MASTER’S THESIS
Effects of Exposure to Information on Safe-Ecstasy Use on
Young Adults’ Motivation to Share Harm Reduction Messages on Facebook Rosinsko Hiro Susanto
Student ID: 10914188
University of Amsterdam
Graduate School of Communication Master’s program Communication Science
Supervisor: Dr. Saar Mollen
Abstract
This study examines whether exposure to information about safe ecstasy use affects young adults’ motivation to share information about safe ecstasy use on their own Facebook profile. A model is proposed in which exposure to information about safe ecstasy use is expected to increases the perceived norms of ecstasy use, which will lessen the level of perceived public stigma and self-stigma towards ecstasy users, and ultimately increasing motivation to share information about safe ecstasy use. The model is not supported; exposure to information about safe use of ecstasy is not showing any effect on motivation to share information about safe use of ecstasy. Exposure is also showing no effect to the perceived norms. However, this study found some interesting relations and those are: (1) perceived norms relate negatively to the level of perceived public stigma towards ecstasy users; and (2) the level of self-stigma shows a negative relation to motivation to share information about safe ecstasy use. This study has a theoretical value by contributing to the topic of how exposure to information on Facebook may influence norms perception and the level of stigma which is still very limited. Practical implications that this study has is inferring that in order to raise the likelihood of information about safe ecstasy use being shared on Facebook the person’s level of self-stigma need to be reduced. Moreover, suggestion for future research to confirm is also discussed.
The number of young adults who use ecstasy in The Netherlands is continuously rising (Trimbos, 2014). Ecstasy use is popular amongst young adults, because people perceive it to be relatively safe. Some users, however, frequently worry about the risk to health and wellbeing that result from using ecstasy (Murphy, Wareing, & Fisk, 2006). Therefore, some ecstasy users are constantly seeking information on how to minimize the adverse effects of taking the ecstasy (Panagopoulis & Ricciardelli, 2005). This information to reduce the negative effect is also known as harm-reduction messages (Panagopoulis & Ricciardelli, 2005). As for the source of harm-reduction messages, a rising trend to seek information from online sources has been reported (Falck, Carlson, Wang, & Siegal, 2004). In 2002, only less than 20% of young adults seek information about drugs use online, a few years later the percentage of young adults who also use ecstasy and go online to seek more information for harm-reduction rise to more than 50% (Falck et al., 2004). For ecstasy users, the online sources that they trust and visit the most are the independent harm-reduction sites such as DanceSafe or the Vaults of Erowid, where they can freely share experience, ask questions about usage or discuss scientific findings (Falck et al., 2004). These independent online harm-reduction sources are more trustworthy, because young adults’ believe the information comes from their experienced peers instead of the governmental institution that often preach the “anti-drugs” messages instead of harm-reduction (Falck et al., 2004; Panagopoulos & Ricciardelli, 2005).
Based on these facts, Falck et al. (2004) suggested health practitioners to develop a peer-oriented network strategy as a more effective way to reach ecstasy users. The suggestions were to develop peer-led interventions in dance clubs to disseminate the danger of ecstasy use, and developing a government-sponsored websites that is more appealing to young people needs to be developed along the way (Falck et al., 2004). Howbeit, these recommendations are seem like a
two separate strategies and did not integrate personal-network and online mechanism. If we see the today’s time online landscape, social networking sites (SNS) could be a better fit to
accommodate both strategies in a single medium. First, SNS are appealing to young adults; in fact most young adults spend most of their time online to stay connected with their peers through SNS (Chang & Heo, 2014). Second, SNS are seen as a potentially effective medium to spread health information and encourage healthy behavior, because they leverage the existing social relationships between the targets (Hansen & Johnson, 2012). Based on these two reasons, it seems SNS should be a perfect medium to spread harm-reduction messages to ecstasy users. However, Hansen and Johnson (2012) acknowledge that disseminating health message on SNS can be problematic if the health message is related to a certain stigma. The reason is because a person is unwilling to engage with a stigmatized content because such content might jeopardize a person’s self-representation (Chen & Marcus, 2012).
Managing self-presentation is important, because in society individuals are expected to behave in accordance to established norms that were set by the general population or often referred as “most people” (Link, 1987). If a person is seen as deviating from the norms, the society has the power make a collective agreement to set a social distance towards them and put negative labeling on them (Link, 1987; Link, Cullen, Frank & Wozniak, 1987). To be excluded from society is considered a severe punishment for some people, hence they will try to follow the norms, or trying their best to keep their stigmatized status a secret (Palamar, 2012). Yet, even though norms act as a code of conducts that govern stigmatization towards a person with negative labeling. Norms are not a written law, and it always changes depending on the context (Cinnirella & Green, 2007). Here another factor, exposure, comes into play. Norms are
discussions, direct observations, and indirect interaction with the media (Rimal & Lapinski, 2015; Chung & Rimal, 2016). This means if a person have more interaction with drug users or issues surrounding drug use, they will have a different perceived norms compared to other people with less exposure to such interaction (Palamar, 2012). Eventually, if the norms change there might be a possibility that the stigma will also change. For example, students in health promotion, social workers, or nurses will held fewer stigmatized beliefs towards the drug users compared to general population because they understand the complex issues surrounding drug use and have more empathy towards the users (Mackert, Mabry, Hubbard, Grahovac & Steiker, 2014). Based on evidences from earlier literature, this current study tries to answer the following research question: To what extend does exposure to information about safe use of ecstasy
changes young adults’ perception of the norms regarding the use of ecstasy and their level of perceived stigma and how does this change influence their motivation to share information about safe ecstasy use on their Facebook profile?
Theoretical Framework
Information Sharing on Facebook
As heavy users of Facebook, young adults typically spend 10 to 60 minutes on Facebook every day (Hum, Chamberlon, Hambright, Portwood, Schat & Bevan., 2011). According to Peluchette and Karl (2009), young people make a conscious attempt to portray a particular image when they use Facebook to impress their peers. To achieve that particular image on Facebook, young adults are regularly involved in self-disclosure and self-presentation to a large audience on the internet (Hum et al., 2011). Self-disclosure is the factual communication that an individual uses to present oneself, i.e. self-presentation (Johnson, 1980; as cited in Chen & Marcus, 2012).
The need to manage self-disclosure to achieve a suitable self-presentation on Facebook becomes greater since interactions on Facebook are seen as similar to the real-life (Hew, 2011; Chen & Marcus, 2012). Young adults has shown to strategically choosing what type of information they want to disclose, for example choosing which photos to post, activities or pages to likes so it suit the intended presentation they want to portray (Chen & Marcus, 2012; Peluchette & Karl, 2009).
The way young adults disclose information on Facebook has led researchers to study whether those contents really relates to their real-life behavior. The study found that some references in contents that young adults posts (i.e., photos, page information and status updates), can reliably predict their real-life behavior, such as smoking, sports and alcohol habit (van Hoof, Bekkers & van Huuren, 2014). However, the study could found any meaningful references to illicit drug use. The study then surmise, even though young adults use drugs, posting any content that has cues towards illicit drug use are beyond the limit of what they want to disclose publicly on Facebook (van Hoof, Bekkers & van Huuren, 2014). This could mean that young adults refrain to post contents related to drug use because they do not want their self-presentation have any relation to drug use. Therefore, this finding is in accordance to problem identified by prior studies which suggested that disseminating information that was perceived to be stigmatized on Facebook can be problematic because it might jeopardize self-representation (Hansen &
Johnson, 2012; Chen & Marcus, 2012). Thus, in the following section the study will first explain how stigma is defined and what are factors that make young adult’ could have a perceived stigma towards a certain behavior and a person related to it.
Stigma
Illicit drug use has been deemed unacceptable throughout most of society; therefore, it is a stigmatized behavior (Palamar, 2012). Even so, previous research found that not all drug users are stigmatized equally, the stigma levels are vary based on social acceptability (Palamar, Kiang & Halkitis, 2012). For example, ecstasy is perceived as a drug used by young people in clubs (Umeh & Pattel, 2004) while heroin is perceived as a harder substance used by irresponsible users who share needles, have hepatitis C, and have become homeless (Simmonds & Coomber, 2009; Palamar, Kiang & Halkitis, 2012). From the example, we could see that stereotype towards the users play an important role to influence how a person’s stigmatization level.
Stigma by the definition indeed, entails the occurrence of stereotyping, separation, and discrimination towards a population with perceived negative behavior that often create “us” versus “them” (Link & Phelan, 2001). This separation known as social distance is defined collectively by the society towards the stigmatized person or group (Link et al., 1987). A person views stigma in two ways, first through the perceived public stigma, which defined as a person’s perception of the extent to which the public collectively stereotype or discriminates against a stigmatized individual (Corrigan, 2004). And second through self-stigma, which is defined as an internalized stigma that individuals hold towards a person or group with the perceived negative behavior (Mak & Cheung, 2010). In this study, both concepts will act as the antecedents of motivation to share information about safe ecstasy use on Facebook.
Perceived Norms
Person or groups are stigmatized because they have strong negative labels attached to them. Inevitably, such negative strong labeling will create distances between the society (also
referred as “most people”) towards the stigmatized group (Link et al., 1987). Stigma is also defined as social disqualification in response to specific flaw or negative attribute that includes elements such as exclusion, discrimination and rejection (Link & Phelan, 2001). Importantly, the process to set this social distance is mainly influenced by perceived norms (Norman, Sorrentino, Windell, & Manchanda, 2008).
Perceived norms and stigma are closely related, in which stigma is created by the perceived norms, while on the hand norms are only meaningful to the extent where individual fears of the social sanction from deviating from the norms (Norman et al., 2008; Bendor & Swistak, 2001). The social sanction referred here is the social distance created by a social group close to the person, which often comes as a form of rejection. A person who uses drugs, often times will get rejections from closest relatives such as friends and family (Luoma, Thowig, Waltz et al., 2007). Therefore, in order to avoid rejection, a person will try to follow the norms.
The needs to follow to norms are described in two interrelated ideas, which are descriptive norms and injunctive norms. Descriptive norms are defined as a person’s beliefs about what most people in his or her social group are actually doing (Lapinski & Rimal, 2005). Descriptive norms’ influence a person’s behavior because generally people want to do the right thing by following what they assume most people are doing (Cialdini & Trost, 1998). The second idea is injunctive norms, which refer to a person’s beliefs about what most people ought to be done (Lapinski & Rimal, 2005). Injunctive norms, influence people because generally people are motivated to maintain affiliation with others (Cialdini & Goldstein, 2004). From those ideas that build norms, it is conclusive that, “doing what others do” or “doing what others think a person should do” is important for a person to be able to follow the norms and to be stay allowed within his or her social group. However, not all people want to obey the norms at all
times. In fact, some people tried to avoid rejection and stigma by concealing their stigmatized status through secrecy (Link, Yang, Phelan, & Collins, 2004). Secrecy is known to protect drugs users from experiencing stigma (Palamar, 2012). These findings concur with study from
Peluchette & Karl (2009) which suggested that young adults’ found more comfort to share sensitive information when there is anonymity (Peluchette & Karl, 2009). Based on these findings, we can conclude that people try to avoid social sanction by obeying the norms, or go against the norms but keeping a stigmatized behavior or status a secret.
Exposure
Norms are unwritten rules that are socially negotiated and understood by the people through social interactions (Chung & Rimal, 2016). Social interaction comes in a form of
communication as interpersonal discussions, direct observations, and indirect interaction with the media (Rimal & Lapinski, 2015; Chung & Rimal, 2016). These elements of social interaction affect how people understand norms, consequently affect their stigma perception. Prior study has shown that exposure to a stigmatized group or person is related to lower levels of stigmatization because a range of experiences lead to greater tolerance and acceptance (Batson et al., 1997; Corrigan et al., 2002). Therefore, some research beliefs that exposure can help to lowering the perception of “us” versus “them” (Corrigan & Watson, 2004). Exposure is also believed to be able to reduce misinformation or stereotypes, and create empathy which will result in lower stigma (Brewer & Miller, 1984; as cited in Palamar, 2012).
Ecstasy users are known to attain knowledge about the drug use from friends and online forums (Falck et al., 2004). The processes to gather information online and offline are also a form of social interaction. For example, interpersonal discussions are happening in
harm-reduction websites, which lead Falck et al (2004) to suggest a peer-oriented network strategy to reach ecstasy users. Second, direct observations also happen when a person meet their friends who are also using ecstasy (e.g., Mackert et al., 2014). More exposure also means a person will have more knowledge and closer proximity towards the drug use and lessening the perceived stigma (e.g., Palamar, 2012; Mackert et al., 2014). However, there are still limited researches that study whether exposures of information about safe ecstasy use on Facebook can count as a form of social interaction.
To summarize, young adults’ sees Facebook as a tool of self-presentation and since they may stigmatized ecstasy users, they may not want their Facebook post to present a profile of an ecstasy users. Stigma perception that young adults’ have is mainly influenced by norms, in which norms is always change depending on the influence of social context and exposure. How all of these variables related are depicted in the model of the study (see Figure. 1), and the how this study expects the outcome of the model is formulated in this hypothesis statement: Exposure to information about safe-ecstasy use will increase the perceived norms of safe-ecstasy use
practices which will decrease the level of self-stigma to share such information and increase the motivation to share the information about safe use publicly on Facebook.
Figure 1 – Conceptual model with independent variable, mediators, and dependent variable Independent Variable:
Exposure
Dependent Variables: Motivation to share Mediator 2:
Public and Self-stigma Mediator 1:
Method
Participants and design
An online between subjects experiment was conducted, where two groups were compared. Those groups are a group of participants with exposure to information about safe ecstasy use vs. group of participants without exposure to the information about safe ecstasy use. Participants that were invited and allowed to participate are those who have to be 18 years or older and have used ecstasy at least once in their life. Initially, the data received 173 responses and with 68% completion rate, the data ended up with 117 complete responses. After reviewing the control question, seven participants seems to know the goal of the study is to examine the motivation to share information about safe ecstasy use on Facebook. Since knowing the purpose of the study might affect their answers, those seven participants were excluded from the analysis.
All participants are required to have a Facebook account and have a good understanding of the English language. In total 110 people (63 percent male, 36 percent female and 1 percent other) were used for the data analyses. The average age of the participants is 22 years old (M = 21.74, SD = 3.12). To enhance the participation rate, ten participants who completed the survey would win €10 through a raffle system. This study has obtained ethical permission from
University of Amsterdam Ethical Committee. Procedure
Participants were approached via direct messages on Facebook and a message board on Changing Perspective Facebook group. Changing perspective is a private Dutch Facebook group that has a shared interest towards drugs use and harm-reduction. Participants then received a link to a Qualtrics survey. Before the study started, all participants were asked to read an invitation
letter and a factsheet that briefly described the goal of the study. However, the true intention of the study to examine motivation to share was not mentioned in both the invitation and the factsheet. The participants only informed that they will answer a set of questionnaire about thoughts and behaviors of people their age towards ecstasy use and party scenes. Afterwards, participants had to provide informed consent, by clicking the agree button.
Manipulated timeline. In the first part of the study, participants were asked to browse
through a manipulated Facebook timeline. There were two timelines created, each timeline contains five different posts. The first timeline is the exposure timeline which consists of two posts on safe ecstasy use and three posts about unrelated entertainment news. The messages of safe ecstasy use were taken from real messages posted by harm-reduction organizations, namely: DanceSafe, with the message of instructions how to use ecstasy testing kit; and Unity.org, with information to test young adults’ knowledge on drugs and alcohol consumption. The second timeline is the control timeline which consists of five unrelated posts about entertainment news and lifestyle. From these two timelines participants were randomly assigned to one of the two experimental groups. These groups were divided based on which Facebook timeline they observed. Afterwards, all participants were asked to answer a set of questionnaire.
Questionnaire structure. The questionnaire was divided into four blocks. The first block
was entitles behavior and thoughts of others, which included measures for perceived norms towards ecstasy use and perceived public stigma towards ecstasy users. The second block was personal behavior and thoughts, which asked participants about their personal stigma towards ecstasy users. And the third block entitled information exchange consisted of question regarding participant willingness to share or tag certain information on their Facebook timeline. Lastly, general questions of participants’ demographic and past behavior, such as frequencies age,
gender, level of education, nationality and the level of familiarity towards harm-reduction organizations were asked. Before participants can submit their answers, a debriefing statement was shown to tell them the true intention the experiment is to study how perceived norms and stigma play role in people’s willingness to share information about safe ecstasy use on Facebook.
Measures
Motivation to share information about safe ecstasy use. Two seven-point Likert items (1
= definitely will not…7 = definitely will) were created to measure motivation so share information related to safe ecstasy use. The items were “I will post information about safe ecstasy use on my Facebook timeline”, and “I will tag my friends on information about safe ecstasy use on Facebook”. A correlation analysis shows a weak positive correlation (r = .31, p = .002). Since both items correlate positively, it means those items are measuring a common thing, therefore they were averaged together to measure motivation to share (M = 2.30, SD = 1.59). In this study, outliers were determined by the dependent variable in which z-score < 1.96 is considered as the normal range. The results show (see Table 1), nine more participants from the total 110 were excluded as outliers which brings the final number of the participants to 101.
Table 1
Identifying outliers with z-scores
Frequency Valid Percent
Valid 2 Probable outliers (z > 2.58) 3 2.7
3 Potential outliers (z > 1.96) 6 5.5
4 Normal range 101 91.8
Total 110 100
Public Stigma. In this study stigma is conceptualized as perceived public stigma and
self-stigma. These two concepts are measured separately. First, perceived public stigma was measured with Perceived Public Stigma scale from Palamar, Kiang and Halkitis (2012). The original scale consists of ten items seven-point Likert scale (1 = strongly disagree; 7= strongly agree) to measures how participants perceived the public stigma towards the users of ecstasy (Palamar, Kiang, & Halkitis, 2012). One example of the item is, “Most people feel that ecstasy use is a sign of personal failure”. After conducting a principal factor analysis with direct oblimin rotations, the ten items were found to load in two factors. Eight items in the first cluster seems to represent what a person thinks of how the public might value a person who uses ecstasy, while two other items clustered in the second factor seems to represent what a person thinks of how employers might value a worker who uses ecstasy (see Appendix 3, for complete list of the items). Then, the two items loaded in factor 2 (i.e., “Most employers will not hire a person who uses ecstasy”; and “Most people would not accept an ecstasy user as a teacher of young children in public school”) were excluded to fit the purpose of the study to measure the perceived public stigma which refers to “most people” (Link, 1987). Furthermore, after a reliability analysis was conducted, one more item (“Most young women would not date someone who uses ecstasy”) was dropped to increase the reliability score. The final scale of perceived public stigma consists of seven items and in combination explained 62.03% of the variance, and is a good and reliable scale to measure public stigma with Cronbach’s alpha score of .92 (M = 3.08, SD = 1.3).
Self-stigma. Since self-stigma is an internalize stigma based a person’s own judgments
towards a stigma. In which this internalize views make a person decide to keep secret of his or her stigmatized status, this concept will be measured with a secrecy scale from Palamar (2011). The scale used is a seven-point Likert scale (1 = strongly disagree; 7= strongly agree). The scale
was based on the Secrecy scale which consist of seven items with question such as “I have avoided telling others about my ecstasy use” (Palamar., 2012). A principal axis factor analysis was conducted on the items with oblique rotation (direct oblimin), and all seven items were loaded in one factor and explained 48.17% of the variance. The seven items were shown to be a good reliable scale to measure self-stigma with Cronbach’s alpha score of .87 (M = 3.80, SD = 1.28).
Perceived norms. Perceived norms are built from two interrelated concepts, descriptive
norms and injunctive norms. This study, one scale for descriptive norms and one scale for injunctive norms scale, and these scales use a seven-point Likert scales (1 = strongly disagree; 7= strongly agree) which were averaged together to measure perceived norms. Item for
descriptive norms is, “Most people my age use ecstasy themselves”; while item for injunctive norms is “Most people my age accept the use of ecstasy”. A correlational analysis were conducted and it shows both scales to have a strong positive correlation (r = .57, p = .000), which mean they are measuring the same thing. Therefore, the scale of descriptive norms and injunctive norms are averaged to measure perceived norms (M = 4.27, SD = 1.32).
Results Randomization Check
The goal of this study is to examine the effect of exposure to information about safe use of ecstasy on motivation to share the information about safe use on young adults’ personal Facebook account. To check whether randomization to the two exposure conditions was indeed successful, the author checked if participants were equally distributed in both experimental groups based on some control variables. ANOVA and chi-square analyses showed there are no differences between the groups in terms of age, F(1, 99)= .23, p = .132, gender, x2 (2)=1.89, p =
.387, level of education, x2 (5)=2.55, p = .769, nationality, x2 (16)= 19.171, p = .387, and familiarity towards harm-reduction organizations, F(1, 99) = .22, p = .643. Based on these analyses we can assume that randomization successful.
Sequential moderation analysis
To test the effect of exposure on motivation to share through perceived norms and stigma, a PROCESS macro analysis from Hayes was conducted (Hayes, 2012). PROCESS was used to test the hypothesis, because it could provide a path analytical framework to estimate direct and indirect effects in the proposed mediation model. Since macro provides a test for indirect effects, it is suitable for this study which has two mediators, and only assumes exposure has indirect effect to motivation to share and no direct effect. Then we run the analysis using Model 6 in PROCESS macro based on the template guide for models with two mediators by Hayes (2012).
In the analyses, 10,000 bootstrap samples were used to estimate the bias-corrected bootstrap confidence intervals (BCBCI). Since the second mediator, stigma is conceptualized as two variables: perceived public stigma and self-stigma, two process analyses were conducted to test the effect of exposure on motivation to share through perceived norms of use and perceived public stigma and self-stigma. Figure 2 shows the tested serial multiple medial models. The paths described in this figure correspond to the results in Table 2. The c-path in the model includes the direct effect of exposure on motivation to share, independent of the effect of the mediators (c’), and the total effect of exposure on motivation to share (c), which is the sum of the direct effect and the indirect effect via the mediators (Hayes, 2012).
Figure 2. Tested sequential multiple mediation model. Note: Effect of exposure on motivation to share via perceived norms and perceived stigma; Asterisks suggest a significant effect, see table 2.
Table 2
Effect of exposure on motivation to share via perceived norms and stigma Stigma Indirect effect a1 a2 *a3 b1 *b2
c (total) c’ (direct) Public .04(.06)[-.053,.191] .27(.26) -.03(.25) -.30(.09) .13(.09) -.07(.09) .20(.23) .15(.23) Self .04(.07)[-.082,.211] … .01(.26) -.01(.10) .16(.09) -.18 (.09) .20(.23) .16(.23)
Note: Unstandardized b-coefficients (with SE between parentheses); … = the scores are the same as the scores above; Numbers in bold suggest p < 0.05; N = 101
The results (see Table 2) show that there is no significant effect of exposure on perceived norms (ba1 = .27, SE = .26, p = .307). There is, however, a significant relation of perceived
norms to perceived public stigma (ba3 public stigma = -.30, SE = .09, p = .019), but not on the
self-stigma (ba3 self-stigma =-.01, SE = .10, p = .954), as shown in path a3. The regression weight for
perceived public stigma indicates a significant medium negative relation between perceived norms with perceived public stigma, while the relation to self-stigma is not significant. The negative relation between perceived norms and public stigma means that, the more people perceived ecstasy use as the norm, the less they will perceive the public stigmatize the ecstasy users. However, perceived norms do not show significant relation on their personal view towards ecstasy users (i.e., the level of self-stigma). Moreover, public stigma (bb2 public stigma = -.07, SE =
Independent Variable: Exposure
Dependent Variables: Motivation to share Mediator 2:
Public & Self-stigma Mediator 1: Perceived norms a1 a2 a3* b1 b2* c, c’
.09, p = .455) in contrast to self-stigma (bb2 self-stigma = -.18, SE = .09, p = .049), does not show a
significant relation with the motivation to share information. This means, when the level of self-stigma decreases the level of motivation to share will increase. In sum the result do not found significant effect of exposure to motivation to share and perceived norms. But, the results show significant relations between perceived norms and perceived public stigma, and self-stigma and motivation to share.
The total effect (c) of exposure as the independent variable on motivation to share as the dependent without accounting the mediators were shown to be not significant (total effect = .20, SE =.23, 95% CI [-.260,.666], p = .386). Since there are two models with different second mediator, perceived public stigma and self-stigma, the direct effect (c’) which represented in path a1+a3+b2 were once again, analysed separately. The direct effect (c’public stigma) of exposure
on motivation to share with the perceived public stigma as the second mediator was not significant (bdirect effect = .15, SE =.23, 95% CI [-.304,.619]). Moreover, the direct effect (c’ self-stigma) of exposure on motivation to share through self-stigma as the second mediator was also
shown to be not significant (bself-stigma = .16, SE =.23, 95% CI [-.293,.614]). Both models were
shown to be not significant, which means the hypothesis was not supported. Nevertheless, some results are interesting, namely negative relation of perceived norms on public stigma and negative relation of self-stigma on motivation to share information about safe ecstasy use. Those findings will be discussed further on the following section.
Discussion & Conclusion
This study aimed to examine how exposure to information about safe ecstasy use on Facebook changes young adults’ norms perception of ecstasy use and the subsequent perceived
public stigma and self-stigma level associated with ecstasy users, and how this would
subsequently affect young adults’ motivation to pass along the information of safe ecstasy use on their personal Facebook account. Based on theory and scientific evidence in the topic of
perceived norms, stigma and substance abuse, a model was proposed in which exposure to information about safe ecstasy use was expected to increases the perceived norms of ecstasy use, which lessen the level of perceived public stigma and self-stigma towards ecstasy users, and ultimately increasing motivation to share information about safe ecstasy use. The result shows no significant effect of exposure to information about safe ecstasy use on the level of perceived norms of ecstasy use.
Furthermore, perceived norms were found to have a significant negative relation towards the perceived public stigma, but not towards self-stigma. Lastly, self-stigma was found to negatively relate to motivation to share information about safe ecstasy, however no significant relation found on the level of perceived public stigma. Based on the results, the model proposed in this study was not supported, either in the model mediated by perceived public stigma or in the model mediated by self-stigma. These findings indicate that exposure to information about safe ecstasy use on Facebook timeline has no effect on young adults’ motivation to share information about safe ecstasy use on their Facebook account.
Although prior research suggested that exposure can affect perceived norms, the result shows exposure to information about safe use of ecstasy use has no significant effect on perceived norms of ecstasy use. The reason might be because exposure that was defined in earlier study is referring to social interactions that include interpersonal discussions, direct observations, and indirect media interaction which might indicates a deeper interaction between a person and issues surrounding the stigmatized person (Chung & Rimal, 2016). Based on those
facts, the author assumes that exposures to information about safe ecstasy use in this study which act as a mere stimulus for the experiment are not strong enough to evoke different responds from the participants.
Moreover, a significant negative relation was found between the perceived norms and the level of perceived public stigma towards ecstasy users. This means if young adults’ perceived most people use and accept the use of ecstasy, young adults’ will perceived most people will have a more lenient attitude towards ecstasy users. Significant relation between perceived norms and public stigma is justifiable, in accordance with the definition of public stigma itself. In prior study, public stigma is defined as a collective agreement made by the public to set social distance to a person or group with a negative behavior (Link et al., 1987). Additionally, perceived public stigma is defined as a person’s perception of the extent on how most people collectively
discriminate a stigmatized individual (Corrigan, 2004). Thus it make sense if a person’s perceived a behavior such as ecstasy use is commonly accepted by most people, they will perceived most people have fewer stigma towards ecstasy users.
Interestingly, the perceived norms did not affect their own view (i.e., self-stigma) towards ecstasy users. The reason might be because self-stigma is an internalize view that a person’s hold towards a stigmatized person or group, and in this case self-stigma towards ecstasy users means a stigma towards themselves. This internalized stigma then guides a person to decide whether they need to hide their stigmatized status to avoid social sanction. The author assumes that this view might come from other internal factors that not rely on the society. However, it is important to note that this is just the author’s speculation based on a warning given by Palamar (2012), stating that future research should aware that demographic background of a person might affect their stigma perception, and on top of that stigma could possibly pre-existed prior to the study.
Another interesting result that the authors’ would like to discuss is the fact that self-stigma shows a negative significant relation to motivation to share information about safe ecstasy use, but there was no significant relation on the perceived public stigma and motivation to share. This result means, when young adults’ hold fewer level of self-stigma; their motivation to share information about safe use of ecstasy on Facebook will increase. Previous literature suggested that young adults’ share information on Facebook, to achieve the ideal self-presentation (Hew, 2011; Chen & Marcus, 2012). In order to achieve the ideal self-presentation, young adults consciously choose which type of information they would like to disclose on Facebook (Chen & Marcus, 2012; Peluchette & Karl, 2009). However, previous literatures on self-representation on Facebook showed a contrasting view on the ideal self-presentation that young adults’ try to achieve. In one side, it was suggested that some young adults are refraining themselves to disclose contents that associated with negative cues, since they are afraid to face the
consequences in the future, such as being rejected by future employer or being ousted by their peers (Clark & Roberts, 2010; Peluchette & Karl, 2009). On the other side, other studies found that some young adults’ intentionally misrepresent themselves to gain social acceptability (Peluchette & Karl, 2010). In some cases of illegal drug use, some young adults’ who wished to enhance their social acceptability would include photographs and comments that contained cues to illicit drug use, in order to appear wild or as someone who like to party (Peluchette & Karl, 2010). These opposing views lead the author to infer that motive to post information on Facebook is an independent choice made by each individual.
Given the findings, this study has some theoretical and practical implications. First, the result corroborates to earlier finding that suggested perceived norms and perceived public stigma are related (e.g., Link et al., 1987; Link & Phelan, 2001; Norman et al., 2007; & Palamar, 2011).
Moreover, the relation between perceived norms and perceived public stigma are negative, which means if a person perceived a behavior to be acceptable by most people, they will more likely to believe such behavior is less stigmatized. In addition, perceived norms do not show any relation to self-stigma, and this result brings us to the second implications. Based on the result and
inferring to earlier literatures, perceived public stigma and self-stigma are two different concepts. From these two concepts of stigma, self-stigma seems to be the only type of stigma that relates to motivation to share information about safe ecstasy use on Facebook. Based on the results, it seems clear that in order to increase the likelihood of young adults’ motivation to share information about safe ecstasy use on Facebook, an attempt to reduce the level of self-stigma will be needed. However, future research is still needed to confirm this trend, most likely with another experiment to determine if there is a causal relation between self-stigma and motivation to share information about safe ecstasy use. The answer to this question might bring further implications to health practitioners to better understand how self-stigma is developed and how to reduce it.
Even though this study is still far from giving a concrete answers to researcher and practitioner, this study do have some value to be considered. The reason is because we know that stigma is a product of norms which was influenced by social interaction such as interpersonal discussion, direct observation, and indirect media interaction, however to date the study within this topic with take focus on interaction in SNS is limited (Chung & Rimal, 2016). Most studies on stigma and substance abuse highlighted interpersonal discussion and direct observation between a person and drug users (e.g., Couture & Penn, 2003; Mann & Himelein, 2008, in Mackert et al., 2014). While on indirect media interaction, most study still focusing on traditional media such as TV and billboard. Since the focus is on traditional media, those studies mainly
raised focus on smoking and excessive drinking and not touched the topic of substance abuse (e.g., Chia & Gunther, 2006; Gunther, Bolt, Borzekowski, Liebhart, & Dillard, 2006). SNS on the other hand is a new form of media which provide a vast range of information, from the most common to the most taboo topic for young adults’ to access and interact with. However, another debatable question may arise on how should interaction to information and between the users on SNS can be categorized under the elements of social interaction. And ultimately, will interaction on SNS works in a similar with the common definition of social interaction and will it eventually works for people to negotiate norms, are also an interesting area for future research to look into.
References
Batson, C. D., Polycarpou, M. P., Harmon-Jones, E., Imhoff, H. J., Mitchener, E. C., Bednar, L. L., ... & Highberger, L. (1997). Empathy and attitudes: Can feeling for a member of a stigmatized group improve feelings toward the group?. Journal of personality and social
psychology, 72(1), 105.
Bendor, J., & Swistak, P. (2001). The evolution of Norms1. American Journal of
Sociology, 106(6), 1493-1545.
Chang, C. W., & Heo, J. (2014). Visiting theories that predict college students’ self-disclosure on Facebook. Computers in Human Behavior, 30, 79-86.
Chen, B., & Marcus, J. (2012). Students’ self-presentation on Facebook: An examination of personality and self-construal factors. Computers in Human Behavior, 28(6), 2091-2099. Chia, S. C., & Gunther, A. C. (2006). How media contribute to misperceptions of social norms
about sex. Mass Communication & Society,9(3), 301-320. Chung, A., & Rimal, R. N. (2016). Social Norms: A Review.
Cialdini, R. B., & Trost, M. R. (1998). Social influence: Social norms, conformity and compliance.
Cialdini, R. B., & Goldstein, N. J. (2004). Social influence: Compliance and conformity. Annu.
Rev. Psychol., 55, 591-621.
Cinnirella, M., & Green, B. (2007). Does ‘cyber-conformity’vary cross-culturally? Exploring the effect of culture and communication medium on social conformity. Computers in Human
Behavior, 23(4), 2011-2025.
Clark, L. A., & Roberts, S. J. (2010). Employer’s use of social networking sites: A socially irresponsible practice. Journal of Business Ethics, 95(4), 507-525.
Corrigan, P. W., & Watson, A. C. (2002). The paradox of self‐stigma and mental illness. Clinical
Psychology: Science and Practice, 9(1), 35-53.
Corrigan, P. (2004). How stigma interferes with mental health care. American
psychologist, 59(7), 614.
Couture, S., & Penn, D. (2003). Interpersonal contact and the stigma of mental illness: a review of the literature. Journal of mental health, 12(3), 291-305.
Falck, R. S., Carlson, R. G., Wang, J., & Siegal, H. A. (2004). Sources of information about MDMA (3, 4-methylenedioxymethamphetamine): perceived accuracy, importance, and implications for prevention among young adult users. Drug and Alcohol Dependence, 74(1), 45-54.
Field, A. (2013). Discovering statistics using IBM SPSS statistics. Sage.
Gunther, A. C., Bolt, D., Borzekowski, D. L., Liebhart, J. L., & Dillard, J. P. (2006). Presumed influence on peer norms: How mass media indirectly affect adolescent smoking. Journal of
Hansen, D. L., & Johnson, C. (2012, January). Veiled viral marketing: disseminating information on stigmatized illnesses via social networking sites. In Proceedings of the 2nd ACM SIGHIT
International Health Informatics Symposium (pp. 247-254). ACM.
Hayes, A. F. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling.
Hew, K. F. (2011). Students’ and teachers’ use of Facebook. Computers in Human
Behavior, 27(2), 662-676.
Hum, N. J., Chamberlin, P. E., Hambright, B. L., Portwood, A. C., Schat, A. C., & Bevan, J. L. (2011). A picture is worth a thousand words: A content analysis of Facebook profile photographs. Computers in Human Behavior,27(5), 1828-1833.
Lapinski, M. K., & Rimal, R. N. (2005). An explication of social norms.Communication
Theory, 15(2), 127-147.
Link, B. G. (1987). Understanding labeling effects in the area of mental disorders: An
assessment of the effects of expectations of rejection.American Sociological Review, 96-112.
Link, B. G., Cullen, F. T., Frank, J., & Wozniak, J. F. (1987). The social rejection of former mental patients: Understanding why labels matter.American journal of Sociology, 1461-1500.
Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual review of Sociology, 363-385.
Link, B. G., Yang, L. H., Phelan, J. C., & Collins, P. Y. (2004). Measuring mental illness stigma. Schizophrenia bulletin, 30(3), 511-541.
Luoma, J. B., Twohig, M. P., Waltz, T., Hayes, S. C., Roget, N., Padilla, M., & Fisher, G. (2007). An investigation of stigma in individuals receiving treatment for substance abuse. Addictive behaviors, 32(7), 1331-1346.
Mackert, M., Mabry, A., Hubbard, K., Grahovac, I., & Holleran Steiker, L. (2014). Perceptions of Substance Abuse on College Campuses: Proximity to the Problem, Stigma, and Health Promotion. Journal of Social Work Practice in the Addictions, 14(3), 273-285.
Mak, W. W., & Cheung, R. Y. (2010). Self‐Stigma among Concealable Minorities in Hong Kong: Conceptualization and Unified Measurement.American Journal of
Orthopsychiatry, 80(2), 267-281.
Mann, C. E., & Himelein, M. J. (2008). Putting the person back into psychopathology: an intervention to reduce mental illness stigma in the classroom. Social psychiatry and
psychiatric epidemiology, 43(7), 545-551.
Murphy, P. N., Wareing, M., & Fisk, J. E. (2006). Users' perceptions of the risks and effects of taking ecstasy (MDMA): a questionnaire study. Journal of Psychopharmacology, 20(3), 447-455.
Norman, R. M., Sorrentino, R. M., Windell, D., & Manchanda, R. (2008). The role of perceived norms in the stigmatization of mental illness. Social psychiatry and psychiatric
epidemiology, 43(11), 851-859.
Palamar, J. J. (2012). A pilot study examining perceived rejection and secrecy in relation to illicit drug use and associated stigma. Drug and alcohol review, 31(4), 573-579.
Palamar, J. J., Kiang, M. V., & Halkitis, P. N. (2012). Predictors of stigmatization towards use of various illicit drugs among emerging adults.Journal of Psychoactive Drugs, 44(3), 243-251.
Panagopoulos, I., & Ricciardelli, L. A. (2005). Harm reduction and decision making among recreational ecstasy users. International Journal of Drug Policy,16(1), 54-64.
Peluchette, J., & Karl, K. (2008). Social networking profiles: An examination of student attitudes regarding use and appropriateness of content.CyberPsychology & Behavior, 11(1), 95-97. Peluchette, J., & Karl, K. (2009). Examining students’ intended image on Facebook:“What were
they thinking?!”. Journal of Education for Business,85(1), 30-37.
Rimal, R. N., & Lapinski, M. K. (2015). A Re‐Explication of Social Norms, Ten Years Later. Communication Theory, 25(4), 393-409.
Simmonds, L., & Coomber, R. (2009). Injecting drug users: A stigmatised and stigmatising population. International Journal of Drug Policy, 20(2), 121-130.
Trimbos Instituut. (2014). Kerncijfers drugsgebruik 2014. Netherlands Institute of Mental Health and Addiction.
Umeh, K., & Patel, R. (2004). Theory of planned behaviour and ecstasy use: An analysis of moderator‐interactions. British journal of health psychology, 9(1), 25-38.
van Hoof, J. J., Bekkers, J., & van Vuuren, M. (2014). Son, you’re smoking on Facebook! College students’ disclosures on social networking sites as indicators of real-life risk behaviors. Computers in human behavior, 34, 249-257.
Appendix 1 Facebook timeline with exposure to information
Appendix 2 Questionnaire
Factsheet
Dear Sir or Madam,
You are invited to participate in a research project for my master’s thesis. This research is being carried out under the auspices the Amsterdam School of Communication Research from the University of Amsterdam. The research “Social media and information exchange” requires your assistance. We are specifically looking for people:
who are at least 18 years old; have a Facebook account;
have a good understanding of the English language; and have tried ecstasy (XTC) at least once in their life.
In this research, you are asked to look through a Facebook timeline, and we will ask you to fill out some questionnaires. This research will last approximately 10 minutes. Among participants who fit the above criteria and who complete the entire study in a serious manner will get a chance to win one of the ten €10 prizes that will be raffled.
Informed consent form "Social media and information exchange"
I declare that I have been informed in a clear manner about the nature and method of the research, as described in the factsheet “Social media and information exchange.” My questions have been answered satisfactorily.
I agree, fully and voluntarily, to participate in this research study. With this, I retain the right to withdraw my consent, without having to give a reason for doing so. I am aware that I may halt my participation in the experiment at any time. If my research results are used in scientific publications or are made public in another way, this will be done such a way that my anonymity is completely safeguarded. My personal data will not be passed on to third parties without my express permission.
If I wish to receive more information, either now or in future, I can contact: Rosinsko Hiro Susanto (rosinsko.susanto@student.uva.nl), or my supervisor Saar Mollen (s.mollen@uva.nl) at the University of Amsterdam.
Should you have any complaints or comments about this research, you can contact the Ethics Committee representing ASCoR, at the following address:
ASCoR Secretariat, Ethics Committee, University of Amsterdam,
PO Box 15793, 1001 NG Amsterdam; 020-525 3680;
ascor-secr-fmg@uva.nl.
Behavior and thoughts of others Perceived Norms of Ecstasy Use
1. What is the percentage of people your age, who either regularly or occasionally, use ecstasy according to you?
2. To what extent do you agree or disagree with this statement a. Most people my age accept the use of ecstasy b. Most people my age use ecstasy themselves
3. What is the percentage of people your age who employ one or more harm-reduction strategies (e.g., tested their pills, drink sufficient water) when using ecstasy, according to you?
4. To what extent do you agree or disagree with this statement a. Most people my age always test their ecstasy
b. Most people my age drink sufficient water while using ecstasy c. Most people my age never mix ecstasy with alcohol
d. Most people my age never mix ecstasy with other drugs 5. To what extent do you agree or disagree with this statement
a. Most people my age think you should always test the ecstasy
b. Most people my age think you should drink sufficient water while using ecstasy c. Most people my age think you should not mix ecstasy with alcohol
d. Most people my age think you should not mix ecstasy with other drugs Stigma
1. (Perceived Public stigma) To what extent do you agree or disagree with this statement a. Most people believe ecstasy users cannot be trusted
b. Most people believe that ecstasy users are dangerous
c. Most people would not accept an ecstasy user as a close friend d. Most people feel that ecstasy use is a sign of personal failure e. Most people will take a known ecstasy user’s opinion less seriously f. Most people will think less of a person that uses ecstasy
g. Most people would treat an ecstasy user just as they would treat anyone else (R) h. Most employers will not hire a person who uses ecstasy
i. Most people would not accept an ecstasy user as a teacher of young children in public school
j. Most young women would not date someone who uses ecstasy Personal behavior and thoughts
1. (Self-stigma/Secrecy) To what extent do you agree or disagree with this statement a. I hide the fact that I have used ecstasy
b. I have avoided telling others about my ecstasy use
c. I worry about certain people finding out about my ecstasy use d. If you use ecstasy, the best thing to do is keeping it a secret
e. When I meet someone for the first time I make special effort to keep hidden the fact that I have used ecstasy
f. I encourage my friends or family to keep my ecstasy use a secret g. I have worried that others will view my ecstasy use unfavorably Information exchange
1. To what extent do willing to do these activities, definitely will not … definitely will. a. Posting information on music events that are interesting on my Facebook timeline b. Tagging my friends on music events that are interesting on my Facebook timeline c. Posting information about safe ecstasy use on my Facebook timeline
d. Tagging my friends on information about safe ecstasy us on my Facebook timeline
e. Posting recent entertainment news on my Facebook timeline
f. Tagging my friends on the recent entertainment news on my Facebook timeline 2. Please state to what extent the following is true for you
a. I have shared information about my partying activities (e.g., attending festivals) in the past on my Facebook timeline
b. My friends have shared information about their partying activities (e.g., attending festivals) in the past on their Facebook timeline
c. I have shared information about safe ecstasy use in the past on my Facebook timeline.
d. My friends have shared information about safe ecstasy use in the past on their Facebook timeline.
e. I have shared recent entertainment news on my Facebook timeline.
f. My friends have shared recent entertainment news on their Facebook timeline. General questions
1. What is your gender? 2. What is your age?
3. Please state your country of origin
4. What is the highest level of education you have completed
5. How often you went partying (i.e., festivals or clubs or house party) in the past 6 months 6. How often did you take ecstasy in the past 3 months?
7. Please state how familiar you are with these organizations (i.e., dancesafe.org, unity.nl, bluelight.org, erowid.org)
Debriefing
This study was an investigation into the effects of exposure to messages related to ecstacy (XTC) harm reduction messages (for instance on testing your pills) on social media and how this influences people's willingness to share harm reduction messages about safe ecstasy use on their social network sites.
Background
In the past years, ecstasy use becomes more popular amongst youth. Social conversations about ecstasy use are also becoming more frequent in the public sphere. This includes dance music festivals scenes, news, blogs, and online forums. However, there is one platform where this conversation rarely happens, Facebook.
A prior research on social networking suggested that, when information is related to a stigmatized behavior (as ecstasy use may be), people will be more reluctant to engage with the content (share, like or follow). Stigma towards a behavior is thought to come from person’s perception of norms. For instance, the extent to which others disapprove or approve of (safe) ecstasy use.
Since social norms are not a written law, they may change depending on the social situation you are in. Information in the media plays a significant role in shaping people’s perceptions of norms. Therefore, norms regarding (safe) ecstasy use may be affected by exposure to information in the media. Therefore, this research wants to see how exposure to messages on social media affect people’s perception of norms and how this then affects people's willingness to share messages regarding safe ecstasy use themselves. To investigate this two timelines were created, and you were assigned randomly to browse one of the two timelines. Some participants were assigned to browse a Facebook timeline that shows several safe ecstasy-use related posts. The other timeline contained messages on an unrelated topic. After looking at the timeline people are asked to answer questions on norm perceptions, stigma toward ecstasy use and willingness to share a message on safe use of ecstasy. This way we can investigate if exposure to these messages indeed causes people to become more willing to share them, due to changes in norm perceptions and reduction in stigma.
We would like to thank you for your co-operation and stay safe!
Please contact Rosinsko Hiro Susanto at the following e-mail address
(rosinsko.susanto@student.uva.nl) if you have any questions regarding this study or if you wish to receive a summary of the results upon completion of this research.
