Poor communication between doctors and patients is widely seen as a problem in American healthcare. Now more and more healthcare providers are giving patients new ways of accessing doctors to ask questions or express concerns. In the age of email, texting, video chatting and social media, a look at the promise and limitations of digital communication to improve patient experiences and outcomes.
Guest Host: Susan Page
The term “peer pressure” usually carries negative connotations of teens trying drugs and families going into debt to keep up with the Joneses. But Pulitzer Prize-winning journalist Tina Rosenberg argues there are also powerful and often overlooked benefits of peer pressure. She’s written books about dealing with moral and political problems in Latin America and post-communist Europe. In the process, she stumbled upon what she calls “the social cure” for seemingly intractable problems across the globe. She gives examples of positive peer power in action in Serbia, India, South Africa, and the U.S.
- Tina Rosenberg writes "The Fixes" online column for the New York Times, winner of the Pulitzer Prize and National Book Award-winning, “The Haunted Land."
Author Extra: Tina Rosenberg Answers Audience Questions
Q: I am fascinated by this idea of using identity formation to influence or change behavior. I’m interested in juvenile justice reform and what comes to mind immediately listening to Tina’s ideas is how the ‘social cure’ could be utilized by schools, courts and other legal institutions, to focus more on fostering pro-social, positive identities in marginalized youth instead of the more common deterrence-based punitive approach that, if anything, is contributing to the development of criminal identities. One example of the punitive approach is charging juveniles as adults. – From Sarah Jane in St. Louis
A: You raise a very important issue. Since peer pressure is the biggest force in bringing kids into delinquent behavior to begin with, it’s reasonable to think that peer pressure can be an antidote. In fact, there are numerous successful programs – midnight basketball is probably the best known – that do try to give at-risk kids a different peer group. These programs tend to work best when the counselors are as much like the clients as possible – best if they are former gang members themselves. Like other programs that work with really marginalized people, these programs tend to have trouble keeping their funding, but it’s not because they don’t work.
Q: This book sounds like a fantastic way to explain theories on inter-group relations from social and cognitive psychology – theories like social identity theory (Tajfel and Turner) and cognitive dissonance.Did Tina Rosenberg use social and cognitive psychology in her book? – From Thomas
A: Yes, my first chapters in the book are all about the science of why we are so driven to seek the approval of the group. There have been numerous studies that talk about this.
Q: How can teens and young adults keep from excluding or bullying others that they don’t want to belong to their group? It seems they have a tendency to fall into cliques. – From J.M.
A: This is a very tough problem. But there are great examples of successful programs that work by forming kids into groups where the social norm is zero tolerance of bullying. It helps if some of the kids in these groups are the “power groups” in the school – the children who are role models for others. It may be hard to change the behavior of bullies, but it is relatively easy to reduce the general tolerance for a bully’s behavior – and that is a big contributor to bullying.
Read an Excerpt
From Join the Club: How Peer Pressure Can Transform the World. Copyright 2011 by Tina Rosenberg. Excerpted by kind permission of W. W. Norton & Company.
MS. SUSAN PAGEThanks for joining us, I'm Susan Page of USA Today sitting in for Diane Rehm. Numerous academic studies show peer pressure contributes to delinquency and gang membership. Journalist Tina Rosenberg argues that peer pressure can be equally powerful to bring about positive social change. The recipient of a National Book Award, Pulitzer Prize and MacArthur Genius Grant, Tina Rosenberg has written a book titled, "Join the Club." She joins me in the studio to talk about applying what she calls "the social cure" to transform the world's most difficult problems. Tina, welcome to "The Diane Rehm Show."
MS. TINA ROSENBERGIt's nice to be here, Susan. thank you.
PAGEWe invite our listeners to join our conversation. You can call our toll free number later this hour 1-800-433-8850 or send us an e-mail at email@example.com or you can find us on Facebook or Twitter. So you talk about the social cure. What does that mean?
ROSENBERGThe social cure means using positive peer pressure to help people change their behavior and traditionally, we have tried to help people change their behavior by giving them information about how their current behavior is bad or by appealing to fear and in some situations those work, but in many situations, those don't work. And the social cure gets people to change their behavior, which can bring about larger societal change by giving them a new peer group to identify with. The point is that people change because of identification, not because of information.
PAGESo when we give people information about the dangers of smoking, does that work in getting people to stop smoking?
ROSENBERGWell, it may work for some adults getting them to stop smoking, but it certainly doesn't work to keep teenagers from starting. And this is really important because if you don't start smoking when you're a teenager, chances are, you're not going to start smoking. But interestingly, studies show that teenagers overestimate the dangers of smoking. They think it is actually worse than it is. This is part of the appeal for teenagers. I mean, for a teenager, a cigarette is not a delivery system for nicotine, it's a delivery system for rebellion. It's a way to tell the adult world, I don't have to listen to you. I'm my own person and so up until the late 1990s, back in 1997, 36.7 percent of high school seniors were smokers. It was astronomically high and we had no idea what to do about it. But then in 1998, the State of Florida hit upon a way to use peer pressure to help teenagers get the same satisfactions of rebellion by not smoking.
PAGEAnd how did they do that?
ROSENBERGThey organized against the tobacco companies. They made this series of really great TV ads that showed teens making prank phone calls, for example, to advertising executives who worked on tobacco campaigns or they filmed a road trip of a bunch of kids traveling from Florida to Richmond, Va., which is the headquarters of Philip Morris. And they went to ask the guard if they could see the Marlboro Man and the guard, clueless man, said, oh, he's dead. And in fact, the man who played him in the ads had just died of lung cancer (laugh).
ROSENBERGAnd they filmed all this and they put it on the air and teenagers loved it and they supplemented it with these clubs that were organized all over Florida where they did sort of street theater and events that were basically to tell tobacco companies, stop manipulating us. This worked. Then over the next two years, Florida saw the single biggest drop in teen smoking that anyone had ever seen in the United States. And then the strategy went national and over the last 10 years, in Florida and in many other states, teen smoking has been cut by half.
PAGESo this is a case, teen smoking, where this kind of social cure clearly can work. Are there kinds of problems that we have, we face as a society, where it's not the cure, that it doesn't apply and the social cure really won't help you address a problem?
ROSENBERGIt certainly works better among some groups of people and for some problems than others. Teenagers are particularly susceptible to peer pressure in part...
PAGEBecause they want to be part of a group...
PAGE...they want to be friends.
ROSENBERGYes. I mean, you hang with the pack when you're a teenager and also, your brain formation. The part of your brain that regulates judgment is not fully formed. This is not going to come as a surprise to any parents at all, but there are good, you know, biological reasons that teenagers are idiots sometimes, but -- so this particularly works very well with teenagers, but it does work also in adults in many cases and I have stories in the book of the working.
ROSENBERGFor example, there's a program, to get pretty far from Florida, in a very poor part of India where really the world's most downtrodden women, illiterate women, from the untouchable Dalit class who have no standing at all in society, they have been turned into their village doctors and greatly improved the health of the villages around them. And the way that they have been given the skills and the confidence, more important the confidence, to do this was through fellowship with other women in their same situation who have come before them in the program and they have gotten their strength from this sisterhood, so it can work in situations for adults.
PAGEYou know, the idea of forming a network or reaching out to get help from some other people to address a problem together, maybe this is sexist of me to think this, but it feels like a very female solution to problems we face. Do you think that's right or am I wrong?
ROSENBERGI think that it's probably easier for women to get their minds around doing this than men, that's true, but if you had asked me before I started working on this book can peer pressure be used for positive ends, I would have thought of Alcoholics Anonymous and probably I wouldn't have thought of anything else. Now I see the potential uses for it everywhere, but AA is something that we've come to think of as the solution, as the way to deal with problems of addiction and personal behavior for men and for women, so I think we understand that on a gut level.
PAGENow, you write, though, about the AA program of sponsorship and who it helps and who it doesn't help and you write that it helps the sponsor more than the person being sponsored.
ROSENBERGThat's correct. It does.
PAGEWhy is that?
ROSENBERGWell, you see similar studies, for example, about prison mentorships, people who have just come out of prison helping even more newly released prisoners. It helps the sponsor more probably because you have to invest yourself in that behavior if you're going to be trying to hold someone else to it and also, it does provide a way to hold you accountable because you have the expectations of your sponsee, your protege, to live up to. And you have to understand something really well to be able to teach it. I think for all those reasons, but the way this works the best is if you have two people.
ROSENBERGFor example, if you have diabetes and you want to be sure that you stick to your treatment plan and you get exercise on a daily basis. Let's say that's what you're working on. The most effective way of doing that is to recruit somebody else who is in the same situation, so in effect, you're both sponsors and sponsees and you can hold each other accountable. You can give each other the support you need.
PAGEAnd you hear a lot more about insurance companies and employers developing programs just like that that try to form partnerships to address chronic health issues and get people to take their pills every day or to exercise every day or whatever the agenda is.
ROSENBERGBecause it saves money. The health care costs in the United States, the big dinosaur that has not been dealt with, is the problem of poor treatment adherence. We're very bad at taking our pills on time and we're even worse at doing the reforms in our life to live more healthfully like exercise and eating right and this causes a tremendous amount of unnecessary sickness and death and costs us billions of dollars every year and it's a problem that doctors are really uncomfortable with.
ROSENBERGI've talked to a lot of doctors who just simply fire patients who aren't adherent, but we need to deal with treatment adherence and doctors are not really the people to do it, lay people are. The more that you're like the patient, the better success you're going to have with helping them do their program better and the best people to do it are peers, people in the exact same situation.
PAGEOf course, we all, I think, probably have experiences with making a New Year's resolution about some fundamental life change you're going to make that's going to make your new year better, it's going to make your health better, it's going to make you happier, but people find that really hard to stick to.
ROSENBERGYeah, it lasts about three weeks. You know, just like every diet works if you stick to it, but people don't stick to it. That's the problem, it's adherence. There is a proven solution to adherence that's in use all over the world except the United States and I'm campaigning to try and have us bring it here. It's called DOTS and that means Directly Observed Treatment Short Course. Short Course is a misnomer because it was developed to help tuberculosis patients stick to their six-month course of treatment, which is not short at all.
ROSENBERGBut the directly observed treatment means somebody comes to your house and watches you swallow your pills. And it can be a family member or a friend or a healthcare worker and it's a great program because it's often free, often very low cost and with the institution of DOTS China, for example, brought its tuberculosis cure rates from 50 percent to 94 percent in areas where DOTS was used. It has been tremendously successful and it is not much in use in the United States, but I don't see why not. I don't see why doctors don't prescribe medicine with take with spouse on the bottle alongside take with food or take with child.
ROSENBERGI mean, I know my girls would love to have the job of trying to get mom to stick with her treatment plan whatever my treatment plan is, but this really could be in use in America and I think it would be tremendously helpful and save a lot of money.
PAGEIs there a kind of American resistance to being ordered to do something or to have somebody else providing surveillance whether you take your pill or do whatever it is you're supposed to do?
ROSENBERGYes, there is. I mean, we have a very individualist society and it's harder to institute something like this here than it would be in a village in India, for example, but I think if doctors can explain to people this is something that will help you get better and it doesn't have to be that intrusive, I think people would accept it.
PAGEWe're talking to Tina Rosenberg about her new book, it's called, "Join the Club: How Peer Pressure Can Transform the World." She's been a guest on "The Diane Rehm Show" for a previous book. She's written a book about violence in Latin America. Her more recent book is, "The Haunted Land: Facing Europe's Ghosts After Communism." We're going to take a short break. When we come back, we're going to talk to Tina about how she got on this rather different topic of using peer pressure for positive social change and we'll take some of your calls. Our phone lines are now open, 1-800-433-8850 or send us an e-mail at firstname.lastname@example.org. Stay with us.
PAGEWelcome back. I'm Susan Page of USA Today sitting in for Diane Rehm. We're talking with Tina Rosenberg, she's the winner of the Pulitzer Prize. She has a new book out, it's called, "Join the Club: How Peer Pressure Can Transform the World." This is different from the previous books you've written. How did you stumble upon this topic?
ROSENBERGI had spent most of my career writing about social problems in various parts of the world and it started to seem interesting to me to write more about solutions to some of these problems. So after a couple of stories I had written, I realized that while I was writing about projects that were very different in very different places of the world, they had something in common, which was they relied on the strategy. And one of them was the teenage prevention program in South Africa and one of them was a student movement in Serbia that eventually grew to the point where it was instrumental in toppling Slobodan Milosevic.
ROSENBERGAnd these programs don’t seem like they would have anything in common, but they both focused on motivating people to change their behavior. In the case of South Africa to help teens avoid taking risks and in the case of Serbia to get people out of their houses and onto the street and into political activism when they were very afraid and very fatalistic and passive, it motivated them by making a club that was just the coolest thing to join so people could really be a member of the in group and be heroic and have that experience and it worked.
PAGECourse, you could have, as you did in Serbia, used this technique, this strategy to help topple a Despot, but couldn't you also use it to promote fascism or some other less laudatory goal using the same techniques, making people part of a club, part of the in group, it's kind of fun, to espouse use that we would find hateful?
ROSENBERGYes. Of course you could use it that way. And then we can probably find examples throughout history of it being used that way. Look, I'm not saying that peer pressure can't be used for bad ends, we all know about that. What I'm trying to say in the book is that it can also be used for good ends, which is the part that we haven't really focused on. What these kids did in Serbia was something I have never seen before. I've lived in two dictatorships and I've observed, you know, a dozen or more different democracy movements close up and what they did was something new to me.
PAGEAnd what did they do to make fighting the machine to getting rid of Milosevic, what did they do to make that the thing that other kids wanted to do?
ROSENBERGWell, they first of all said -- looked at when in Serbian history have people really felt idealistic and motivated and they focused on the partisans in World War II. And they thought, how can we be nonviolent partisans? We're not going to give speeches, we're not going to have marches. People don't need information about how bad the dictator is, they know how bad the dictator is. They need to have a reason to overcome their fear and come out, so they decided they would follow the guiding spirit of -- and I'm not kidding -- "Monty Python's Flying Circus," which was a TV show they had all grown up watching and that was their inspiration and so they used street theater and pranks.
ROSENBERGFor example, they took an oil barrel and they painted it with Milosevic's picture and rolled it down a very populated pedestrian street. And you could - for the price of a coin, you put a coin in the slot and you could take a bat and whack Milosevic in the face. And the police didn't know what to do about this, they couldn't let it go, they couldn't let people take a bat to Milosevic's face, but then they arrested the group. The people fled so the police ended up arresting the barrel and they looked ridiculous and the whole country sniggered at this. And they used these kinds of pranks to grow their movement slowly and they went from 11 people in October of 1998 to at least 70,000 -- people were coming in so fast that they stopped counting -- two years later.
PAGEYou know, it's definitely true that shows like "The Simpsons" have a very subversive quality when it comes to authority.
PAGEI mean, the same thing as Monty Python.
ROSENBERGYes. And again, people like that. They don't like being pushed around, they like being in control and being rebellious. The other thing that these kids in Serbia -- the movement was called Otpor, which means resistance. The other thing they did that I thought was very original was they used danger in their favor. They realized after a while that it would be extremely likely that any action would end with arrests, but the people weren't terribly mistreated. They would be held in a police station for a couple of hours, usually let go by nightfall.
ROSENBERGAnd so what Otpor did was anytime anybody was arrested, they would assemble a group outside the police station and the group would be other Otpor members, opposition journalists, lawyers. They would make a lot of noise so the detainees inside knew that they were not alone. And then a couple hours later, when the detainee was released, they would come out and see this group of their supporters, people cheering them. They would give interviews to the opposition media and then they would go out and have a beer and they were heroes. People started to compete to be arrested.
PAGE'Cause it made it less scary. You didn't think it was going to cost you your life to go protest.
ROSENBERGThat's right. That was an advantage that Serbia has that other countries do not have, but what it did was it allowed you to become your own James Bond. And I met one guy in Novi Sad who had been arrested at least 17 times. This was a big deal. I mean, you went to school the next day and all the girls wanted your phone number.
PAGENow, we've seen a lot of prodemocracy demonstrations or an anti-repression demonstrations across the Arab world in recent weeks and I wonder, did these same techniques play a role, say, in Egypt in the movement there?
ROSENBERGThey did and that is not a coincidence. The group that led Otpor, some of them then started an organization that now teaches these techniques to democracy movements all around the world. And among the groups that they trained was the April 6 movement in Egypt. And actually, if you look at the logo of the April 6 movement, it's a white fist on a black background, which is the identical logo that Otpor designed. And some of the techniques that were used in Egypt, for example, being nice to the police, treating the police and the military as allies in waiting rather than as enemies, were techniques that Otpor taught them.
PAGELet's go to the phones and invite some of our listeners to join our conversation. Our first caller is Carlos calling us from Miami. Carlos, thanks for joining us on "The Diane Rehm Show."
CARLOSHi, how are you? Congratulations on the subject. I was very interested in what you're saying about the technique, especially for youth. I come from Mexico where, as you know, it's pretty much upside down because of the drug cartels. And it's actually cool, from what I've been investigating, you know, to be in the big truck with the expensive stuff and it's just become like a social standard to be like the drug dealers. And that obviously generates a lot of post misconception of what to do. How would your theories apply to somewhere -- to a place where getting together outside a prison would make them a target and basically, you know, you could die?
ROSENBERGThat is a really good question, Carlos, and I'm glad you've asked it. As a matter of fact, in the last chapter of my book, I propose ways that the social cure can be used in different situations. And one of them that I talk about at some length is fighting corruption in Mexico. Now, what you're talking about is something a little bit different. I think that this could be used very easily to start an anti-corruption movement, but dealing with the drug problem is something different because, as you say, it is extremely dangerous.
ROSENBERGBut I think the basic technique is there. I mean, why do people want to go into drug cartels? Because it gives them respect, it gives them standing, it gives them physical protection, which can be illusory, but they think it does. And this is very similar to why people join gangs all over the world. The technique of the social cure has been successfully used in anti-gang programs in Washington, D.C. and in many other places. You try and find ways to give kids these same satisfactions, but with a different kind of group, one that has positive ends rather than negative ends. I don't know. It sounds like it would be complicated to try and apply it in Mexico, but I think it is a problem that might indeed be susceptible.
PAGEI wonder if that -- the Mexico example would be one of those cases where the realistic assessment of danger makes it hard to do. And I'm thinking -- we were talking before about Egypt where the protestors were able generally to protest without terrible consequences to their own safety. There were some incidents, but generally, the people did not lose their lives by protesting in the square. But then you think about a place like Iran where protestors, I think, get dealt with much more harshly. Does that make it harder to use the social cure?
ROSENBERGIt does, it does. However, if you think about a democracy movement as a long struggle, you can gradually build the political space to give yourself the room to protest. And in Serbia, as an example, in 1991, there were student protests in Serbia and militia patrolled tanks out into the street. Now, that could not have happened in later years because the Serbian opposition had won the political space, for example, to get opposition television. They had won that in 1996 and 1997 and that's something they used to their advantage. So it's -- political space, the Serbs say, is never granted, it's always conquered. And you can use these strategies to gradually conquer it.
PAGESo thinking about -- maybe we've got listeners who are thinking, well, I would really like to get -- to form a club, use a social network, get peer pressure to help my community or to help my family. How do you go about getting started?
ROSENBERGCall someone. I mean, this can be very informal. You know, take Weight Watchers as an example. That's a formal corporate-sponsored group meeting program to help you stick to your diet. You don't need the formal corporate sponsored part, you just need the group meeting part and that's something you can do by assembling some of your neighbors, some of your colleagues or co-workers. As long as the people have the same goal as you, this can be your group.
PAGEBut one of the keys is to make it not a chore, but kind of fun.
PAGEI mean, it seems that that's a key to all the success stories that you're telling.
ROSENBERGYeah, the challenge of the social cure is that it involves going to meetings and going to meetings takes a lot of time, as we all know. So you have to make people want to come to them. So fun is really an important part of this. The other way that people keep going to meetings is if they feel it's working for them. I mean, I don't know how much fun Alcoholics Anonymous meetings are, but people don't skip them because they know that it's saving their life.
PAGELet's go back to the phones. From Radford, Va., we're joined by Tom. Hi, Tom.
TOMHi, how you doing?
TOMFirst of all, I'd like to say that I am an ultra-conservative who loves Diane Rehm.
PAGEWell, that's good to hear.
TOMAnd I have been working with Scouts for decades and the program you're talking about this morning I love because it fits right into what Boy Scouts have been doing for a century. Boy Scout Troops are Scout One, which means that the older scouts provide the leadership and positive appearance for the younger scouts. And then as they grow up and take over so that a Scout Troop is a continuing system of older more mature scouts providing positive image and leadership for younger scouts and adults are just there to supervise and it works wonderful. And if anybody wants to get involved, I would recommend Boy Scouts as a great place to start, especially since young men are probably the biggest problem we have in this country as far as acting out goes (laugh).
PAGEYes. Well, Tom thanks so much for your call and thanks for your service to the Boy Scouts. What do you think, Tina?
ROSENBERGThat's great to hear. I didn't know that the Scouts work that way, but I have no doubt that it's successful. Congratulations.
PAGELet's go to Westminster, Md. and talk to Marissa. Marissa, we appreciate having you on the air.
MARISSAHello. Thank you for having me. I was going to talk about how peer pressure creates a positive influence for children in that when they go to middle school, they are offered honors programs. And the honors programs will lead them into college classes by high school. And I know for a fact that I was pressured into it because all of my friends were and I didn't want to not fit in by being not well educated. And so I made sure that in middle school, I worked as hard as I could. And in high school, I worked as hard as I could so I could be seen as smart by all of my friends and all of my teachers.
PAGEYou know, Marissa, that's such a great story, but I know that also there are -- I've read stories about experiences, say, in the D.C. schools, where it's considered not cool to be in the high -- you know, in the gifted class or in the college track class and it's something that teachers and administrators have to battle against the idea that the cool place to be is not there. What do you think, Tina?
ROSENBERGWell, first of all, I want to congratulate Melissa for her achievements, but also recognizing that this is peer pressure. I mean, we parents, we think of it as peer pressure when our kids are drawn into gangs or drugs or bad behavior, but we tend not to think of it as peer pressure when their peer group helps them to do well because we like to think of it as excellence in parenting, right, or just our kids' natural abilities, but it is peer pressure also.
ROSENBERGSusan, you raise a very good question which is, how do you help people to acquire a peer group that values and respects achievement in cultures where it is often not respected? And I have some examples in the book of a program that has been very successful in helping minority students to ace calculus at elite colleges and it uses group learning. It allows people to study in groups where the students teach each other and it's been helpful in part because it gives kids who never had academic friends, academic friends.
PAGEI'm Susan Page and you're listening to "The Diane Rehm Show." We're going to take your calls, 1-800-433-8850. So this acing calculus, it's -- you get a group of kids who meet and study together.
ROSENBERGYes. Actually, the schools organize it. It started at Berkley in the 1970s and it was born out of the realization that what separated successful from unsuccessful calculus students is that the successful ones studied in groups and the unsuccessful ones studied alone. And so they started discussion sections that gave the kids not remedial problems, but extra challenging problems to work on, but they studied in groups of three or four and they helped each other.
ROSENBERGAnd that allowed you to feel more comfortable asking questions 'cause you were asking them of your peers sitting across the table rather than raising your hand in a big group and it allowed you to have academic friends, people who it was really cool to like math with. And a lot of the students at Berkley had really been isolated in their high schools because it had not been cool to like math and this has dramatically raised math achievement among minorities.
PAGEAnd was it a key to have -- say this is a program to increase math achievement among minorities -- to have all minority members in the study group?
ROSENBERGNot necessarily all minority members, but it seems to work better with minorities. It also helps non-minorities, but it helps minorities more.
PAGEAnd to what degree did it help? Just because I bet if you got together in a study group, you spend a lot more time studying calculus than you might if you were going back to your dorm room alone studying.
ROSENBERGThat was part of it. People did study longer, but they say that their understanding of the material was greatly increased by learning it from their peers and teaching their peers 'cause you have to know how it works really well to be able to explain it to someone else. And there were studies about it that showed that one of the keys to doing well was the greater the number of friends you had in these groups, the better you did in math.
PAGEYeah, interesting. Well, Tina Rosenberg, she's joining us this hour. Her book is called, "John the Club: How Peer Pressure Can Transform the World." We've been talking to her about how you can use peer pressure not only to get kids to join gangs, but also to keep kids from joining gangs and for a lot of other purposes. We're going to continue our conversation after a short break. You can give us a call, 1-800-433--8850 or send us an e-mail at email@example.com. Stay with us.
PAGELet's go back to the phones and talk to Mannal (sp?) calling us from Indianapolis, Ind. Hi, you're on the air.
MANNALHi, hi there. Hi, Susan.
MANNALI love your show, too, as well. I love (word?) so on your show as well. I would like you to ask your guest if she has an such thing that some teen changes life to opposite way of their peers and they decided to come (word?) life because they saw all the bad peoples wasting their life and so they decide to do their own life oppositely -- totally opposite than the peers and to do and they came out victorious in life and...
PAGEInteresting question. Let me ask Tina what she thinks.
ROSENBERGYes, I think people do change their lives that way, but it's -- with teenagers, not the way to bet. Teenagers will generally go with what their peers are doing, many adults, too, but especially teens and that makes some of the strategies that people have used to try and help teenagers stay on the right path really counterproductive. I'm just thinking of some anti-smoking adds that showed a bunch of fish of one color, then it had another fish of another color and it said, dare to be different. Don't smoke. And you look at that and you go, why would anybody think this would work?
ROSENBERGYou know, there are people who hit bottom and that really causes them to rethink how they live. I think we all know people who've had that experience. It's generally not teenagers.
PAGEWe do hear from a lot of adults who have come from difficult circumstances and turn their lives around, but they often talk about a teacher or a counselor or a coach who was important in kind of bringing them along. I mean, I rarely hear kids talk about turning their lives around totally on their own.
ROSENBERGNo, I think that's right. And I don't want to discount the importance of adults and authority figures and mentors. Obviously, peer pressure's not the only way people change, but I think that it's very difficult -- when you decide you want to live differently, it's very difficult to live differently unless you can surround yourself with other people who are also living the same way.
PAGEIt's such a basic human instinct to want to have some people around you that like you, that you like, that you want them to think well of you, they want you to think well of them.
ROSENBERGWe seek the respect of the group. We seek to belong. It's in our genes.
PAGELet's talk to Amy calling us from Mt. Olive, Ill. Amy, hi, you're on the air.
AMYHello. I just wanted to say that I'm a graphic designer and going to school, we were told that we could do design advertising for good or evil and that was really stressed, evil being, you know, alcohol and cigarette companies, along with other companies like that. But like you were saying that, you know, American doesn't have much things going on in the way of kind of getting peer pressure out there, positive peer pressure. At my school, at the Kansas City Art Institute, we were told to do a visual -- an advocacy project. I chose to do advocacy project promoting anti-suicide awareness. Another person chose to do to get away from alcohol. How can you get a designated driver, you know.
AMYAnd what was nice was the fact that we were all students who got to talk to each other and bounce ideas around, which was really helpful because it was not adults telling us what to do, it was students telling each other good ideas and what we should do as peers to help each other out with getting these positive projects done.
PAGEAmy, thanks so much for your call. Tina.
ROSENBERGThat sounds like a great project and it sounds like your school is very enlightened.
PAGEGeorge has sent us a message asking us to talk about the example of microcredit programs in Bangladesh. Now, would that be an example of a similar project, do you think, Tina?
ROSENBERGIndeed it is. Microcredit, which is perhaps the most significant new development in fighting poverty of the last 40 years, is a system that works on peer pressure. It lends very small sums of money to very poor people, almost all of them women, and the women form borrowing groups. And you -- initially, the Grameen Bank said, if you -- if one person in your group didn't pay back their loan, then nobody else can get a loan.
ROSENBERGSo you know that you're only going to let people into your borrowing group who are going to repay. But actually, the interesting thing is Grameen dropped that requirement after a while. It wasn't necessary. People repaid their loans on time because they wanted the respect of their group and the respect of the community. So it worked just as well without this requirement that your good behavior meant someone else could get a loan.
PAGEInteresting. let's go to Birmingham, Ala. and talk to Pat. Pat, thanks for holding on.
PATHey, I was listening to the program and I thought back to my law school days and went to Cumberland School of Law in Sanford and like most law schools, they actively encouraged the students to form study groups because we would go all semester long with no tests at all. Your grade was entirely dependent on a three-hour exam at the end of the semester in each course. And so these study groups were absolutely invaluable in terms of figuring out, you know, what did we learn all this year in this course and getting it into an organized manner where to where we could spit it all back out. And they actively encouraged the formation of the study groups.
PAGEAnd how did the study groups at your law school get formed, Pat? Did the students form them or did the faculty help?
PATThe students would form them themselves. They simply were taught -- really, we were kind of told by older students during our first few days of class that, now, you know, somewhere towards the middle of the year, you need to start thinking about who's going to be in your study group because you just can't survive first year final exams without having been in a study group (unintelligible).
PAGEAnd who would you look -- what kind of qualities would you look for in other members of your study group?
PATWell, (laugh) among other things, you were looking for somebody who'd actually been paying attention (unintelligible).
ROSENBERGYeah, you need one of those people.
PATYou know, but it usually turned out that the group would have people that somebody had picked up on one area -- you know, one aspect of the case or of that particular course and then somebody else had gotten some particular information somebody else had missed out on. And so we would together, as a joint project, develop this big outline for -- you know, of everything we had learned in that given course. You know, start arguing over who was right about things where we had differences of opinion, but then, you know, and then go find some book that would give us the right answer and eventually come up with this outline and then a way of memorizing the outline to where we could spit it all back out in three hours' time, so.
PAGEAnd Pat, just one last question about it. Did people ever get ejected from the study group because they weren't really contributing?
PATYes. In fact, my wife, who later followed me through law school, formed a threesome and one of the people in their study group basically kind of didn't hold up his end of the bargain, so when the second semester came around, they just conveniently didn't let him know when they were starting to meet and he kind of had to go find another place.
PAGEAll right (laugh). Pat, thanks so much for your call. Tina.
ROSENBERGThat is such a dynamite example and you raise a really important question, which is why isn't this being used in other things then to help kids learn calculus? This group learning is something that can be applied to organic chemistry and it can be applied to help kindergarteners learn to read.
PAGEYou know, when I was covering the Reagan White House for Newsday, I had a lot of trouble getting senior White House officials to let me interview them because they, of course, have many demands from many different organizations and we formed a group which we called a tong, several of them were formed, actually, where there'd be five or six different news organizations that weren't really competing with each other and we would go together to interview officials because it made it a bigger bang for the official 'cause they could get rid of five or six different news organizations at once and it gave us access to officials that otherwise we were having trouble reaching. And I'd never thought of it as an example like you're talking about, but it is a kind of club.
ROSENBERGIt is. It may not be one that fits my definition in the sense of it didn't help you to change your behavior, but you were changing the behavior of White House officials.
PAGELet's go back to the phones and talk to Sean calling us from Cape Cod, Mass. Hi, Sean.
SEANHello. All right. Thanks for taking my call. So here's my question. When I was in high school, and I'm 40 now, one of the things I had realized is that I internalized this notion that as an African-American, that if I couldn't do something on my own, it only confirmed that I was intellectually inferior. And unfortunately, I didn't learn that what the successful students did, at least in math, is they did study in groups. And so I guess I was wondering from your guest if she looked at that sort of issue in particular, some of the ingrained sort of cultural stereotypes and how that can serve as a block for people getting together in these kind of groups.
PAGEThank you, Sean.
ROSENBERGThat is a really good point you make, Sean, and yes, I do write about that in the context of these calculus clubs. One of the reasons that these clubs tend to work better for minorities is the phenomenon that you are describing, which is called stereotype threat. People internalize the stereotypes that the wider world has about them and a lot of black kids told me that they would never raise their hand in class and ask a question because they were terrified that they would look dumb. And they felt much more empowered to be wrong about something when they were in the cozy little confines of their own little small group.
PAGEInteresting, Sean. Sean, anything else you'd like to ask or say?
SEANNo, no, no. Thank you very much. That was good, thank you. I'm going to check this out even further. I think this is some strong research and I appreciate your comments.
PAGEAll right. Thanks so much for your call. Cabida (sp?) is calling us from Washington, D.C. I hope I'm saying your name correctly.
PAGEYes. Thanks for calling. Please go ahead.
CABIDAYes, my (laugh) (unintelligible) topic, but I just want to say that I'm from East Africa, Ethiopia, and what I would like to know is how -- hello?
PAGEYes, we're listening. Please go ahead.
CABIDAYes. How can you apply this (word?) when in my country, there is a big political repression by the regime and, you know, all the -- hello?
PAGEYes, thanks for your call. You know, Cabida is asking about using these techniques in a place like Ethiopia, his home country, where there's a lot of repression, might be difficult. It's harder in a situation like that, isn't it.
ROSENBERGIt is harder, but the -- if you would talk to the Serbs from (word?), they would say that it can be used. I mean, they originally developed this course that they teach for Zimbabwe and Belarus at the same time. Now, those are two completely different countries with very different levels of repression, so many of the techniques they use are things that can be applied in countries like Ethiopia as well to bring about some political change and it might be worth checking out.
PAGEAnd of course, one of the things we see now with social networks, with the use of the internet, Twitter and Facebook, some of these techniques get, I think, exposed internationally in ways that perhaps they never could before.
ROSENBERGYeah. A lot of people have asked me whether the kinds of social cure strategies I'm talking about can happen over the internet and my response is that the internet is really good for disseminating information about it, but most of my cases really require the strong peer pressure that comes from a face-to-face contact.
PAGEI'm Susan Page and you're listening to "The Diane Rehm Show." Let's go to Patterson, N.J. and talk to Grev. Hi, you're on the air. Grev, are you there?
RAYOh, hi, this is Ray.
PAGERay, okay. I'm sorry. I had your name wrong. I apologize for that.
RAYOkay. That's all right. Thank you very much for taking my call. Just a quick question and I have a few comments if there is sufficient time. Would it not be helpful or more helpful to identify or define what peer pressure is? I'm an attorney and I do a lot of writing and social sciences and the humanity and for me, listening to the conversation, I have a problem with the concept of peer pressure. It doesn't identify the elements or the dynamics as to what the pressure is. It seems to be an all compassing concept, and all compassing term.
RAYWhen we talk about peer pressure, would it not be more beneficial in understanding that peer pressure or pressure, the term pressure, is an overriding influence by -- on a person by an outside party, by another party, so it may be competition, as your guest had explained a little earlier, but it may also be ethnocentrism where, for example, a student may go -- who comes from the east coast and attends school in the Midwest holds onto their values, their customs and mannerisms on the east coast and doesn't adopt the expressions or customs and mores of Midwesterners.
PAGEInteresting, Ray. What do you think, Tina?
ROSENBERGI haven't made this very complicated. My definition of peer pressure is pressure that comes from your peers, which means people like you, to conform to the social norm of your peer group.
PAGEYou know, we've talked about some things that are not so serious and some things that are very serious. Certainly one of the big issues that we face as a world now is the threat from suicide bombers in various parts of the world. And you write about using this social cure even to counteract incidents of terrorism. Tell us about that.
ROSENBERGI think this is a potentially very interesting solution. I do not want to claim that this is the solution to terrorism, but I think it's something that's worth exploring. We all know and research has shown that people join cults or groups because of peer pressure. It isn't that you join, you know, the Moonies or Baader-Meinhof Gang before you like their ideals. What happens is you meet somebody, you get drawn into the group and then their ideals escalate. People radicalize each other in this cocoon and you drive away all others so your social norm is really reduced to the pressure of this one group.
ROSENBERGAnd that is also the way that terrorist groups function in large part. Mark Sageman, who is a former CIA officer and forensics psychiatrist, has studied who becomes a Jihadi and in the majority of cases, these are people who are radicalized by small groups far from home. Many of them were people from North Africa who were studying in Europe, for example. And they're very far away from their home social norms and so they're very susceptible, they're lonely and they're very susceptible to the pressures of this small group of people.
ROSENBERGSo the question is, this is a vicious circle. Can we turn it into a virtuous circle? And what I write about in the book is a program that is based in the Brixton of London and it's a program called STREET, the Strategy to Reach, Empower and Educate Teenagers. It's run by a group of very fundamentalist, hard-lined Solophies (sp?) and that is a very Orthodox form of Islam and it is a group that tries to take young men who are susceptible to the message of terrorism and a lot of people are sent there from prison by the London probation officers and surround them with people who are like them in every way, except they're nonviolent. They share many of the religious ideologies, they share many of the grievances of these young men, but they are against violence.
PAGETina Rosenberg, thank you so much for joining us this hour to talk about your new book. It's title, "Join the Club: How Peer Pressure Can Transform the World." Thanks for being with us.
ROSENBERGThank you for having me, Susan.
PAGEI'm Susan Page of USA Today sitting in for Diane Rehm. Thanks for listening.
ANNOUNCER"The Diane Rehm Show" is produced by Sandra Pinkard, Nancy Robertson, Susan Nabors, Denise Couture, Monique Nazareth and Sarah Ashworth. The engineer is Tobey Schreiner. Dorie Anisman answers the phones. Visit drshow.org for audio archives, transcripts, podcasts and CD sales. Call 202-885-1200 for more information. Our e-mail address is drshow.org and we're on Facebook and Twitter.
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