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Perceptions of a drug prevention public service announcement campaign among street-involved youth in… Ti, Lianlian; Fast, Danya; Small, William; Kerr, Thomas Jan 13, 2017

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RESEARCH Open AccessPerceptions of a drug prevention publicservice announcement campaign amongstreet-involved youth in Vancouver,Canada: a qualitative studyLianlian Ti1,2, Danya Fast1,4, William Small1,3 and Thomas Kerr1,4*AbstractBackground: Due to the popularity of public service announcements (PSAs), as well as the broader health andsocial harms associated with illicit drug use, this study sought to investigate how drug prevention messages foundin the Government of Canada’s DrugsNot4Me campaign were understood, experienced, and engaged with among agroup of street-involved young people in Vancouver, Canada.Methods: Qualitative interviews were conducted with 25 individuals enrolled in the At-Risk Youth Study, and athematic analysis was conducted.Results: Findings indicate that the campaign’s messages neither resonated with “at-risk youth”, nor providedinformation or resources for support. In some cases, the messaging exacerbated the social suffering experiencedby these individuals.Conclusions: This study underscores the importance of rigorous evaluation of PSAs and the need to considerdiverting funds allocated to drug prevention campaigns to social services that can meaningfully address thestructural drivers of drug-related harms among vulnerable youth populations.Keywords: Public service announcement, Public health communication campaign, Illicit drug use, Street-involvedyouth, Social sufferingBackgroundDuring the past half-century, public service announce-ments (PSAs) to promote healthy behaviors have becomeincreasingly popular, including PSAs focused on preventingdrug use among youth, which target both young peopleand their parents [1]. PSAs can be described as advertise-ments or commercials that aim to provide information oradvice about a particular health or social issue, or promoteactivities that serve the wider community [2].Across various settings, the literature on the effective-ness of drug prevention PSAs reveals mixed results [2, 3].Some have argued for the need for more rigorous researchinto the circumstances under which PSAs may be effect-ive, including more nuanced considerations of audiencedemographics such as age, gender, ethnicity, culture,and socioeconomic status [3–8]. However, others havemaintained that PSAs are an ineffective method tocommunicate health information [2, 9–11].Many PSAs focused on preventing drug use amongyouth use fear-based appeals in an effort to motivatebehavioral change. Fear-based appeals can be defined asmessages that aim to motivate behavioral change byfrightening or threatening target audiences with negativeoutcomes if unhealthy behaviors are initiated or continued,and recommendations are not followed [6, 12]. To date,literature on the effectiveness of fear-based appeals in PSAshas also revealed mixed results [4, 5, 12]. Many have arguedthat the arousal of fear through PSAs can foster feelings ofantagonism, alienation, or resentment among target* Correspondence: uhri-tk@cfenet.ubc.ca1British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital,608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada4Department of Medicine, St. Paul’s Hospital, University of British Columbia,608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, CanadaFull list of author information is available at the end of the article© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Ti et al. Harm Reduction Journal  (2017) 14:3 DOI 10.1186/s12954-017-0132-7audiences [4, 13–15]. Additionally, it has been suggestedthat by focusing on, and to a certain extent caricaturing,negative outcomes, fear-based appeals can encourage stig-matizing and oversimplified understandings of those who“fail” to follow the recommendations outlined in the PSA,such as people who use drugs [2, 13–15]. Indeed, PSAs canpowerfully shape the way viewers understand and articulatefundamental questions about health and social issues likeaddiction and youth drug use [16].The present study sought to understand how onegroup of street-involved young people in Vancouver,Canada understood, experienced, and engaged with theimages, ideas, and information found in two video PSAsreleased as part of the Canadian Government’s Drugs-Not4Me campaign. Given the continued popularity offear-based appeals, we also sought to investigate the po-tential effect of the campaign in preventing the initiationof more severe and potentially harmful forms of druguse among young people experiencing social, economic,and institutional marginalization. Despite the campaign’sperceived target audience of youth who are at high riskof initiating drug use but have yet to, we chose todiscuss the campaign with street-involved young peoplewho had already begun engaging in heroin, crackcocaine, and crystal methamphetamine use. While werecognize that this campaign was not specifically aimedat our study population, it was important to elicit theseyoung people’s perspectives on the campaign becausethey were at one time part of a particularly “high risk”segment of the broader Canadian youth populationtargeted by the campaign. On the one hand, these youngpeople arguably stood to benefit the most from aneffective drug prevention mass media campaign; on theother, this group of young people would also likely bethe most negatively impacted by an ineffective drugprevention mass media campaign. Additionally, we wereinterested in investigating the wider impacts of theDrugsNot4Me campaign on individual and collectiveunderstandings of youth drug use, from the perspectiveof marginalized young drug users themselves. Whetheror not they had initiated more severe and potentiallyharmful drug use prior to first exposure to the Drugs-Not4Me campaign, we asked youth to reflect on how thePSAs could shape their understandings of themselvesand their lives in the context of current or past experi-ences of addiction, as well as broader public understand-ings of the “problem” of youth drug use.MethodsThe DrugsNot4Me PSAsIn 2009, as part of its National Anti-Drug Strategy, theGovernment of Canada released DrugsNot4Me, a drugprevention PSA campaign that primarily targeted youth.From 2007 to 2012, a total of CDN $29.8 million wasbudgeted for the Government’s Prevention Action Plan,which included the DrugsNot4Me campaign [17]. Thecampaign centered around two video PSAs: Fast For-ward [18] and Mirror [19], featuring a young male andfemale character, respectively. From 2009 to 2012, FastForward and Mirror appeared frequently on televisionand were made available on the campaign’s website(which also included information about illicit drugs andtheir effects directed at various audiences, includingyoung people, parents, and educational institutions). TheDrugsNot4Me campaign was also widely disseminatedvia print PSAs on public transit. The print PSAs featuredthe tagline, “Drugs, do you know where they’ll takeyou?,” embedded within stills of either the young maleor female lead from the video PSAs.The video PSA Fast Forward begins with a scene of ahouse party. Inside the house, there is loud music playing,and we see a group of teenagers dancing. The primarycharacter, a young Caucasian male in his early teenageyears, moves through the crowd. The next scene is of asmall group of teenagers congregating outside of thehouse, smoking a “joint” of what we assume is marijuana.The primary character is offered the joint. The PSA thencuts to a rapid series of different scenes, in which theprimary character is imagining the consequences ofaccepting the offer. These include a scene where he istaking what appears to be ecstasy (pills with “smiley faces”on them); a scene of him having a heated argument withhis mother and scaring his younger sister; a scene of himsleeping during class while in school; a scene of himexperiencing significant mental distress in his bedroom athome; and, finally, a scene of him getting caught with abag of marijuana at school by an authority figure, presum-ably a teacher or principal. Following this, the PSA cutsback to the primary character refusing the offer of thejoint. In the final scene, he is shown inside the party,laughing and talking with a different group of teenagers. Amale voice narrates: “Drugs. Do you know where they’lltake you? To learn the effects of drugs and how you toocan say no, visit drugsnot4me [dot] ca” [18].The video PSA Mirror follows a young Caucasianfemale. The majority of the PSA takes place in her bed-room, and depicts her physical and psychological demiseover time as a result of substance use. Her transformationis signaled by progressive changes in physical appearance(including her hairstyle, make-up, clothing, and personalhygiene), as well as her behavior, which becomes increas-ingly angry, erratic, and desperate. The PSA includes amusical rhyme, reminiscent of a children’s nursery rhyme,in which a female voice sings: “One, two, kicked out ofschool. Three, four, snort some more. Five, six, need myfix. Seven, eight, it feels too late.” At the end of the rhyme,we are shown a before-and-after image, in which the stillhealthy and attractive teenage girl sees her emaciated,Ti et al. Harm Reduction Journal  (2017) 14:3 Page 2 of 8dirty, and distressed “addict self” reflected in the mirror.Her reflected self has sores on her arms and mouth,implying the use of more severe drugs such as crystalmethamphetamine and crack cocaine. The PSA closeswith a scene of the young woman smiling and laughing asshe leaves her house, accompanied by two other teenagers.A male voice completes the scene with the same narrationas above (Government of Canada, 2009b).Study sample, data collection, and data analysisStudy participants were recruited from the At-Risk YouthStudy (ARYS), an ongoing prospective cohort study ofstreet-involved and drug-using youth in Vancouver,Canada [20]. Twenty-five in-depth, semi-structured, quali-tative interviews were conducted with 11 women and 14men. Interviews were conducted retrospectively, a numberof years after the release of the DrugsNot4Me campaign,rather than as part of a prospective evaluation. Partici-pants ranged in age from 20 to 32 years, with a medianage of 25 years. Of the participants that self-identified as asingle race or ethnicity, ten (40%) self-identified as White,five (20%) as Aboriginal, two (8%) as Southeast Asian, andone (4%) as Black/African-Canadian. Of the participantsthat self-identified as more than one race or ethnicity, five(20%) self-identified as Aboriginal and White, one (4%) asAboriginal and Black/African-Canadian, and one (4%) asWhite and Black/African-Canadian. Each interview lastedapproximately 1 h and was conducted by two femaleresearchers (LT and DF) at the ARYS frontline office indowntown Vancouver between April and June of 2015. Allparticipants provided written informed consent andreceived a thirty-dollar honorarium for their participation.The study was undertaken with ethical approval grantedby the Providence Healthcare/University of BritishColumbia Research Ethics Board.The study participants were not required to have seenthe DrugsNot4Me video PSAs prior to the interview, andwere shown both Fast Forward and Mirror several timesthroughout the interview process. However, the interviewsrevealed that the DrugsNot4Me campaign had a high levelof exposure among the study participants. Of the 25 studyparticipants, 23 (92%) indicated that they had beenexposed to the campaign prior to the interview, while two(8%) indicated that they had no previous exposure. Partici-pants indicated that they had been exposed to thecampaign via multiple channels of communication (e.g.,television, Internet) and in multiple locations (e.g., athome, on public transit, in youth shelters).During interviews, we asked young people to describetheir exposure to the campaign, and reflect on how it didor did not impact their own drug use-related decision-making across time. We asked them to tell us how thevisual and audio components of the PSAs contributed tothe specific stories being told and how the PSAs couldimpact individual and collective understandings of youthdrug use in Canada. We also asked youth for theirperspectives on the use of fear-based appeals in drugprevention messaging, and to compare the DrugsNot4Mevideo PSAs with video PSAs from other campaigns theyhad been exposed to. Finally, we asked young people fortheir recommendations on how to improve drug preven-tion PSAs, as well as their ideas about alternatives to drugprevention PSAs for addressing youth drug use.All interviews were audio-recorded and transcribedverbatim, and transcripts were checked by the lead authorto ensure accuracy. Following transcription, a codingframework was generated that captured broad, emergentthemes (e.g., exposure to the DrugsNot4Me campaign);this framework was then refined by the research teamthrough the addition of new codes that captured morecomplex analytic categories (e.g., PSAs and social suffer-ing). NVivo software was used to facilitate data codingand management.ResultsUnrealistic and decontextualized representations of druguseOverall, findings of the present study indicated that theDrugsNot4Me campaign did not affect young people’sdrug using behaviors, whether in terms of preventingthe initiation of more severe forms of drug use or motiv-ating young people to stop using drugs. The majority ofthe study participants characterized the storylines andprimary characters featured in the DrugsNot4Me videoPSAs as unrealistic, using terms such as “inauthentic”,“simplistic”, “illogical”, and “ridiculous”. One aspect ofthe PSAs that participants found particularly unrealisticwas the message that drug use in general inevitablyresults in dire consequences:What really irks me about both of these ads though, isthey’re just saying drugs in general, you know? It’s avery, very, very vague term. And its just, the contextgoes out the window when they play this video. It’slike, you know what? Your message is not clear.(Participant #12, Male, White)Notably, the participants of this study did not considermarijuana smoking to be a harmful form of drug use, nordid they consider it to be a “gateway drug” to more harmfulforms of drug use such as ecstasy (a transition which isdepicted in Fast Forward). It is important to note thatduring the time these PSAs were on the air, marijuana wasessentially being decriminalized in Vancouver, revealing adiscrepancy between the Government of Canada’s Drugs-Not4Me campaign and the drug policy climate in Canadianmetropolitan urban settings like Vancouver. Since the cam-paign, the presence of medicinal marijuana has increasedTi et al. Harm Reduction Journal  (2017) 14:3 Page 3 of 8dramatically in Vancouver, and is easily accessible to mostadults. Yet, of the latest series of drug prevention PSAsreleased by the Government, one continued to focus on thepotentially dire consequences of marijuana use amongyoung Canadians [21]. The other emphasized the harms ofprescription drug abuse [22].Another main issue identified by a large number ofparticipants was that the PSAs failed to acknowledge oraddress the broader contexts of the primary characters’progressive drug use and addiction, including the social,structural, and environmental factors that powerfullyshape young people’s vulnerability to illicit drug use andrelated harms in particular places. These factors includeexperiences of social, economic, and institutionalmarginalization in communities, neighborhoods, andschools; unstable housing and homelessness; and exposureto trauma and abuse, including sexual and physicalviolence [20, 23, 24]. In both video PSAs, the primarycharacters are shown in significant mental distress as theirdrug use and addiction progress. However, study partici-pants consistently emphasized that mental distress—as aresult of problems at home and at school for example—isan important context for initiating drug use:They’re trying to shove like, years of like, drama andabuse into like, five seconds. If I watched and had noidea what was going on [i.e., had no prior knowledgeof how addiction progresses] I would be veryconfused, probably. I would have no idea why she’sfreaking out or anything. It wouldn’t make any senseat all. It’s all implied. (Participant #11, Male, White)A number of young people drew attention to the waysin which the DrugsNot4Me campaign attempted to depicta very particular “reality” about youth drug use. Both ofthe central characters in Mirror and Fast Forward appearto be from middle-upper class families; they have niceclothing, well-furnished bedrooms, and what appear to bestable homes. Importantly, both characters are Caucasian.A number of young people commented that this depictionof youth drug use—and of vulnerability to drug use—wasnot representative of the vast majority of Canadian teen-agers who struggle with addiction, including, notably,young people of Aboriginal descent [25–27]. As oneyoung woman explained about Mirror:Well, she looks like a yuppie. She’s well-dressed, herhair is clean, she’s somewhat pretty-looking, she prob-ably has a good home. My bedroom never lookedlike her bedroom, I’ll tell you that. I don’t relate toher at all ‘cause my mom’s a drug addict. She’s been adrug addict since I was little. I’ve been around drugsall my life. This is—no, this is not realistic. Like, whathappened? What’s her stressor? Like, why does shehave to use drugs? She doesn’t look like the kind ofperson that needs to use drugs. (Participant #21,Female, Aboriginal–White)Reinforcing suffering, stigma, and public fearWhile most participants pointed to the various ways inwhich the PSAs were unrealistic, several youth simultan-eously found that they were able to relate to certain aspectsof the PSAs’ storylines—in particular, the spiraling, negativeconsequences of severe addiction, as depicted in Mirror.Most participants believed that the “addict self” depicted atthe end of Mirror is using crystal methamphetamine(meth), because she is shown with sores on her arms andmouth consistent with the “skin picking” behavior that canaccompany intensive meth use. For those participants whohad been or were currently addicted to meth, or who had afriend in that situation, watching Mirror could be emotion-ally painful, and reinforce feelings of sadness, alienation,and hopelessness. One participant expressed this through aretelling of her friend’s experience:My friend really relates to that ad [Mirror] a lot.‘Cause she’s from [a] well-off family. And like, that’swhat happened to her. She started crying when shesaw that commercial. It like, blew her out of thewater. [It] gave her like, [a] kick in the ass. Yeah, shegot really scared. I think [the ad is] sad. (Participant#6, Female, Aboriginal)Similar sentiments were reflected in other participants’accounts:The [ads] just feel painful. I don’t like the sense ofwhat’s going on. Sucks to watch [it], sucks to live it.(Participant #10, Male, White)This is like, [a] really alienating ad, right here. It’s reallymaking it seem like, there’s no hope for that girl, iswhat I’m getting. And that she’s fucked and you betternot get to that point because there’ll be no hope for youas well. And there’s so may people that, in theiraddiction—whether it’s been a year or twenty years,they feel that way. And I feel like this is just backingthat up. (Participant #17, Male, Aboriginal–White)When asked to think about the impact of the PSAs morebroadly, participants articulated a concern regarding thepotential of the PSAs to create public fear surroundingyouth drug use, and reinforce stigma and discriminationtowards vulnerable young people who were not able to“just say no” to drugs. Regarding Mirror, participantsnoted:[The ad] makes society scared of everybody that’s ondrugs. You shouldn’t be afraid of it. I think you shouldTi et al. Harm Reduction Journal  (2017) 14:3 Page 4 of 8just be more aware of it. More information on [thecontext of youth drug use] would be more helpfulthan to like, just put an ad on. Like, freak out people,you know? (Participant #6, Female, Aboriginal)This ad is not solution-based in any way. It shows aproblem, and [says], you know, prevent a problem bynot doing it. But what if someone was to look at thisad and they are in that place in their lives? How is thisgoing to be bettering [for] where they are in theiraddiction in any way? It’s just kind of creating aseparation, making them appear to be in a differentcategory. Like, the segregation of people who are ondrugs. It’s just saying, ‘Don’t use drugs.’ It’s not sayingthat, you know, ‘But if you do use them, here’s how wecan help.’” (Participant #17, Male, Aboriginal–White)Alternatives to fear-based drug prevention PSAsWhen it comes to preventing youth drug use, almost allstudy participants argued that there are more effectivealternatives to drug prevention PSAs that use fear in anattempt to influence or change individual behavior. Withregard to developing more effective PSA campaigns,participants suggested that PSAs should be more infor-mational and educational, providing facts about illicitdrug use rather than emphasizing emotional storylines.It is important to note that the DrugsNot4Me campaignwas not designed to address the needs of young peoplewho were already engaged in more severe forms of druguse. Nevertheless, study participants consistently charac-terized the video PSAs as “problem-based” rather than“solution-based” and commented on how they promotedabstinence without offering useful information abouthow to access support for those young people strugglingwith addiction or the decision to use more severe andpotentially harmful drugs. Though intended as aresource, the link to the DrugsNot4Me website featuredat the end of the PSA was viewed as insufficient byparticipants. To this effect, one participant explainedabout Mirror:[The ad] said drugsnot4me.com. If I got to learnmore about that resource it would be more beneficialto me. Yeah, I would’ve liked to see more about whathappens when I go to that site—what kind of helpthere is available to me. [Without it] I’m left with astory and a link. [It’s hard to] separate myself fromthe girl and imagine myself getting the help. [Whenshe] goes onto the porch [of her home] and she’swith her friends—that’s great, but how did she getthe help? And choosing not to use won’t justmiraculously change your life. You can be sober andclean and still feel dead on the inside and still haveall of the issues that you had when you were using.(Participant #14, Female, Aboriginal–White)Study participants also suggested that the PSAs couldbe improved through the use of “real people with realstories”:Maybe like, [if the ad] wasn’t fictional. That might helptoo—if it was like, actual people who’d gone throughsome of the things. ‘Cause that might resonate morewith [people] than this fictional political ad created bythe Government, you know what I mean? If it was like,‘Oh, we interviewed some addicts and this is what theyhad to say’ and stuff like that. This is a real person—wedidn’t make this up to sell you an idea. This is anactual person that’s gone through this. (Participant #3,Male, Southeast Asian)One participant suggested this community-based, par-ticipatory approach to creating a drug prevention massmedia campaign:I think it would be more effective for them to hireonto their advertising team and their campaign teampeople who are recovered addicts. People who workin the addiction industry. People who have, like,experience being in and out of rehabilitationprograms. And I feel like those people would have alot of the similar ideas or thoughts that I havetowards this and be able to really make an actualeffective ad and program for people. (Participant #17,Male, Aboriginal–White)However, the majority of participants were adamantthat the taxpayer dollars invested in the production anddissemination of PSAs could have had more impact onyouth drug use if it was used to provide different kindsof support to young people in crisis, such as detox facil-ities and harm reduction and mental health programs.Participants recognized the need for such programs tohelp those who are already addicted to drugs:I would really want to focus on the drug addicts andnot the could-be drug addicts. So what I would spendthe money [used for the DrugsNot4Me campaign] on[is] helping the already addicted. More supportivehousing, more mental health advocates. ‘Cause that’swhat I see right now is the problem. The DowntownEastside is [full of] drug addicts and, you know, drugaddicts with mental health issues. ‘Cause I’m one ofthose people that have both. (Participant #23, Female,Aboriginal)One participant in particular strongly emphasized theimportance of providing community spaces and servicestargeted at vulnerable youth who have not yet initiateddrug use, but are highly vulnerable to drug use. Briefly,Ti et al. Harm Reduction Journal  (2017) 14:3 Page 5 of 8he noted that while access to these kinds of spaces andservices exists in downtown Vancouver, it is limited inother parts of the Lower Mainland and the Province ofBritish Columbia. He described how a community centerin his home town, which provided specific programing foryouth (including leadership and volunteering opportun-ities), played a significant role in allowing him to moveaway from drug use and towards other opportunities:I think the money [used for the DrugsNot4Mecampaign] would be more useful going towardsservices for youth than the ads. I’m sure there are alot of youth who don’t even pay attention to them ordon’t fully understand them. I didn’t have access tothings like a peer support worker or Coast MentalHealth or anything like that [but] for me, it was theyouth center [in the rural community where he grewup]. That was where I really started to take on like,leadership responsibilities and [started] volunteeringand stuff like that. (Participant #9, Male, Aboriginal)DiscussionThe Canadian government’s DrugsNot4Me drug preven-tion PSA campaign had an extensive reach. Indeed, thisstudy provides evidence of its success in reaching some ofCanada’s most vulnerable and marginalized young people.However, the results of the present study indicate that forthis group of young people, the PSAs were simplistic andlacked information, and, for some, were even emotionallyharmful. Importantly, many called for funding of drugprevention PSAs to be diverted to housing, mental health,and harm reduction programs. Our findings thereforesupport previous work which emphasizes the overall inef-fectiveness of drug prevention PSAs, including thosewhich use fear-based appeals [2, 9–11].The findings of the present study are also consistentwith previous work indicating that PSAs can have negativerepercussions for vulnerable populations [2, 4, 13–15].While the PSAs did not affect young people’s drug usepractices, they did have a negative emotional impact onsome participants and could actually exacerbate experi-ences of social suffering. Social suffering refers to how thecollective lived experiences or lived realities of sufferingcan be powerfully shaped by social, structural, and envir-onmental factors beyond individual control [28–30]. Byespousing a simplistic, “just say no” approach to address-ing the problem of youth drug use, the Government ofCanada’s DrugsNot4Me campaign reduces drug use andits harms (e.g., physical and psychological demise) topersonal choice. Reinforcing this personal choice narrativecan deepen the stigmatization of those young peoplewhose “choices” are powerfully constrained by broadersocial, structural, and environmental factors. This includesforms of self-stigmatization, through which young peopleblame themselves for not being able to “just say no” todrugs [31].The potential negative impacts PSAs can have on vul-nerable populations has led to arguments for the rigorousevaluation of PSAs and mass media campaigns in an effortto mitigate, or altogether avoid, these outcomes. However,despite the existence of policies around mandatory stan-dardized post-campaign evaluation for media campaignsof $1 million or more in Canada, evaluative strategiesoften overlook the importance of pre-campaign evalua-tions, and neglect to measure the emotional impactcampaign content can have on audiences, particularlywhen addressing issues related to vulnerable populations;rather, they focus on audience recall and understanding[32]. Further, the existing literature on PSAs reveals a lackof research into strategic methods by which thesecampaigns could be evaluated for both positive and nega-tive impacts, including the emotional impact on targetedaudiences and the potential to increase the stigmatizationand self-stigmatization of vulnerable populations. The fail-ure to develop and implement robust evaluations of publichealth communication campaigns during production andbefore dissemination represents an important area forfuture work [33–37].Given the high costs associated with the productionand dissemination of drug prevention campaigns, as wellas the dire situation of many young people who useillicit drugs in Canada, the findings of the present studyhave implications for resource allocation. The Drugs-Not4Me campaign was on the air from 2009 to 2012.From 2007 to 2012, the Government of Canada bud-geted CDN $29.8 million for its Mass Media Campaign,as a part of its Prevention Action Plan [17]. From 2014to 2015, the Government allocated CDN $5.5 million toHealth Canada for the “prevention of illicit drug use”[38, 39]. These values indicate that the Government hasplaced significant emphasis on the production anddissemination of drug prevention mass media cam-paigns. However, our findings build on a growing bodyof evidence indicating that drug prevention mass mediacampaigns have very little impact on the drug usingbehaviors of vulnerable young people and may actuallyproduce negative outcomes for youth who are alreadyheavily stigmatized in society [2, 4, 9–11, 13, 14]. Thisincludes not only the DrugsNot4Me campaign, but also theGovernment’s latest campaign, released in October 2015,which featured two PSAs about the harms of marijuanaand prescription drug use targeted at parents [21, 22].The need to consider the social, structural, and envir-onmental contexts of health behaviors when designing apublic health communication campaign is emphasized invarious studies [3–6, 40–42]. It has been suggested thatdrug prevention PSAs should be conceptualized with aconsideration of those factors external to the individualTi et al. Harm Reduction Journal  (2017) 14:3 Page 6 of 8choice to “just say no” to drugs [2]. Ultimately, there is anurgent need change the ways in which PSAs are producedcreatively if they are to continue to be employed. Fundingfor drug prevention PSAs should be contingent uponscientific evidence in support of their effectiveness andrigorous evaluation strategies; thus far, such evaluationand evidence has been lacking in Canada.For many of our participants, the creation of drugprevention PSAs and mass media campaigns were notconsidered the most effective use of resources. Rather,participants suggested an alternative approach worthy ofconsideration: that funding for PSAs be reallocated tosocial housing, mental health, and harm reductionprograms, as well as other community supports andservices specifically designed for youth. Better supportsand services for young people in the places of theirchildhoods are needed so that the “decision” to initiatemore severe and potentially harmful forms of drug use doesnot come to seem like the only “decision” congruent withevery day lived experience in the context of entrenchedsocial, economic, and institutional marginalization [24, 43].The present study has several limitations that warrantdiscussion. First, the thematic analysis conducted for thepresent study was focused on only one PSA campaign,and as such, the findings of this study may not apply toother drug prevention PSA campaigns or those on otherhealth issues. Second, the findings revealed by this studyare specific to the study participants and are not repre-sentative of the wider street-involved youth populationin Canada or elsewhere. Third and relatedly, it is import-ant to recognize that the campaign did not directlytarget our study population, street-involved youth, butrather youth who are potentially at high risk of initiationinto drug use. As such, this study cannot speak to theimpact of the campaign among its direct target audience.And finally, it is important to acknowledge the limita-tions of the interview process and the ways questionsare framed, as well as the existence of power relationsembedded in the research process, particularly whenworking with youth, that may influence responses tofavor researchers’ interpretations [43].ConclusionsIn conclusion, the images, ideas, and information found inthe DrugsNot4Me campaign were understood, experi-enced, and engaged by participants in a way that reflectsthe lived experiences or realities [29, 30] of social sufferingamong young people who are street-involved and usedrugs. Our findings ultimately support calls for interven-tions that address the social, structural, and environmentalcontexts that shape these young people’s lived experiencesacross the life course [44]. The obvious disconnectbetween the perspectives of the Government of Canadaand street youth on what constitutes an effective drugprevention campaign necessitates consideration of alterna-tive solutions to drug prevention PSAs and the use offear-based appeals.AbbreviationsARYS: At-Risk Youth Study; PSA: Public service announcementAcknowledgementsThe authors thank the study participants for their contribution to theresearch, as well as current and past researchers and staff.FundingThis study was supported by the US National Institutes of Health(R01DA033147, U01DA038886) and the Canadian Institutes of Health Research(MOP-102742). DF is supported by the Canadian Institutes of Health Researchand the Michael Smith Foundation for Health Research. WS is supported by theMichael Smith Foundation for Health Research. These institutions did not play arole in the design of the study; collection, analysis, and interpretation of thedata; and writing the manuscript.Availability of data and materialsNot applicableAuthors’ contributionsLT and DF collected, analyzed, and interpreted the data and were majorcontributors in writing the manuscript. All authors were involved in thedesign of the study and read and approved the final manuscript.Authors’ informationNot applicableCompeting interestsThe authors declare that they have no competing interests.Consent for publicationNot applicableEthics approval and consent to participateAll participants provided written informed consent and received a thirty-dollarhonorarium for their participation. 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