat study, Congress should consider limiting
appropriations for the National Youth Anti-Drug Media Campaign
beginning in the fiscal 2007 budget year until ONDCP is able to provide
credible evidence of the effectiveness of exposure to the campaign on
youth drug use outcomes or provide other credible options for a media
campaign approach. In this regard we believe that an independent
evaluation of the new campaign should be considered as a means to help
inform both ONDCP and Congressional decision making.
Agency Comments and Our Evaluation:
We provided a draft of this report to the Director of the Office of
National Drug Control Policy for comment on July 31, 2006. ONDCP
provided us with written technical comments on the report, which we
incorporated where appropriate. In addition, ONDCP provided written
comments about our report in which it raised a question about our
matter for congressional consideration and outlined a number of
concerns that it had with our report on Westat's findings. These
written comments are reproduced in appendix II. In our evaluation of
ONDCP's written comments, we address each of the other concerns in the
order ONDCP presented them.
Westat Evaluation's Role in Judging the Impact of the Advertising
Campaign:
ONDCP comments that Westat's evaluation is ill suited to judge the
impact of an advertising campaign in part because Westat attempted to
establish a causal relationship between exposure and outcomes, and
this, ONDCP indicates, is something that major marketers rarely attempt
because of its difficulty. ONDCP writes, "we take issue with the
fundamental method pursued by Westat and GAO, and therefore, believe
that the study's findings are deeply flawed." We find this response
surprising for a number of reasons. First, ONDCP is on record as
stating that the evaluation conducted by Westat would be the means to
assess the impact of the campaign. Indeed, in February, 2001, in the
ONDCP publication entitled Youth Drug Use and the National Youth Anti-
Drug Media Campaign, ONDCP states:
"ONDCP, on the other hand, is measuring the impact of the Media
Campaign with a thorough, rigorous, and independent evaluation. The
nationally representative evaluation is being conducted for ONDCP by
the National Institute on Drug Abuse (NIDA).…The evaluation is a 4-year
longitudinal study of parents' and their children's exposure and
response to the Media Campaign.…ONDCP will be able to assess the extent
to which changes in anti-drug attitudes and beliefs or drug using
behavior can be attributed to the Media Campaign."[Footnote 29]
ONDCP officials had opportunities during the evaluation to raise
concerns about Westat's design and its efforts to establish a link
between exposure to the campaign and outcomes, but we are not aware of
their having done so. However, we are aware of ONDCP's participation in
a NIDA-sponsored expert panel review of Westat's evaluation that was
held in August 2002. Our review of the minutes of that meeting reveals
that while an ONDCP official raised concerns about issues such as
assessing the nonadvertising components of the campaign and the number
of interim reports, ONDCP officials did not at that time raise concerns
that the evaluation was fundamentally flawed. The consensus of the
expert panel was that Westat's evaluation was "pretty impressive" given
the challenges presented by the absence of baseline data and of an
experimental design. Panel members also asserted that Westat's use of
propensity score models to isolate the effects of the campaign was
termed both "sensible" and "state-of-the-art."
ONDCP further states that major advertisers evaluate the success of
their campaigns by rigorously testing advertisements prior to airing
and by developing correlations between messages and consumer attitudes
and behavior. While we do not dispute whether this is a commonly used
approach among major advertisers, we believe that in assessing the
expenditure of public funds researchers should attempt, where feasible,
to establish causal relationships or use research designs that attempt
to isolate the effects of federally funded interventions. While we
acknowledge that establishing causal relationships is difficult, we
maintain that Westat used sophisticated and appropriate statistical
methods that aimed to isolate the effects of recalled exposure to the
campaign on youth drug use. Further, adopting a methodology that relies
upon correlations between advertising messages and an outcome, such as
reductions in youth drug use, without attempting to take into account
many of the other factors that could affect drug use allows for too
many post hoc explanations of findings. Westat's analysis included
socioeconomic factors, parent characteristics, television viewing
habits, risk of using drugs, and sensation-seeking tendencies to be
able to determine whether exposure was related to drug use net of the
influences of these factors. We conclude, on the basis of our
assessment of Westat's methods, that exposure to campaign messages
generally did not influence youth drug use net of these other
influences.
ONDCP notes that correlational findings have been used to assess anti-
tobacco advertising campaign results. We have not reviewed the anti-
tobacco campaign and cannot comment on its relationship to youth
smoking prevalence. We notice, however, that in ONDCP's comments on
"Consequences of Further Budget Cuts," it appears to contradict its
statements about establishing causal relationships to determine the
effect of advertising campaigns. ONDCP writes, "Previous studies have
established a relationship between exposure to anti-tobacco messages
and smoking rates among teens." ONDCP goes on to draw an analogy
between anti-smoking messages and anti-drug messages to write, "We
should expect similar results for illicit drug use if anti-drug
messages decline." These statements emphasize very directly the same
kind of causal relationships that ONDCP cites as not appropriate in its
opening comments.
We also note that ONDCP indicates in its comments that it has made
multiple refinements to the media campaign on the basis of earlier
findings from the Westat study. This seems to be inconsistent with a
position of major concerns with the fundamental soundness of the study.
Finally, the three research papers that ONDCP cites on page 2 of its
comments on "Conflicting Evidence from Other Research" all use exposure-
response methodologies that are analogous to Westat's and all attempt
to isolate the causal effects of exposure either to ONDCP's campaign or
to other media campaigns. Thus, it would seem that ONDCP's comment that
efforts to isolate causal effects of media campaigns are fundamentally
flawed would also apply to these three studies.
ONDCP Made Campaign Changes as a Result of Westat Interim Findings:
ONDCP indicates that it has sought to improve the performance of the
media campaign by using the results from the Westat study and other
data. We are aware that ONDCP redirected the campaign in 2002 in
response to Westat's interim findings that indicated some negative
impacts of the campaign on youth marijuana use. However, the 2002 to
2004 Westat study results also did not show positive outcomes. Westat's
study is the only national evaluation of the campaign. Although
Monitoring the Future provides context regarding general drug trends
among youth, as ONDCP has stated:
"These surveys [MTF, the National Household Survey on Drug Use, and the
Youth Risk Behavior Survey] will permit the determination of whether
drug use behavior and related attitudes and beliefs changed after the
launching of Phase III of the Media Campaign in mid-1999. However, they
will not be able to answer the critical question of whether these
changes were the result of the Media Campaign. These surveys do not ask
respondents about their exposure and reactions to the messages of the
Media Campaign that can then be linked to their drug-related attitudes
and behavior."[Footnote 30]
More recently in late 2005, ONDCP launched a newly designed campaign.
The impact of this campaign is not known and should be independently
evaluated.
Other Youth Drug Use Findings:
ONDCP believes we did not provide adequate discussion of studies that
report findings contrary to those of Westat. Our report mentions two of
the three studies that ONDCP identifies--the Longshore and Palmgreen
studies. Our report does not mention the third study, Slater, because
it focused on a different anti-drug media campaign approach and not on
the ONDCP media campaign. Overall, these studies' findings are not
necessarily "contrary" to Westat's findings. Rather, they assess small
slices of the youth population or particular circumstances (such as
other programs that could reinforce an anti-drug message) and find some
positive results. The Westat national findings do not preclude the
findings of positive results for some subpopulations of youth. The
Palmgreen study, for example found a positive effect for the media
campaign on high-sensation-seeking youth, but did not find an effect on
non-high-sensation-seeking youth in the two moderate size communities
in which the study was conducted. The distribution of these youth in
the nationwide population could be consistent with both studies being
correct. Our objective was to assess the Westat study as a national
evaluation of the impact of the national campaign. In the Slater study,
after being trained in the use of campaign media materials, leaders in
each of eight communities that received a media campaign were allowed
to develop their own media strategies and were able to use whatever
materials they chose or developed on their own. This approach
emphasized the flexibility to adopt different media strategies deemed
appropriate by individual communities and not the use of a single
national strategy.
ONDCP expressed concern that we had not discussed Westat's hypothesis
concerning why the campaign might have contributed to youth
experimentation with marijuana. We are unable to draw a conclusion
about this hypothesis based on Westat's report, nor do we have
additional information upon which to base an assessment. ONDCP also
faults our report for not discussing other potential competing
explanations for the substantial downturn in teen drug use and increase
in anti-drug attitudes. Although this is beyond the objectives of this
report, we note that multiple other indicators of youth responsibility
also seem to be trending in a positive direction at the same time that
MTF reports declines in youth drug use. For example, from 1991 through
1999, the teen pregnancy rate declined by 27 percent and from 1991
through 2002, the teen birth rate fell 30 percent. Similarly, the
number of juvenile homicides declined by 44 percent from 1993 to 2002,
and the juvenile violent crime arrest rate fell by more than 40 percent
from 1994 to 2003. All of these trends--including declines in drug use-
-could be related to broader environmental, familial, or other
influences. The coincidence of these trends with drug use trends
indicates that factors other than the campaign could be responsible for
the decline in drug use and points to the necessity of trying to
isolate the effects of the campaign, rather than relying upon simple
correlations.
Steps Taken to Remedy Potential Problems:
ONDCP states that it has taken extensive "due diligence" steps that are
briefly acknowledged in our report, but that our report "fails to
acknowledge the thoroughness of our actions to identify, assess, and
attenuate any possible negative consequences of the campaign once
Westat reported the possibility of such an effect." Apart from those
actions described in Westat's evaluation reports, a full discussion of
the steps that ONDCP took in response to Westat's interim evaluation
reports that highlighted the possibility of unintended negative
consequences of exposure to the campaign on youth initiation of
marijuana was not salient to our assessing whether Westat took
appropriate steps to address the evaluation implementation challenges
that it faced. However, Westat's findings for the period from 2002 to
2004 showed that the campaign also was not effective after ONDCP took
these steps.
ONDCP Cites Major Changes in Campaign:
ONDCP states that the campaign is substantially different from what it
was when the last data were collected by Westat more than 2 years ago.
We are not in a position to comment on ONDCP's new campaign ("Above the
Influence"), launched in November 2005, as these current efforts are
beyond the scope of our report and outside the time frame of the Westat
data collection. At this time, neither we nor ONDCP have empirical
information with which to assess this revised campaign. However,
Westat's evaluation showed that neither the campaign as initially
implemented nor the redirected campaign implemented after 2002 was
effective. Hence, although a new and improved campaign may be
effective, Westat's findings raise concerns about whether any campaign
can affect youth drug use, especially since the lack of effect does not
seem to be related to recognition of campaign ads, but rather to
subsequent impact on attitudes and behaviors. Finally, ONDCP cites the
receipt of awards from both the advertising and communications industry
for its newest campaign. While laudable, these awards are not evidence
that the new campaign will change youth drug attitudes and behavior.
Only an independent evaluation can assess the current campaign's
effectiveness.
ONDCP Offers an Alternative Explanation for Counterintuitive Results:
ONDCP stated that there is growing research evidence showing that
asking people a question about their future behavior influences the
subsequent performance of the behavior in question. ONDCP then
indicates that the use of a panel design for the Westat study with
repeated interviews of youth concerning drug attitudes and behaviors
might, itself, have resulted in increased perceptions that drug use is
widely pervasive among youth. If, during the course of the Westat
study, ONDCP and NIDA, who acted as monitor for the study, felt that
the study itself--that repeated interviews of youth by Westat
concerning the campaign and drug attitudes and behavior--was resulting
in a negative effect, it would have been appropriate for them to
discontinue the study to avoid potential harm to subjects. Although
ONDCP raised this issue in its comments to us, neither ONDCP nor NIDA
mentioned this issue in any of our previous meetings specific to this
engagement.
ONDCP Takes Issue with the Timing of Our Review:
ONDCP said that the "long delay" in receiving our assessment of the
Westat report has prevented it from making progress on the next round
of evaluation. We note that Westat's draft final report was not made
available to us until spring 2005 (not 2 years ago as seems to be
indicated in ONDCP's comments). The volume of reports from the 4½-year
study, and the complexity of the review required a great deal of time
from our most skilled social scientists and statisticians. Time was
required to ensure that our review of the Westat study was both
comprehensive and correct.
Points Concerning Our Matter for Congressional Consideration:
ONDCP said that our matter for congressional consideration--that
Congress consider limiting appropriations until ONDCP is able to
provide credible evidence of the effectiveness of exposure to the
campaign on youth drug use outcomes--offers insufficient detail
concerning how to demonstrate satisfactory evidence of progress and
that it was puzzled by our lack of recommendations to ONDCP for
improving the campaign. Our mandate was to assess Westat's evaluation
and to draw conclusions about the reliability of its findings so that
Congress could make decisions about funding for the campaign, and
developing suggestions for improvements to the media campaign itself
was beyond our scope. In so doing, we focused on Westat's methods and
efforts to address challenges in implementing the evaluation. Our
matter for congressional consideration was intended to allow ONDCP to
explore a number of approaches to providing credible evidence of
campaign effectiveness to Congress. Our report clearly indicates that
one approach is the one applied in the Westat evaluation, which is the
focus of this report, but we do not want to rule out other approaches.
At the same time, we acknowledge that providing such evidence is not
easy.
ONDCP Posits Consequences of Further Budget Cuts:
ONDCP states that further budget cuts to the campaign could have far-
reaching and unfavorable consequences in youth drug use. Given that the
Westat findings show that the campaign was not having a positive
impact, we found no evidence that a reduction in campaign
advertisements would have a negative impact. ONDCP cites the 2005 MTF
as an indicator of media campaign effectiveness by indicating that the
reduction in anti-drug messages has resulted in a flattening of 8th
graders' perception of risk. Again, as ONDCP has indicated, the
relationship cannot be assessed with MTF because it does not ask
respondents about their exposure and reactions to the messages of the
media campaign that can then be linked to their drug-related attitudes
and behaviors.
Failure to continue the media campaign's efforts, according to ONDCP,
is "raising a white flag to those who favor drug legalization, with the
expectation that youth drug use soon would begin to rise, reversing
years of hard-earned positive news." In our view, on the other hand,
continuation of programs that have been demonstrated not to work
diverts scarce resources from programs that may be more effective.
We are sending copies of this report to other interested congressional
committees and the Director of the Office of National Drug Control
Policy. We will make copies of the report available to others upon
request. In addition, the report will be available at no charge on
GAO's Web site at [Hyperlink, http://www.gao.gov].
If you or your staff have any questions about this report, please
contact either Nancy Kingsbury at 202-512-2700 or by e-mail at
KingsburyN@gao.gov or Laurie Ekstrand at 202-512-8777 or by e-mail at
EkstrandL@gao.gov. Contact points from our Offices of Congressional
Relations and Public Affairs may be found on the last page of this
report. Key contributors are listed in appendix III.
Sincerely,
Signed by:
Nancy Kingsbury, Managing Director:
Applied Research and Methodology:
Signed by:
Laurie E. Ekstrand, Director:
Homeland Security and Justice:
[End of section]
Appendix I: Westat's Methods for Addressing Evaluation Implementation
Issues:
This appendix provides additional details about how Westat's addressed
evaluation implementation issues related to the coverage of the
National Survey of Parents and Youth (NSPY), sample attrition, and its
analytic methods.
Coverage in the NSPY:
The NSPY was a nationwide household survey of youth aged 9 to 18 and
their parents. Westat used a dual-frame sampling frame--or list of the
members of the population from which the sample was ultimately
selected. One frame--the area frame--consisted of housing units that
had been built by late 1991; the second frame--the building permit
frame--consisted of building permits issued between January 1990 and
December 1998 for new housing.[Footnote 31] Combined, these frames
constituted an estimated 98 percent of dwelling units nationwide that
existed by the end of 1998.
A household had to meet two criteria in order to be eligible to be
included in the NSPY sample: It had to (1) contain children within a
specified age group and (2) be a housing unit that was built before
April 1, 1990, was a mobile home, or was selected from a roster of
building permits for new housing units issued between January 1990 and
December 1998. To identify households that met these conditions, Westat
drew a sample of dwelling units and from this sample it screened
households to determine their eligibility for inclusion in the NSPY,
that is, whether a household contained children in a specified age
group, where the specified age groups were children aged 9 through 13,
12 and 13, or 9 through 18.
According to estimates provided by Westat, after completing enrollment
in the NSPY--which occurred during waves 1 through 3--the NSPY sample
covered more than an estimated 95 percent of occupied dwelling units
(households) nationwide. From its sample of occupied dwelling units,
Westat developed rosters of households that were believed to contain
youth in the target age range. At this second stage of sample
enumeration, Westat experienced a drop-off in the coverage of
households that were believed to be eligible for inclusion in the
sample. The number of eligible households enumerated in the NSPY was 30
percent smaller than the number expected from the 1999 Current
Population Survey (CPS) data.
According to Westat, coverage losses in the NSPY could have occurred
for several reasons: (1) because an interviewer may have decided to
classify a household as an ineligible household rather than as a
nonresponding household, (2) because the household respondent took cues
from the screening questions to avoid selection into the sample by
giving an incorrect answer, or (3) because the doorstep enumeration
process was considered to be intrusive. Westat reported that it could
not conclusively rule out the first explanation for coverage losses.
However, it undertook sample validation procedures that examined
whether ineligible households in the recruitment waves were
misclassified, and it found none. Neither Westat nor the National
Institute on Drug Abuse reported that undercoverage was primarily due
to respondents avoiding selection into the sample by taking cues from
the screening questions and giving incorrect answers as a way to avoid
selection into the sample. Overall, Westat reported that the main
reason for undercoverage was the rostering component of the survey,
which required actual entry into the home, and led to "a great many
respondents" asking the interviewer to come back at a later date, only
to repeat the request when the interviewer reappeared. Westat inferred
that this represented passive refusal to participate. Therefore,
according to Westat, most of the coverage losses occurred during the
doorstep screening process in which simple, focused screening questions
about the composition of the household were used to identify households
from which to sample eligible youth.
NSPY and CPS Comparisons of Distributions on Analyzed Variables:
In response to questions from us, Westat provided data that indicated
that the coverage losses in the NSPY did not result in differences in
the estimated distributions of population characteristics from the NSPY
as compared with those estimated from the CPS data. In other words, the
distributions of characteristics of eligible households with youth
included in the NSPY were broadly consistent with a variety of
corresponding distributions from the 1999 Current Population Survey.
The comparisons of NSPY-estimated populations to CPS-estimated
populations were based on weighted NPSY estimates, where the weights
adjusted for nonresponse at the doorstep and household enumeration
(roster) stages, and the weights also reflected the differential
probabilities of retaining a household for the NSPY depending on the
screener group to which it was applied. These weights were calculated
prior to Westat's poststratification calibration techniques, which
brought the estimated NSPY population totals into line with the
estimated CPS population totals. Hence, if upon using the weights based
only on the probability of selection and nonresponse adjustments, the
population characteristics in the NSPY differed widely from those
derived from the CPS, this would constitute evidence of potential bias
in the NSPY sample due to undercoverage.
Westat compared NSPY and CPS distributions for each of the three
enrollment waves of the NSPY (waves 1 through 3) on several variables,
including the race/ethnicity of the householder and the presence of
males 28 years of age or older, the distribution of eligible households
by the age of the youth in the household, the age and gender
distributions of youth, and the age distributions of youth by race and
ethnicity. Each of these comparisons involved discrete subgroups within
the focused subpopulation of the NSPY. The largest differences between
the NSPY and CPS estimates arose in the comparison of the distributions
by race/ethnicity of household and the presence of a male 28 years of
age or older in the household. Some of these differences could also
arise from sampling variance, as both the NSPY and CPS estimates are
based on samples that are subject to sampling errors. Although Westat
did not provide sampling errors with the estimates that it provided to
us, some of the differences in distributions could be apparent, as
opposed to real, differences, in statistical terms.
Undercoverage in the NSPY and Other Widely Known and Used Longitudinal
Surveys:
Coverage issues are not an uncommon problem with surveys that focus on
relatively small subpopulations within a larger population, such as
occurred with the NSPY's focus on youth aged 9 to 18. The NSPY's target
population of households with youth aged 9 to 18 focused on a
subpopulation that, according to 1999 CPS data, constituted about 25
percent of the roughly 104 million households in the United States.
The estimated extent of undercoverage of eligible youth in the NSPY was
comparable to the extent of undercoverage in other well-known and
widely used longitudinal surveys. Both the National Longitudinal Survey
of Youth (NLSY)--sponsored by the Bureau of Labor Statistics--and the
National Immunization Survey of Children (NIS)--sponsored by the
National Immunization Program (NIP) and conducted jointly by the NIP
and the National Center for Health Statistics of the Centers for
Disease Control and Prevention--focus on specific subpopulations, and
both experienced undercoverage that was comparable to that of the NSPY.
The 1979 NLSY is a nationally representative sample of men and women
born in the years 1957 to 1964 who were ages 14 to 22 when first
interviewed in 1979. It had a coverage rate of 68 percent. The 1979
NLSY has been widely used and cited to examine a wide variety of policy
issues. As documented in the National Longitudinal Surveys' annotated
bibliography, about 3,100 journal articles, working papers, monographs,
and other research documents have been catalogued as having used the
1979 NLSY data. The target population for the NIS is children between
the ages of 19 and 35 months living in the United States at the time of
the interview, and it has been conducted annually since 1994. The
survey involves the selection of a quarterly probability sample of
telephone numbers, and the coverage has been about 20 percent lower
than estimated by two other benchmark surveys. Survey data are used
primarily to monitor immunization coverage in the preschool population
in the nation and to provide national, state, and selected urban area
estimates of vaccination coverage rates for these children.
Sample Attrition across NSPY Interview Rounds:
In the NSPY, respondents initially recruited into the sample were to be
tracked for three additional survey rounds that covered about a 3-year
period following the recruitment round. By the final survey round of
the NSPY, the cumulative response rate--the percentage of youth or
parents in eligible households that completed all four interviews--
reached between 50 percent and 55 percent. These cumulative response
rates after four survey rounds were determined largely by the response
rates during the enrollment waves, as postenrollment, Westat was able
to track, contact, determine eligibility for reinterview, and complete
interviews for between 82 percent and 94 percent of previously
interviewed respondents between two successive interview waves. The
response rates achieved for the first three survey waves--the
enrollment waves--were generally similar. Specifically, about 74
percent to 75 percent of the dwelling units determined to be eligible
for the survey in waves 1 through 3 completed the household enumeration
(or rostering of youth). After obtaining consent to conduct interviews
from parents and youth, interviewers completed extended interviews--
that is, completed the full NSPY questionnaire--with about 91 percent
of the sampled youth in each of waves 1 through 3. Among sampled
parents, about 88 percent gave consent and completed extended
interviews in the enrollment waves. (See table 2.)
Table 2: NSPY Survey Rounds and Response Rates, Sampled and Surveyed
Youth:
Rounds and stages of sampling: Survey waves: Wave 1; Survey waves:
Wave 2; Survey waves: Wave 3.
Rounds and stages of sampling: Round 1: enrollment waves:
* Percentage of sampled dwelling units for which eligibility was
determined;
Survey waves: Wave 1: 95.1%;
Survey waves: Wave 2: 95.7%;
Survey waves: Wave 3: 95.5%.
Rounds and stages of sampling: Round 1: enrollment waves:
* Percentage of eligible dwelling units completing household roster;
Survey waves: Wave 1: 74.4%;
Survey waves: Wave 2: 74.6%;
Survey waves: Wave 3: 75.3%.
Rounds and stages of sampling: Round 1: enrollment waves:
* Percentage of youth completing interview;
Survey waves: Wave 1: 90.3%;
Survey waves: Wave 2: 91.9%;
Survey waves: Wave 3: 91.2%.
Rounds and stages of sampling: Round 1: enrollment waves:
* Cumulative (overall) response rate, enrollment waves;
Survey waves: Wave 1: 63.8%;
Survey waves: Wave 2: 65.5%;
Survey waves: Wave 3: 65.5%.
Rounds and stages of sampling: Round 2: first follow-up:
* Percentage of dwelling units (from prior wave) refielded for follow-
up;
Survey waves: Wave 4: 94.2%;
Survey waves: Wave 5: 92.9%.
Rounds and stages of sampling: Round 2: first follow-up:
* Percentage of refielded dwelling units for which eligibility was
determined;
Survey waves: Wave 4: 86.8%;
Survey waves: Wave 5: 93.8%.
Rounds and stages of sampling: Round 2: first follow-up:
* Percentage of youth completing interview;
Survey waves: Wave 4: 93.5%;
Survey waves: Wave 5: 93.6%.
Rounds and stages of sampling: Round 2: first follow-up:
* Cumulative (overall) response rate;
Survey waves: Wave 4: 54.1%;
Survey waves: Wave 5: 58.4%.
Rounds and stages of sampling: Round 2: first follow-up:
* Follow-up (conditional) longitudinal response rate;
Survey waves: Wave 4: 82.2%;
Survey waves: Wave 5: 88.8%.
Rounds and stages of sampling: Round 3: second follow-up:
* Percentage of dwelling units (from prior wave) refielded for follow-
up;
Survey waves: Wave 6: 85.1%;
Survey waves: Wave 7: 89.8%.
Rounds and stages of sampling: Round 3: second follow-up:
* Percentage of refielded dwelling units for which eligibility was
determined;
Survey waves: Wave 6: 93.1%;
Survey waves: Wave 7: 92.8%.
Rounds and stages of sampling: Round 3: second follow-up:
* Percentage of youth completing interview;
Survey waves: Wave 6: 94.7%;
Survey waves: Wave 7: 93.8%.
Rounds and stages of sampling: Round 3: second follow-up:
* Cumulative (overall) response rate;
Survey waves: Wave 6: 53.1%;
Survey waves: Wave 7: 56.0%.
Rounds and stages of sampling: Round 3: second follow-up:
* Follow-up (conditional) longitudinal response rate;
Survey waves: Wave 6: 93.4%;
Survey waves: Wave 7: 91.6%.
Rounds and stages of sampling: Round 4: third follow-up:
* Percentage of dwelling units (from prior wave) refielded for follow-
up;
Survey waves: Wave 8: 78.7%;
Survey waves: Wave 9: 83.5%.
Rounds and stages of sampling: Round 4: third follow-up:
* Percentage of refielded dwelling units for which eligibility was
determined;
Survey waves: Wave 8: 95.9%;
Survey waves: Wave 9: 94.8%.
Rounds and stages of sampling: Round 4: third follow-up:
* Percentage of youth completing interview;
Survey waves: Wave 8: 94.0%;
Survey waves: Wave 9: 94.3%.
Rounds and stages of sampling: Round 4: third follow-up:
* Cumulative (overall) response rate;
Survey waves: Wave 8: 50.2%;
Survey waves: Wave 9: 53.4%.
Rounds and stages of sampling: Round 4: third follow-up:
* Follow-up (conditional) longitudinal response rate;
Survey waves: Wave 8: 92.4%;
Survey waves: Wave 9: 93.4%.
Source: Westat, June 2005.
[End of table]
Across the three follow-up rounds of the NSPY, Westat achieved between
an 82 percent and a 94 percent longitudinal response rate. Follow-up
required that respondents be tracked over time and across places, as
persons enrolled in the sample could move, and their eligibility for a
follow-up interview had to be determined. For example, youth who turned
19 years of age between survey rounds would no longer be eligible for
reinterview, as they were beyond the target age of the campaign.
Efforts to track individuals prior to the second survey round included
verifying address change information with the U.S. Postal Service and
obtaining location information from a national database company. Westat
obtained updated location information from these sources, and telephone
interviewers placed calls to these households to verify the identity of
respondents. According to Westat, a high proportion of the households
that moved were contacted and respondents verified their new addresses.
During the third and fourth survey rounds, Westat used procedures to
track and verify addresses that were similar to those used to track
respondents from the first to second survey rounds, although Westat
modified these procedures as necessary. The key eligibility requirement
for youth for a follow-up interview was the youth had to be 18 years of
age or younger at the time of the interview.
For the first follow-up round--waves 4 and 5--Westat located
individuals and determined eligibility for 92 percent of the youth and
92 percent of the parents who completed an initial interview during the
first round of the survey--that is, in waves 1, 2, and 3, and of these
youth who were still eligible, 94 percent completed an interview. Among
parents from the first round who were tracked and determined to be
eligible in the second round, 92 percent completed a second round
interview. In the third and fourth survey rounds of the NSPY, between
96 percent and 97 percent of the youth and parents who had completed
prior round surveys were tracked and determined to be eligible, and of
these, the youth response rates were 96 percent and the parent rates
were 95 percent.
Comparisons of Respondents and Nonrespondents across NSPY Survey Waves:
Even with the relatively high follow-up response rates that Westat
achieved, it is possible that respondents could differ from
nonrespondents in follow-up rounds, and if so, the NSPY estimates of
the effects of exposure on outcomes would be biased. Westat provided
data that compared nonrespondents to the respondents across the three
enrollment waves, indicating that with some differences, nonrespondents
were generally similar to respondents with respect to characteristics
that might affect survey outcomes. Nonrespondents were compared to
respondents on gender, age at interview, whether both parents were in
the household, the number of youth in the household, the type of
household dwelling, and the type of area in which the household was
located. For example, apart from the three differences below,
nonrespondents and respondents were similar in characteristics across
survey waves: In the three enrollment waves, nonrespondents were
proportionately older youth than respondents; in waves 2 and 3, there
were proportionately more youth living in cities among nonrespondents
than respondents; and in wave 1, there were proportionately more youth
in the building permit sample among nonrespondents than respondents.
Differences in Sampling Methodologies between NSPY and MTF:
Westat compared estimates of drug-use prevalence from the NSPY data
with those obtained from other national surveys such as Monitoring the
Future (MTF). While the NSPY estimates of marijuana use prevalence
differ over some periods covered by the NSPY from those derived from
the MTF survey of youth in school, differences between the two surveys'
sampling frames and methodologies mean that direct comparisons between
the two surveys must be made with caution and must take the
methodological differences into account. Specifically, MTF showed a
decline in marijuana use for some teenage groups during the 2000 to
2002 period, while the NSPY showed the increases reported above.
However, the difference in drug use rates reported from the two surveys
could plausibly arise from differences in the sampling frames. The MTF
sampling frame covers only youth who are in school and not those who
drop out of school, who are truant on the survey day, or who are 17-and
18-year-olds who have graduated from high school. To the extent that
high school dropouts and truants have more involvement with drugs than
those who stay in school, the MTF estimates of drug use may
underrepresent drug use among all youth of high school age. By
comparison, the NSPY household survey includes youth who are not
enrolled in school in its sampling frame. To the extent that dropping
out of high school is correlated with drug use, and given that dropouts
are excluded from the MTF sampling frame, differences in drug use
between MTF and NSPY could reflect the fact that youth enrolled in high
school reported drug use at different rates from all youth in the
general population covered by the NSPY, which would include dropouts
who may be at higher risk of using drugs.
The Capacity of the NSPY to Detect Reasonably Small Effects:
One challenge in designing surveys to evaluate changes in outcomes as
the result of an intervention lies in selecting a sample with
sufficient power to detect differences between groups--including the
same individuals at two points in time--or significant associations
among variables, such as between levels of exposure to the campaign and
outcomes. Sample size is a major factor determining a study's power to
detect differences, and while larger sample sizes will generally allow
researchers to detect smaller differences over time, as the size and
power of a sample to detect changes increases, so too generally does
its cost.
In consultation with the National Institute on Drug Abuse (NIDA),
Westat chose to compute power for analyses of annual change in a
prevalence statistic--that is, change in the percentage of a population
that reported an outcome. For purposes of its power analysis, Westat
chose to assume different baseline prevalences for parents and for
youth of all ages and to assume that the study should be able to detect
reliably declines of specified sizes. For example, for youth of all
ages, Westat assumed a baseline prevalence of 10 percent and determined
the power of its sample for detecting a minimum downswing in an
outcome--such as past-month drug use--of 2.3 percentage points over a
year.[Footnote 32] The power of the sample to detect this difference
was well within conventional power criteria.[Footnote 33]
As reported above, the sizes of differences that Westat's sample could
detect were consistent with the Office of National Drug Control
Policy's (ONDCP) goals for the campaign. In early meetings on the
design of the evaluation of the media campaign, ONDCP officials
reported that ONDCP had a specific Performance Measures of
Effectiveness (PME) system and that the campaign was embodied within
the first goal of the National Drug Strategy, which was to "educate and
enable America's youth to reject illegal drugs as well as the use of
alcohol and tobacco." Under this goal, ONDCP's PME proposed targets for
reducing the prevalence of past-month use of illicit drugs and alcohol
among youth from a 1996 base year: by 2002, reduce this prevalence by
20 percent, and by 2007, reduce it by 50 percent. ONDCP officials
further identified specific targets for the media campaign, again with
respect to a base year of 1996: by 2002, increase to 80 the percentage
of youth who perceive that regular use of illicit drugs, alcohol, and
tobacco is harmful; and by 2002, increase to 95 the percentage of youth
who disapprove of illicit drug, alcohol, and tobacco use. To achieve a
goal of 80 percent of youth who perceive that regular use of marijuana
is harmful would require increasing the 1996 baseline percentage of
youth perceiving marijuana as harmful from 60 percent, as measured by
MTF, or by about 3.3 percentage points per year from 1996 to 2002.
Westat's sample had sufficient power to detect this amount of annual
change in youth attitudes.
The power of the NSPY to detect changes in outcomes due to exposure to
the campaign also presumes that it was possible to accurately measure
and characterize exposure to the campaign by the reported number of
advertisements recalled by respondents. While the general question of
how exposure to advertisements affected respondents was beyond the
scope of the evaluation, if by exposure is meant a recognition-based
task--or encoded exposure--then the NSPY measures of exposure can be
viewed as valid. According to communications researchers, often what is
of interest to campaign planners and evaluators is whether the
presentation of campaign content generates at least a memory trace in
individuals. At this point, a potential audience member can be said to
have engaged the campaign's presentation in a meaningful sense, and
this is what is meant by encoded exposure. To measure exposure to the
campaign for both youth and parents, NSPY interviewers asked
respondents about their recall of specific current or very recent
television and radio advertisements.[Footnote 34]
There was variation in recall of advertisements by both youth and
parent respondents, and this type of variation is needed in order to
examine associations between levels of exposure and outcomes. For
example, for the entire campaign, youth reported a median of 12
exposures per month, and 76.7 percent reported 4 or more exposures per
month. Comparatively few youth--about 6 percent--reported less than 1
exposure per month. Youth recall of specific exposure also varied, as
41.2 percent of youth reported 12 or more television exposures per
month throughout the campaign while reporting a median of 4.4 exposures
to television advertisements. Additionally, Westat's measures of
exposure and outcomes have demonstrated sensitivity to detect favorable
campaign effects among parents.
Westat's test for associations between exposure and outcomes--the gamma
coefficient--was an ordinal test statistic for whether two variables
(e.g., exposure and marijuana use initiation) have a montonic, but not
necessarily a linear, relationship. Therefore, were there nonlinear
relationships, its test would have allowed for them. Finally, nonrandom
measurement error in the measure of exposure is unlikely to have biased
estimates of campaign effects, as if the nonrandom measurement error
were constant, it would not affect measures of association, and if it
was not constant, it would be addressed by Westat's statistical
methods.
Westat Methods to Measure Outcomes:
Westat measured a variety of outcomes for youth and parents and took
steps to ensure that the measures were consistent with existing
research. The youth questionnaires included numerous questions that
were designed to measure exposure to the campaign advertisements and
other anti-drug messages. The youth question domains included exposure
propensity to media; current and past use of tobacco, alcohol,
marijuana, inhalants, and Ecstasy; past discussions with and
communication of anti-drug messages from parents and friends;
expectations of others about respondent's drug use; knowledge and
beliefs about the positive and negative consequences of drug use;
exposure to campaign messages; family and peer factors; personal
factors; and demographic information. Westat used two separate
questionnaires for youth of different ages; one questionnaire was used
for children (aged 9 to 11) and another one was used for teens (aged 12
to 18).
The NSPY parent questionnaire also included numerous questions that
were intended to measure parents' exposure to the campaign's messages
and other anti-drug messages. The question domains for parents included
media consumption; past discussions with child about drug attitudes and
avoidance strategies; past child monitoring behaviors; self-efficacy of
discussing drugs with child and monitoring of child's actions; belief
that the child is at risk of drug use; belief that drug use has bad
consequences; exposure to the campaign's advertising, including brand
recognition; parent's own current and past use of tobacco, alcohol, and
drugs; and demographic information.
Westat followed generally accepted procedures in developing the survey
instruments for the NSPY by using information from a prototype prepared
by NIDA and using information from other surveys that addressed youth
drug use and prevention. Prior to the phase III evaluation, and in
preparation for the NSPY, NIDA convened an expert panel to assist in
the development of the youth and parent questionnaires. The panel,
which consisted of experts in adolescent drug use prevention and
parenting behaviors, drafted NSPY survey questionnaires for children,
teens, and parents, and NIDA shared these prototypes with Westat at the
beginning of Westat's evaluation contract. In developing the final
questionnaire for the NSPY, Westat created a questionnaire development
team consisting of evaluation experts. In developing the final NSPY
questionnaires, the Westat team reviewed NIDA's prototype and other
surveys.
Westat measured youth drug use by self-reported data on use. We have
previously cautioned about limitations associated with self-reported
data on youth drug use.[Footnote 35] Additionally, the National
Research Council (NRC) of the National Academy of Sciences also has
pointed out limitations associated with self-reported drug use in
national surveys such as the National Survey of Drug Use and Health
(NSDUH) and MTF.[Footnote 36] As NRC has pointed out, while self-
reported data on drug use may have limitations for estimating the
actual levels of use at a particular point in time, they may not suffer
from these same limitations when they are used to assess changes in use
over time, unless there is reason to believe that attitudes about drug
use change in ways that affect respondents' willingness to honestly
report drug use, or stigma.
Specifically, if there is a stigma associated with self-reporting drug
use, that stigma may affect the levels of use reported, as some have
argued that the propensity of respondents to give valid responses may
be affected by social pressures. In particular, the incentive to give
false negative reports may increase over time if drug use becomes
increasingly perceived as harmful or socially unacceptable. Using data
from NSDUH and MTF, NRC showed an inverse relationship between the
percentages of respondents who either disapproved of illegal drug
consumption or perceived it to be harmful. Thus, as stigma increased,
self-reported drug use decreased. As NRC cautioned, one could interpret
this relationship as indicating that changes in stigma are associated
with changes in invalid reporting, or as stigma increases, false
negative reports increase, rather than necessarily indicating that as
stigma increases, drug use decreases.
The NRC analysis leads to two inferences: First, if social stigma
remains constant over time, changes in the propensity to give valid
responses would be unaffected and estimates of change in self-reported
drug use would not be biased by social stigma. For the evaluation
results, this would imply that its measures of changes in self-reported
drug use would provide valid measures of changes in use, so long as
factors other than stigma did not affect the propensity to self-report
use. Second, if the social stigma associated with reporting drug use is
inversely related to disapproval of illicit drug use or increased
perceptions that it is harmful, then the estimates of self-reported
drug use are likely to decrease as a result of the stigma. According to
results from the evaluation, trends in youth attitudes and beliefs
about illicit drugs changed significantly over the entire campaign in a
direction that was favorable to the campaign. Specifically, the trends
in youth attitudes and beliefs about illicit drug use meant that youth
were more likely to believe, as the campaign went on, that use of
illicit drugs was likely to have negative consequences. Alternatively,
the social stigma associated with drug use increased over time. If the
relationship between stigma and reporting that NRC found held and
applied to the data in the evaluation of the campaign, this would imply
that the increased stigma associated with drug use would lead to
decreases in self-reports of drug use over time.
Westat's Analytic Methods:
To control for the many factors that could have influenced both
exposure and outcomes independently of, or in conjunction with, the
campaign, Westat used propensity scoring methods to match individuals
based on numerous measured attributes and to create groups of
individuals who differed on their underlying propensity to be exposed
to different levels of campaign advertisements. A propensity score is a
weighted sum of the individual effects of variables in a model that
predicts the likelihood of exposure to campaign messages. Westat's
propensity scoring methods resulted in the creation of groups of
individuals who were statistically similar on exposure propensities.
These groups can be considered as statistical analogues to randomly
assigning individuals to different levels of exposure. After creating
these groups, Westat then analyzed outcomes between the groups having
different propensities to be exposed to campaign messages.
Westat used ordinal logit models to estimate the chances of being
exposed, where exposure was measured alternatively as a three-or four-
level variable--e.g., low, medium, or high exposure.[Footnote 37]
Westat used a myriad of variables to predict exposure levels in both
the youth and parent models. For example, in the youth models, the
propensity score models included measures of demographic attributes,
educational attainment and educational aspiration, family and parent
background, parent consumption of television and other media, income
and employment, reading habits, Internet usage, location of residence
in urban areas, among other variables. After estimating models, Westat
also assessed the balance of variables in its propensity models. For
propensity models to remove the effects of confounding variables from
the association between exposure and response, it is necessary that the
population means of the confounder variables not vary across exposure
levels. If a confounder is successfully balanced, then it will have the
same theoretical effect across all exposure levels.
The net result of the propensity scoring models is to provide each
individual with a score that reflects the individual's propensity to
recall advertisements based upon a weighted sum of all of the variables
in the model. Therefore, while two individuals may differ on the
likelihood that a particular variable affects their chances of being
exposed to messages or on their levels of a certain variable--such as
age or education--they could be similar in their overall propensity to
be exposed to campaign messages if the differential effects of any
individual variables sum to the same total propensity.
In order for the results of propensity methods to be valid, it is
important that the propensity scoring models include all relevant
variables that could otherwise explain differences in both exposure and
outcomes. Propensity score models can adjust only for confounding
variables that are observed and measured. In other words, they are
built upon the assumption that all relevant variables are measured and
controlled for. If an important variable is omitted from the propensity
model, the results of analyses may be affected. Westat made reasonable
attempts to identify and control for a variety of confounding
variables, include them in its models, and reduce bias.
[End of section]
Appendix II: Comments from the Office of National Drug Control Policy:
Executive Office Of The President Office Of National Drug Control
Policy:
Washington, D.C. 20503:
August 10, 2006:
Mr. David M. Walker:
Comptroller General:
Government Accountability Office:
441 G Street, NW:
Washington, DC 20548:
Dear Mr. Walker:
I am writing in response to your request for comments on the Government
Accountability Office (GAO) report (GAO-06-818) entitled, "Contractor's
National Evaluation Does Not Find That the Youth Anti- Drug Media
Campaign Was Effective in Reducing Youth Drug Use." I appreciate the
opportunity to respond to the findings and recommendation made in the
report and to provide you with additional information on how the Office
of National Drug Control Policy is dedicated to the task of reducing
youth drug use through media outreach.
I have a number of concerns with the Westat findings and your report's
assessment of them. In brief. 1) Westat's evaluation is ill-suited to
judge the impact of an ad campaign; 2) the findings are now more than 2
years old and have limited relevance; 3) conflicting evidence from
other research is given minimal attention; 4) the Campaign has
undergone major changes - with encouraging results to date; 5) our "due
diligence" efforts to address the potential for harm are not well
characterized; and 6) your recommendation to Congress offers
insufficient detail to demonstrate satisfactory evidence of progress.
Finally, I have identified probable consequences of further cuts to the
Campaign budget that might be made pursuant to your recommendation to
Congress.
Westat Evaluation is Ill-Suited to Judging Impact of an Advertising
Campaign:
Major advertisers, who spend billions of dollars annually on
advertising in the U.S. and abroad, do not attempt to establish a
causal relationship between advertising exposure and product sales, but
evaluate the success of their advertising campaigns by rigorous testing
of individual ads prior to air (which the Campaign has consistently
done with increasing rigor), monitoring the performance of the ads once
aired (which the Campaign has done) and by carefully developing
correlations between various advertising messages, levels of media
expenditure, and consumer attitudes and behavior.
Establishing a causal relationship between exposure and outcomes is
something major marketers rarely attempt because it is virtually
impossible to do - particularly if both a pre-advertising baseline and
/ or unexposed control groups are lacking. As a senior market
researcher at a major advertiser has recently said, "Even when campaign
design includes a media blackout region as a control (inappropriate for
a public-service campaign), non-measured factors make it impossible to
isolate the effect of a single advertisement or advertising campaign."
This is one reason why the "truth" anti-tobacco advertising campaign,
acclaimed as a successful initiative in view of the significant
declines we've seen in teen smoking, did not claim to prove a causal
relationship between campaign exposure and smoking outcomes, reporting
instead that the campaign was associated with substantial declines in
youth smoking. They relied instead on the correlations between campaign
weight levels in various markets (they were able to vary advertising
weight by market) and teen behavior in those markets as tracked by the
University of Michigan's "Monitoring the Future" survey (see American
Journal of Public Health, March 2005, "Evidence of a Dose-Response
Relationship Between Antismoking Ads and Youth Smoking Prevalence").
Consequently, we take issue with the fundamental method pursued by
Westat and GAO, and therefore, believe that the study's findings are
deeply flawed.
Findings are "Old News"
Your report's findings do not come as a surprise to us, for each year
as preliminary results have been made known to us, to Congress, and to
the public through media coverage, we have studied the reports and have
sought to improve the performance of the Campaign, using these and
other data that we have available. We have responded when such
findings, although not conclusive, were released to the public or to
researchers, and have dealt with criticisms of the Campaign from
adversaries, including those who advocate the legalization of drugs.
And we have periodically needed to place these findings in context,
especially because all major youth surveys report declining teen drug
use, including Monitoring the Future, which documents a 19% decline in
current illegal drug use among 8tH 10` and 12`H graders combined over
the past four years, and a 21% decline in marijuana use from 1998 to
2005 among these youth.
Conflicting Evidence from Other Research:
Although two recent studies that report findings contrary to Westat
(Longshore and Palmgreen) are cited, no assessment of their importance
is provided. GAO does not explain why such studies are not given more
credence. For example, Longshore examined the possibility of
synergistic effects between in-school drug education and the Campaign,
and concludes that results ".showed that marijuana use in the past
month was significantly less likely among adolescents who received both
the ALERT Plus curriculum and weekly exposure to the Campaign's anti-
drug media messages." This has significant implications nationally, and
should not be dismissed. Palmgreen et al, whose paper has now been
accepted for publication in the prestigious peer-reviewed American
Journal of Public Health, concluded that the Campaign's marijuana
initiative "reversed upward developmental trends in high sensation
seeking 30-day marijuana use and significantly reduced positive
marijuana attitudes and beliefs in this at-risk population."
Another recent peer-reviewed journal article (Slater et al, "Combining
in-school and community-based media efforts: reducing marijuana and
alcohol uptake among younger adolescents," in Health Education Research
- Theory and Practice, September 2005) which evaluated the results of
an in-school media campaign in 16 cities (8 campaign cities and 8
control communities) with a similar strategy and brand to our new Above
the Influence campaign, has shown very positive results. The authors
conclude that "substance use uptake for youth in treatment communities
was half or less than that of control communities" and that
"effectiveness did not depend on the presence of an in-school
prevention curriculum."
Your analysis thoughtfully acknowledges the serious challenges that
Westat faced, due to a lack of a baseline and control group, the
difficulties of retaining youth and parents in the study over the
years, and the need to sort out other possible influences. These
complexities add support to your expressed view that ".virtually all
social science research is imperfect."
Westat, in its assessment of why the Campaign might potentially have
contributed to youth experimentation with marijuana, seems to rely on
the argument that frequent exposure to the Campaign's anti-drug
messages leads youth to conclude that most youth are, in fact, using
marijuana, and in an effort to "fit in"with their peers, they decide to
try marijuana. No theoretical basis for such an argument is provided in
your report, nor is there any critique of the Campaign's underlying
theory, the well-tested Theory of Reasoned Action. Therefore, this
reported effect is wholly counterintuitive because, by Westat data, it
is clear that youth are seeing the Campaign's anti-drug ads, seeing
them frequently, recalling and assessing them evermore favorably,
holding ever-stronger anti-drug attitudes, receiving fewer offers of
marijuana, and overall using drugs (including marijuana) less and less.
No competing explanation for the substantial downturn in teen drug use
or increase in anti-drug attitudes is offered.
Further, key studies, including both Monitoring the Future (MTF) and
the Partnership Attitude Tracking Study (PATS --conducted by Roper for
the Partnership for a Drug-Free America) report positive attitude
changes. PATS data reveal that in the past few years more youth are
likely to say most teens don't smoke marijuana, and those who say they
have friends who smoked marijuana declined substantially. Further,
according to MTF, teens are increasingly likely to disapprove of trying
marijuana, and these higher rates of disapproval are associated with
lower rates of current use, especially among 10`H graders, the core
target audience of the Campaign. And in an analysis conducted of
National Survey of Drug Use and Health (NSDUH) data, youth who reported
having seen or heard media prevention messages in the past year were
significantly less likely to report illicit drug use. And some states
and communities are observing that as teen drug use is declining,
student surveys report an increase in the number of youth who say their
peers disapprove of drug use and attribute the good news in part to
anti-drug media messages (Coalition for a Drug Free Greater
Cincinnati). Your report makes no claims that other media campaigns, or
in-school drug education (which youth say they are getting less and
less of) or other influences are responsible for these substantial
shifts in beliefs, attitudes, and behaviors.
"Due Diligence" Steps Taken to Remedy Potential Problems:
We have taken extensive "due diligence" steps which are briefly noted
in your report. The report, however, fails to acknowledge the
thoroughness of our actions to identify, assess, and attenuate any
possible negative consequences of the campaign once Westat reported the
possibility of such an effect. We have convened experts from mass
communication, youth drug prevention, advertising, behavioral research,
and related fields to explore what might be the theoretical basis for
such potential effects. We have implemented recommendations to
strengthen qualitative and quantitative research methods to probe for
such effects in subsequent advertising, and have made continual
refinements in message strategy and have developed protocols for
minimizing possible normative perceptions. We have increased the
sensitivity to such a possibility among advertising planners of the
Partnership for Drug-Free America - which under our direction provides
most of the advertising for the campaign - as well as the pro bono
advertising agencies who contribute their creative talents to the
campaign. Further, we have strengthened our ability to detect any such
effects through our monthly tracking studies which monitor youth
responses to the media messages they are seeing and hearing.
Major Changes in Campaign:
The Campaign is now substantially different from that which was
measured when the last wave of data was collected by Westat more than
two years ago. The Campaign has changed direction to be even more
relevant to today's youth, and after a full year of research, last
November launched a new brand, "Above the Influence." Designed to
encourage youth to aspire to their full potential by avoiding the
negative influences in their lives - specifically drugs and peer
influences to use drugs - this new brand already is showing positive
results in brand awareness (exceeding within six months the awareness
of the previous brand, the Anti-Drug), perception of the risk in using
drugs, and anti-drug attitudes, as revealed by monthly tracking surveys
that are typical of advertising industry "best practices" for measuring
an advertising campaign. This new Campaign has the breadth to address
not only marijuana but other emerging drug threats, including
methamphetamine and non-medical use of prescription drugs and over-the-
counter medicines. We are pleased to report that "Above the Influence"
already has won significant advertising and communications industry
awards, including the prestigious Media Week "Media Plan of the Year,"
for campaigns spending $25 million or more, the American Association of
Advertising Agencies Jay Chiat Planning Award (the top honor for
creative planning and strategy in its category), and two Webby Awards,
including Best Youth Web Site of 2006, given by the international
Academy of Digital Arts and Sciences.
An Alternate Explanation for Counterintuitive Results:
A possible explanation for these counterintuitive findings could be a
function of what is theorized by Westat to occur with heavy exposure to
anti-drug messages. There is growing evidence from research in
psychology and consumer behavior that asking people a question about
their future behavior influences the subsequent performance of that
very behavior, known as the "mere measurement effect." The Westat
evaluation, by conducting an extensive interview of youth (and their
parents) in their homes, including showing them the ads being studied
on as many as four separate occasions over the life of the evaluation,
could stimulate interest in drugs where none previously existed,
increase beliefs that drugs are important to youth and that more teens
are using drugs, thus stimulating interest in and causing intent to use
drugs and eventual drug experimentation. Impressionable youth, being
inherently interested in pursuing behaviors that they believe would
make them more grown-up, arguably would be more sensitive than adults
to the effects of the evaluation interviews. One recent peer-reviewed
journal article, for example, reported that ".when a question is asked
about a socially non-normative health behavior (i.e. illegal drugs),
instead of decreases in the behavior we see increased rates of the non-
normative behavior" (Williams, Fitzsimons and Block, "Simply asking
questions about health behavior increases both healthy and unhealthy
behavior," Social Influence, 2006). Such a problem would be less likely
with a study design that used only cross-sectional surveys, but the
frequency and intensity of youth interviews required by the Westat
longitudinal design clearly would result in a greater impact of this
type on survey respondents.
Consequences of Delayed Report:
The long delay in receiving the GAO assessment of the Westat report has
had serious operational consequences, such as severely compromising our
ability to make progress on the next round of evaluation. More than two
years ago, ONDCP announced an RFP for the new outcome evaluation, but
in subsequent discussions GAO strongly discouraged us from pursuing
that course because of the difficulty of evaluating this Campaign. GAO
even posed a probable recommendation that we should first undertake an
evaluability assessment. That recommendation is now not put forward by
GAO. As a result, our plans for evaluation when resumed after more than
two years will not provide meaningful outcome evaluation for several
years to come. Meanwhile, we continue to use monthly tracking surveys
to monitor Campaign progress, and although such studies cannot give us
long term outcome data, they do permit real-time tracking of
performance and allow for effective decision-making.
Your Recommendation:
Finally, we are puzzled as to the lack of recommendations for
improvement of the Campaign, given the GAO's extensive review of the
Westat results. For example, after the GAO staff briefing more than a
year ago, we anticipated specific recommendations on future Campaign
evaluations, or on Campaign theory, design, or implementation. While we
appreciate your understanding that the Campaign has rigorously applied
enormous expertise to the Campaign and has made continual improvements,
we are concerned with your conclusion that the result as judged by
Westat ".raises questions concerning the understanding of the factors
that are most salient to teens' decision making about drugs and how
they can be used to foster anti-drug decisions." In addition, while
your recommendation to Congress is clear, there are no criteria set
forth for or even a cursory discussion of how one might demonstrate
".credible evidence of the effectiveness of the campaign on drug use
outcomes" especially given the widely-accepted understanding that a
media campaign, in and of itself, should not be held uniquely
responsible for reductions in teen drug use.
Consequences of Further Budget Cuts:
I want to make it clear that the consequences of further budget cuts to
the campaign could have far-reaching and unfavorable consequences.
Lessons learned from relevant youth health behaviors include recent
evidence on tobacco use among teens which reveals that the downturn in
media exposure to anti-tobacco messages already is resulting in
decreased perception of risk, which more than 30 years of research
shows is directly related to smoking rates (the same is true for
illicit drugs, including marijuana). The 2005 MTF reported that all
three grades surveyed showed a decline in weekly exposure to anti-
tobacco messages, and the rate of decline of smoking is slowing and in
fact has halted among 8`h graders, who have been the bellwethers of
smoking trends among teens. Previous studies have established a
relationship between exposure to anti-tobacco messages and smoking
rates among teens. CDC has observed that smoking prevention media
campaigns are effective in reducing youth smoking initiation and has
expressed concern that less exposure to such messages may translate to
a reversal of the long downward trends in youth tobacco use. We should
expect similar results for illicit drug use if anti-drug messages
decline, and, in fact, already the MTF in 2005 has detected among 8tH
graders a flattening out in the previously increasing perception of
risk, due to somewhat lower media exposures.
Further, because mass media and popular culture convey a pervasive and
disheartening array of pro-drug messages that reach the nation's youth,
further cutting back the Campaign would have the unfortunate result of
essentially abandoning our ability to counter those messages with
clear, consistent, credible anti-drug messages, which only a national
anti-drug media campaign can do. Teens today are exposed to media for
well more than six hours per day. Half of teens live in households
where there are no rules about TV exposure, and among the other half
only one of five reports that those rules are actually enforced. Many
of the most popular films among teens include scenes and references to
drug use, seldom with any portrayal of social disapproval or negative
consequences. Studies of websites accessible to any youth with computer
access report ubiquitous - and highly detailed - pro-drug content,
ranging from where to buy marijuana seeds, how to beat a drug test, and
how to make methamphetamine. And anyone familiar with current trends in
blogs and personal-space websites knows of the overwhelming pro-drug
content, readily accessible to teens without their parents having any
knowledge of such troubling exposures or risks to their children.
Failure to continue the Campaign's efforts to counter such messaging is
the equivalent of raising a white flag to those who favor drug
legalization, with the expectation that youth drug use soon would begin
to rise, reversing years of hard-earned positive news. Compounding the
problem is the fact that the news media seldom cover the risks of drug
use to teens, but often report on the use of drugs by celebrities and
others in the public eye, as well as efforts to legalize drugs and
promote so-called medical marijuana.
In addition, further cuts to the Campaign likely would create a
chilling effect on those media companies who have donated well over a
billion dollars worth of media time and space to ensure youth receive
anti-drug messages, as well as those ad agencies - more than 80 to date
- who have contributed their creative talents towards reducing teen
drug use. The Partnership for a Drug-Free America, whose efforts helped
persuade the Congress of the need for this Campaign, has been
singularly effective at recruiting private sector largesse to this
important goal. Such resources are essential to the success of our
efforts.
Conclusion:
As always, I remain interested in finding ways to improve the
performance of the Campaign, as well as other efforts within the scope
of the National Drug Control Strategy. I, too, once was skeptical of
the ability of a media campaign to make a difference. Due to our
considerable energies spent to re-focus and strengthen the Campaign, I
have come to believe it is among the most important tools we have to
reduce teen drug use. Much is at stake and we must work together to
overcome the unwarranted cynicism over whether we can reduce drug use
among America's teens. We can, we have, and we will continue to do so,
using the best available means we have at our disposal.
Respectfully,
Signed by:
John P. Walters:
Director:
[End of section]
Appendix III: GAO Contacts and Staff Acknowledgments:
GAO Contacts:
Nancy Kingsbury, 202-512-2700:
Laurie E. Ekstrand, 202-512-8777:
Acknowledgments:
In addition to the contacts named above, contributors to this report
included David P. Alexander, Billy Commons, James Fields, Kathryn
Godfrey, Mary Catherine Hult, Jean McSween, Karen V. O'Conor, Mark
Ramage, William J. Sabol, Barry J. Seltser, and Douglas Sloane.
FOOTNOTES
[1] Pub. L. No. 105-61, 111 Stat. 1272.
[2] See: GAO, Anti-Drug Media Campaign: ONDCP Met Most Mandates, but
Evaluations of Impact Are Inconclusive, GAO/GGD/HEHS-00-153
(Washington, D.C.: July 31, 2000). We also reported on ONDCP's use of
consultants in the campaign in GAO, Anti-Drug Media Campaign: An Array
of Services Was Provided, but Most Funds Were Committed to Buying Media
Time and Space, GAO-05-175 (Washington, D.C.: Mar. 31, 2005). We also
described the phase III evaluation in GAO, Program Evaluation:
Strategies for Assessing How Information Dissemination Contributes to
Agency Goals, GAO-02-923 (Washington, D.C.: Sept. 30, 2002).
[3] Hereafter, we refer to the contractor as "Westat," and this
implicitly includes Annenberg. In addition, a second subcontractor, the
National Development and Research Institutes, Inc., provided expertise
in developing drug use questions and assisted in preparing the first
special topics report on trends in drug use.
[4] Westat and Annenberg jointly submitted to NIDA all evaluation
reports except for the final report, which was submitted by Westat
only.
[5] Senate Report No. 108-146, at 143 (2003).
[6] See GAO-05-175 for our review of ONDCP's use of consultants in the
campaign.
[7] Pub. L. No. 105-61, 111 Stat. 1272.
[8] Drug Free Media Campaign Act of 1998, 21 U.S.C. § 1801 et. seq.
[9] The survey is now known as the National Survey on Drug Use and
Health.
[10] All of these reports were submitted jointly by Westat and
Annenberg.
[11] Westat, "Environmental Context of the National Youth Anti-Drug
Media Campaign: Findings from In-Depth Discussions with Representatives
of National Organizations and State Prevention Coordinators." Report
delivered to National Institute on Drug Abuse, National Institutes of
Health, Rockville, Maryland, May 2002.
[12] Hornik, Robert, et al. Evaluation of the National Youth Anti-Drug
Media Campaign: Fifth Semi-Annual Report of Findings, (Rockville,
Maryland: Westat, November 2002), p. xi.
[13] Conference Report No. 108-10, at 1345 (2003).
[14] Pub. L. No. 103-62, 107 Stat. 285 (1993).
[15] Longshore, Douglas, et al., "National Youth Anti-Drug Media
Campaign and School-Based Drug Prevention: Evidence for a Synergistic
Effect in ALERT Plus," Addictive Behaviors, Vol. 31, (2006) pp. 496-
508.
[16] Palmgreen, Philip, et al., "Effects of ONDCP's Marijuana
Initiative Campaign on High Sensation-Seeking Youth." Paper presented
to the American Public Health Association, Philadelphia, Pennsylvania,
December 2005.
[17] GAO/GGD/HEHS-00-153, (Washington, D.C.: July 31, 2000), p. 68.
[18] Each respondent was presented ads that had been broadcast
nationally in the 2 calendar months prior to the interview.
[19] Westat also called its longitudinal analysis a "delayed effects"
analysis.
[20] Propensity score methods have been demonstrated to be robust
against bias associated with the specification of incorrect functional
forms--e.g., linear rather than quadratic--of variables.
[21] According to Westat, the reference period for the general exposure
index, is "in recent months," and this wording was chosen to maintain
equivalence to the wording used in the Monitoring the Future surveys in
its questions about anti-drug advertising.
[22] This was measured as the "Percent perceiving few other kids
regularly use marijuana."
[23] In discussing Westat's findings, any references to significance
refers to statistical significance.
[24] This survey was formerly known as the National Household Survey on
Drug Abuse.
[25] Westat points out, however that the MTF decline in use among 10th
graders between 2001 and 2002 was within the statistical confidence
limits of NSPY.
[26] At the time that ONDCP prepared this document, NSDUH was still
known as the National Household Survey on Drug Abuse, or NHSDA.
[27] Office of Programs, Budget, Research and Evaluation, Office of
National Drug Control Policy, "Youth Drug Use and the National Youth
Anti-Drug Media Campaign," February, 2001 (Washington, D.C.: Executive
Office of the President), p. 16.
[28] Westat's assessed the exposure-initiation relationship using data
from survey rounds 1 and 2, survey rounds 2 and 3, and within survey
round 4; it assessed the exposure-initiation relationship between waves
6 and 8 and waves 7 and 9.
[29] Office of Programs, Budget, Research and Evaluation, Office of
National Drug Control Policy, "Youth Drug Use and the National Youth
Anti-Drug Media Campaign," February, 2001 (Washington, D.C.: Executive
Office of the President), p. 3.
[30] Office of Programs, Budget, Research and Evaluation, Office of
National Drug Control Policy, "Youth Drug Use and the National Youth
Anti-Drug Media Campaign," February, 2001 (Washington, D.C.: Executive
Office of the President), p. 16.
[31] Housing units built after 1998 had no chance of selection in
either sampling frame. Also, a housing unit had no chance of selection
if it had been built during the 1990s in a jurisdiction where no permit
was required. Finally, modular housing built during the 1990s was
inadvertently omitted from the permit sample. Any biases resulting from
excluding housing units built after 1999 are likely to be small, as
they constituted a small fraction of all housing units in the NSPY
sampling frame, and they were accounted for by Westat's
poststratification adjustments. For example, housing units built after
April 1999 accounted for an estimated 1.0 percent of all housing units
in existence in the time period covered by the wave 1 sample.
[32] The power to detect differences for upswings in prevalence would
depend upon the baseline level. However, the power to detect an upswing
from a baseline of 90 percent of youth would be exactly the same as
that for detecting a downswing from a 10 percent baseline.
[33] Specifically, the minimum detectable difference for wave-to-wave
changes was at least 80 percent using a one-sided hypothesis test at
the 0.05 level.
[34] Each respondent was presented ads that had been broadcast
nationally in the 2 calendar months prior to the interview.
[35] GAO: Drug Use Measurement: Strengths, Limitations, and
Recommendations for Improvement, GAO/PEMD-93-18 (Washington, D.C.: June
25, 1993).
[36] National Research Council, Informing America's Policy on Illegal
Drugs: What We Don't Know Keeps Hurting Us. National Academy Press,
Washington, D.C.: 2001.
[37] Propensity score methods have been demonstrated to be robust
against bias associated with the specification of incorrect functional
forms--e.g., linear rather than quadratic--of variables.
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