JHC Link Newsletter Summaries

Volume 12, Issue 3 (April-May 2007)

Article Summaries:

Trust is a critical component in the health care decision making process and may play a significant role in individuals' responses to public health crises, including bioterrorism. Studies document that African Americans relative to other race/ethnic groups are less likely to trust that the public health system will respond fairly to their health needs if there is a bioterrorist attack. This study sought to understand the specific components of trust that influence community responses to a bioterrorist attack and its public health recommendations using qualitative analysis of data from 8 focus groups (n = 75 African Americans) in Los Angeles County. Discussions elicited reactions to information presented in escalating stages of a bioterrorism scenario that mimicked the events and public health decisions that might occur. The authors identified 6 components of trust that were influential in determining responses to evolving public health decisions about a smallpox outbreak. They found that honesty and information consistency were the components most frequently identified compared with fiduciary responsibility, faith, competency, and other trust issues. The relative importance of the 6 trust components varied as the scenario evolved; honesty was most important upon initially hearing of a public health crisis and consistency was important upon confirmation of a smallpox outbreak and the ensuing public health response. Consistent with the risk communication literature, findings suggest that honesty and information consistency across multiple sources are essential to delivering effective risk messages. The absence of differences between groups was inconsistent with the literature suggesting that uniform policies can be used to address groups varying in age and SES.
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Media Depictions of Health Topics: Challenge and Stigma Formats
-- Smith, R. A., & Miller, W.

Protecting Children from Myopia: A PMT Perspective for Improving Health Marketing Communications
-- May O. Lwin; Seang-Mei Saw

While much clinical research has been done on myopia, there is limited research on myopia prevention from a social marketing perspective. In urban Asian cities such as Singapore, myopia prevention is a top national priority with active government intervention and interest. It is imperative that health agencies understand the underlying health beliefs towards this common form of visual disability. This knowledge is critical to the formulation of relevant and effective public health intervention and social marketing initiatives to address the growing public health problem associated with myopia. This research examined the predictive utility of the Protection Motivation Theory (PMT) model for myopia prevention amongst children. An integrative model for myopia prevention behavior of parents was first developed in the context of theory and survey instruments then refined using information gathered from two focus groups. Empirical data was then collected from parents of primary school children in Singapore, a country with one of the highest rates of myopia in the world, and analyzed using Structural Equation Modeling (SEM). Our findings revealed that coping appraisal variables were more significantly associated with protection motivation, relative to threat appraisal variables. In particular, perceived self-efficacy was the strongest predictor of parental intention to enforce good visual health behaviors, while perceived severity was relatively weak. Health marketing communications and public policy implications are discussed.
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Local Media Monitoring in Process Evaluation. Experiences from Stockholm Diabetes Prevention Programme
-- C,M Andersson, G. Bjärås, P. Tillgren and C-G. Östenson

This article presents an approach, which includes methods of media monitoring and media analysis for studying the frequency, prominence and framing of media coverage. Within a community-based diabetes prevention project in Sweden, media coverage related to physical activity in five local newspapers was analysed. The aim was to determine general patterns in the reporting of physical activity and potential influences and dissemination of public health information due to the presence and collaborative efforts of the prevention programme. It was concluded that media monitoring can be a valuable method to strengthen process evaluations in describing local processes, programme exposure and dissemination. The article also highlights the problems of making inferences of programme impact. It is suggested that a pre-planned comprehensive evaluative framework should include information and documentation about media relationships, local media's interest in public health, media coverage prior to the programme and comparisons of general trends of reporting. Such an approach would allow an increased understanding of agenda setting processes and potential programme impact on the media content.
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Understanding Health Inequalities for Uninsured Americans: A Population-wide Survey
--Pauline Hope Cheong; Thomas Hugh Feeley; Timothy Servoss

Employing an ecological perspective of health behavior, this research examines factors associated with medical health insurance status and, in turn, how health insurance status is associated with access to health care and health information. Specifically, the paper compares the insured with their uninsured counterparts with regard to: 1) health status, 2) perceived health threats, 3) perceived care, and 4) mediated health information seeking behaviors, including access to the Internet. Through an integrated investigation of intrapersonal and interpersonal factors associated with medical health insurance status, this study highlights the importance of understanding the interrelations between layers of health inequalities experienced by the uninsured for health communicators seeking to target this critical population. Numbers of the uninsured in America have risen in the past few years to over 40 million people, yet relatively little is known about their health communication behaviors. Data from the 2003 Health Information National Trends Survey (HINTS) was used to analyze the relationship between demographics, health status, health insurance status, online health seeking, and amount of attention paid to various media for health. A random sample of 6,369 Americans indicated several statistically significant differences between the insured and uninsured: the uninsured were more likely younger, less educated, and Hispanic. Findings also indicated that those without health insurance reported being less healthy, more distressed and hold a greater risk perception for cancer, compared to their insured counterparts. Health insurance, when controlling for demographics and health status, explained a statistically significant but small amount of variance in both online health seeking and attention to health messages in various other media.
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Volume 12, Issue 4 (June 2007)

Health Communication in Multilingual Contexts: A Study of Reading Preferences, Practices, and Proficiencies Among Literate Adults in Zambia
--Carol Underwood; Elizabeth Serlemitsos; Mubiana Macwangi

With the burgeoning interest among health communicators in health literacy and the proliferation of print materials developed to communicate health-promoting information and guidelines, it is prudent to examine what reading level is appropriate for a given reading audience or population group. Such assessments take on a higher level of urgency-and complexity-in multilingual countries, such as Zambia, where it is a question not only of level, but also one of language. This article reports the results of a study that tested literate Zambian adults' reading skills in English and the seven official Zambian languages, using health materials written at fourth- and eighth-grade levels. The survey also asked respondents about their language preferences and practices. The Developmental Interdependence Hypothesis, which posits that first- and second-language literacy skills are interdependent in that they both reflect a shared underlying proficiency, was supported in that Zambian-language and English-language scores were equivalent for primary- and middle-school-level respondents who were bi-literate. Not all respondents, however, developed bi-literacy. In fact, about 13 percent of the respondents were able to read and comprehend materials written in one of the seven Zambian languages but could not read texts written in English. Health communicators should be cognizant of language needs in the areas where they work and, in exceptional circumstances, may find a judicious use of limited funds would include the production of print materials in the dominant local language. Or they may find that it would be useful to include some key terms in one or more of the Zambian languages, leaving the main text in English. Regardless of that decision, the data indicate that all health print materials should be published in English at or near a grade-4 reading level. Findings from this research may be of interest to policy makers and program planners in neighboring multilingual countries as they confront some of the same issues and constraints.
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Consent and Counter-Mobilization: The Case of the National Smokers Alliance
--Michael Givel

One important part of modern public relations besides such activities as commercial advertising is also political advocacy. Political advocacy and public relations has played an important role from 1994 to 1999 through the creation of a tobacco industry supported national front group known as the National Smokers Alliance to attempt to weaken or oppose, at all levels of government, increased tobacco taxes and more vigorous regulation of tobacco use. This article considers, during this period, the establishment and the subsequent policy impact of the National Smokers Alliance in competition with health advocates on federal, state, and local tobacco control policies. The results indicate that the mobilization by the National Smokers Alliance was based on traditional lobbying approaches in conjunction with the use of the public relations oriented consent engineering theory of Edward Bernays, Harold Lasswell, and others. This consent engineering theory calls for specialists using public relations to mold public opinion to support a client's preferred public policy outputs. The causal message of this approach by the National Smokers Alliance was that smoking is an adult choice that should not be hindered by undue tobacco taxes or regulations. By contrast, the health advocates used traditional lobbying with non-public relations and front group oriented political education to tell a causal story that tobacco products are a severe health hazard that needs to be taxed and regulated substantially more. The results indicate that the message and attempt by the National Smokers Alliance in its support to weaken or neutralize stronger tobacco regulations and taxes as it clashed with the advocacy and message of the health advocates was effective only for some campaigns at all levels of government.
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Talking about obesity: News framing of who is responsible for causing and fixing the problem
--Sei-Hill Kim and Lee Anne Willis

Over the past several decades, the number of overweight Americans has grown substantially, and obesity is now an increasingly important health issue in the United States. At the center of discussions about the issue of obesity is the question of who is responsible for causing and fixing the problem. How to define responsibility is important because it may shape the overall policy approach, particularly the domain of society to which change effort should be applied (Salmon, 1989). Analyzing newspaper articles and television news, this study explores how American news media have framed the issue of obesity. More specifically, we analyze the way the media present the question of who is responsible for causing and fixing the problem. Our data reveal that over the last ten years, mentions of personal causes and solutions have significantly outnumbered societal attributions of responsibility. Recently, however, a balance was established between individualistic and societal attributions of responsibility. Mentions of societal causes and solutions have increased considerably, whereas decreasing numbers of personal solutions have appeared in the media. It is likely that many health experts and journalists alike have begun to realize individual-level approaches alone cannot solve the problem. Future research building on our findings needs to examine whether news framing affects the way the audience perceives who causes obesity and how to solve the problem. Findings also indicate that television news is more likely than newspapers to mention personal solutions, but less likely to attribute the responsibility to society. Another key finding of our study is that many causes and solutions for obesity have followed rather different trajectories over the years.
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Thinking About "Think Again" in Canada: Assessing a Social Marketing HIV/AIDS Prevention Campaign
--Anthony P. Lombardo and Yves A. Léger

Effective and innovative initiatives are central to helping prevent new HIV infections. Social marketing approaches are commonly used for HIV/AIDS prevention; to improve future efforts, existing HIV/AIDS prevention initiatives require critical reflection. The Canadian "Think Again" social marketing HIV/AIDS prevention campaign, adapted from an American effort, encouraged gay men to rethink their assumptions about their partners' HIV statuses and the risks of unsafe sex with them. This article uses the campaign as a social marketing case study to illustrate its strengths and weaknesses, as a learning tool for future prevention efforts. Overall, the campaign proved a good example of how existing campaigns can be adapted and made culturally appropriate to new audiences. It importantly addressed a more psycho-social issue in sexual decision making, rather than relying on the traditional "use a condom every time" message. The campaign effectively applied the central tenets of social marketing. However, it might have benefited from stronger formative research; more support for all behaviours promoted by the central message; better use of the Internet as "place" for health communication; and greater use of theory in formative research, message design and evaluation. Nonetheless, "Think Again" was successful in many respects, as outlined elsewhere in its formal evaluation report.
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A Classroom-Administered Simulation of a Television Campaign on Adolescent Smoking: Testing an Activation Model of Information Exposure
--Donald W. Helme; Robert Lewis Donohew; Monika Baier; Linda Zittleman

Even though links among sensation-seeking, message sensation value, and drug use have been well established in the substance abuse prevention literature, there is no guarantee that the approach would work equally well in tobacco prevention efforts. This article reports research from a study applying an Activation Model of Information Exposure (AIME) and a Sensation-seeking Targeting approach (or SENTAR) coming out of the model to the design of a simulated television smoking prevention campaign targeting adolescents. Significant main effects or interaction effects that indicate the development of anti-smoking attitudes and behavioral intentions were found in the prime target audience, high sensation-seekers, with low sensation-seekers, the secondary group, showing somewhat fewer effects as predicted. No differences were demonstrated in message effects between those coded as high or low in message sensation value among high sensation-seekers. Researchers wishing to conduct media-based studies on adolescents' attitudes & intentions to use tobacco should be mindful that students are already receiving many anti-tobacco messages from the school and community and these competing messages may impact the effects of their intervention. Overall the results provide support for the application of sensation-seeking and SENTAR to the realm of tobacco control, providing another weapon in the arsenal of anti-tobacco activists and public health professionals who conduct campaigns targeted at adolescents.
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