Why adolescent peer crowds matter: Incorporating youth subcultures and values in health behavior campaigns

Background: Despite evidence that media campaigns are important components of health interventions, many campaigns targeting adolescents have limited success. Strategies to enhance the effectiveness of these campaigns are needed. Adolescent peer crowds present a unique opportunity for the development of effective health campaigns. Peer crowds are macro-level subcultures (e.g., hip-hop) that adolescents identify with. Crowds have different values, stylistic preferences and, importantly, risk behavior patterns. For example, preppy teens exhibit an increased likelihood of alcohol use, while skaters are at increased risk of smoking.  

Objective: This work (1) builds the scientific foundation for the use of peer crowd-based approaches in health campaigns and (2) demonstrates how this foundation translates to practice through a description of the Virginia Foundation for Healthy Youth’s (VFHY) peer crowd-based youth tobacco prevention efforts.

Methods: We conduct a review of the literature to describe the theoretical foundations of peer crowd-based health campaigns and assess the evidence supporting this approach. We describe VFHY’s efforts as a case study for the development of peer crowd-based health campaigns.

Results: Several theories, including Theory of Normative Social Behavior and Social Identity Theory, support the use of peer crowds in adolescent health campaigns. The state of the evidence similarly supports this approach. VFHY’s use of a peer crowd-based approach resulted in significantly less adolescent smoking, underscoring the utility of this approach.

Implications: Peer crowds present an innovative, effective and efficient way to impact adolescent health behavior. Practitioners should design campaigns to change crowd norms, and use peer crowds to target adolescents.