Diffusion of innovations theory for alcohol, tobacco, and drugs.
Article Type: Editorial
Subject: Alcoholism (Prevention)
Alcoholism (Research)
Health education (Usage)
Tobacco habit (Prevention)
Tobacco habit (Research)
Authors: Sharma, Manoj
Kanekar, Amar
Pub Date: 04/01/2008
Publication: Name: Journal of Alcohol & Drug Education Publisher: American Alcohol & Drug Information Foundation Audience: Academic; Professional Format: Magazine/Journal Subject: Health; Psychology and mental health; Social sciences Copyright: COPYRIGHT 2008 American Alcohol & Drug Information Foundation ISSN: 0090-1482
Issue: Date: April, 2008 Source Volume: 52 Source Issue: 1
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: Ohio Geographic Code: 1U3OH Ohio
Accession Number: 179277678
Full Text: More than hundred years have passed since the diffusion of innovations theory originated. But it still remains a popular theory. As of 2002, over 5,200 applications of this theory in various fields have been published (Rogers, 2003). The hallmark of diffusion of innovations theory is that it deals with dissemination of new ideas and adoption by people in a systematic manner. Diffusion of innovations theory is an effective tool for social change. The diffusion of innovations theory deals with dissemination of an innovation is an idea, practice, or product (including services) perceived as new by an individual or other unit of adoption. Communication channels serve as the link between those who have the know-how of the innovation and those who have not yet adopted it. The innovation-decision process (Rogers, 2003) is a five step process: (1) gaining knowledge about the innovation; (2) becoming persuaded about the innovation; (3) decision step of adopting or rejecting the innovation; (4) implementation step of putting the innovation to use; and (5) confirmation step of either reversing the decision or adopting the new innovation.

The applications of the diffusion of innovations theory in public health, health promotion, and health education began with immunization campaigns and family planning programs. Its application in alcohol, tobacco, and drugs can be seen at two levels. The first level pertains to adoption and diffusion of the habit of using alcohol, tobacco, and drugs. The second level pertains to diffusion of successful interventions pertaining to prevention and control of alcohol, tobacco, and drugs. Ferrence (2001) calls these two levels "natural" or spontaneous as in the unplanned diffusion of drugs in a given population and "planned" as in the case of interventions. It is the latter level that our readers would be especially interested. Ebrahim and colleagues (2007) advocate in present times the need for faster diffusion of interventions at a global level with regard to five modifiable risk behaviors of alcohol consumption, tobacco use, overweight and obesity, low fruit and vegetable consumption, and physical inactivity.

Simons-Morton and colleagues (1997) have advocated the use of diffusion of innovations theory in prevention of alcohol, tobacco and drug use. Several interventions in the area of alcohol, tobacco, and drugs have used diffusion of innovations theory for their dissemination. One intervention is the Smart Choices, a school-based tobacco prevention program (Brink, Basen-Engquist, O'Hara-Tompkins, Parcel, Gottlieb, Lovato, 1995; Parcel et al., 1995). It was found that adoption of the program was increased in the intervention districts, and teacher attitudes and organizational factors were responsible for adoption. A unique feature of this study is that it combined social cognitive theory (Bandura, 1986) with diffusion of innovations theory.

Another example of application of diffusion of innovations theory is the dissemination of Centers for Disease Control and Prevention's school guidelines to prevent tobacco use and addiction to state education agencies (McCormick & Tompkins, 1998). It was found that diffusion process requires planned change over time through several communication channels.

In North Carolina an experimental study was done in 22 school districts to ascertain the extent of implementation of school-based tobacco prevention curricula being disseminated based on diffusion of innovations model (McCormick, Steckler, & McLeroy, 1995). The study found that larger organizational size and teacher training were strongest predictors of curricula implementation.

Ferrence (1996) notes several applications of diffusion of innovations theory in tobacco prevention such as limiting exposure to environmental tobacco smoke, diffusion of smoking cessation programs among physicians, and diffusion of policies regarding tobacco control among public health agencies. Rohrbach and colleagues (1996) also advocate use of diffusion of innovations theory to adoption and implementation of alcohol, tobacco, and drugs prevention programs in schools

However, there are some limitations to the diffusion of innovations theory that researchers must consider. First, public health interventions are preventive in nature where the individual has to adopt the new idea today to avoid the likelihood of a negative consequence at a later date. For example, a smoker would need to quit smoking today to prevent development of lung cancer 20 or so years later. Such a long interval poses special challenges and diffusion occurs more slowly (Rogers, 2002). It needs to be kept in mind that diffusion of innovations in health is a complex process that occurs at multiple levels, across many different settings, and utilizes different strategies (Parcel, Perry, & Taylor, 1990).

Second, oftentimes in health promotion and health education the interventions have to be designed for lower socio-economic groups, people with low literacy levels and other vulnerable sections of the community. The adoption and diffusion process occurs easier and smoother in the wealthier and highly educated while in the vulnerable sections it is not as smooth and offers a number of challenges and barriers. As a consequence the gap between those who have and those who do not have widens even farther.

Finally, an issue with the diffusion of innovations theory is what is called pro-innovation bias (Rogers, 2003). This refers to the connotation that an innovation should be diffused and adopted by all members and in a rapid manner without rejection or reinvention. This is often not possible with many of the health promotion and education objectives. For example, with quitting smoking it is virtually impossible at present to think that no one will smoke. Rogers (2003) suggests conducting research while the innovation is still being adopted rather than waiting for it to be completely adopted, studying unsuccessful innovations, and examining the broader context in which an innovation diffuses.

On the whole the diffusion of innovations is a robust theory. More researchers must utilize it in prevention of alcohol, tobacco and drug use.


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Rogers, E. M. (2003). Diffusion of innovations. (5th ed.). New York: Free Press.

Simons-Morton, B. G., Donohew, L., & Crump, A. D. (1997). Health communication in the prevention of alcohol, tobacco, and drug use. Health Education & Behavior, 24(5), 544-554.

Manoj Sharma, MBBS, CHES, Ph.D.

Editor, Journal of Alcohol & Drug Education & Amar Kanekar, MBBS, MPH

University of Cincinnati

526 Teachers College

PO Box 210068

Cincinnati, OH 45221-0068
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