ABSTRACTS

Volume 12, Number 8
December 2007

Vol. 12, Number 8: Contents | Editorial | Abstracts

"I Have Never Heard That One": Young Girls' Knowledge and Perception of Cervical Cancer
    Maghboeba Mosavel a; Nadia El-Shaarawi b

a Center for Reducing Health Disparities, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
b Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, USA

With the advent of a vaccine for the human papillomavirus (HPV), many are claiming that cervical cancer may become a health worry of the past. While the vaccine certainly represents an important step forward in the fight against HPV and cervical cancer, it does not diminish the importance of health education or screening interventions particularly amongst adolescents. This study explores the existing state of cancer and cervical cancer knowledge of Latina and African American adolescent girls from low-income, urban neighborhoods. We found that the study participants expressed a range of attitudes toward cancer. Knowledge of cancer also was varied and somewhat anecdotal, showing no unified body of knowledge, but instead representing an assemblage of information culled from formal and informal sources. Participants were most familiar with breast and lung cancer and mentioned these types of cancer most frequently in the focus groups. Most participants had never heard of cervical cancer, while a few were familiar with several aspects of the disease. Cancer knowledge seemed to be gleaned mostly from personal stories, perhaps suggesting the pervasiveness of cancer incidence in their community. The predominant attitudes expressed toward cancer included fear, uncertainty, and anxiety. Our findings suggest that considerable continued health promotion efforts are needed to improve knowledge about cancer in general, and particularly about cervical cancer, to reduce fear and to highlight the effectiveness of prevention and screening.

Patients' Shame and Attitudes Toward Discussing the Results of Literacy Screening
   Michael S. Wolf a; Mark V. Williams b; Ruth M. Parker b; Nina S. Parikh c; Adam W. Nowlan b; David W. Baker d

a Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University, Chicago, Illinois, USA
b Division of General Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
c Center for Health and Public Service Research, Robert F. Wagner Graduate School of Public Service, New York University, New York, New York, USA
d Division of General Internal Medicine and Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

We investigated patients' willingness to have their reading ability documented in their medical records and the degree of shame and embarrassment associated with such disclosure. Structured interviews were conducted among a consecutive sample of 283 primary care patients at an urban public hospital. Patients' literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Self-report of degree of shame and embarrassment related to literacy skills was measured using an orally administered questionnaire. Fifty-one percent of patients had low literacy skills (sixth grade) and 27.9% were assessed as having marginal literacy (seventh-eighth grade). Half (47.6%) of patients reading at or below the third-grade level admitted feeling ashamed or embarrassed about their difficulties reading, compared with 19.2% of those reading at the fourth-sixth-grade level and 6.5% of those reading at the seventh-eighth-grade level (p < 0.001). More than 90% of patients with low or marginal literacy reported it would be helpful for the doctor or nurse to know they did not understand some medical words. Patients with limited literacy were more likely to report feelings of shame as a result of disclosure (p < 0.05). Health care providers must recognize the potential shame patients might experience as a result of literacy screening.

Understanding Optimal Nutrition Among Women of Childbearing Age in the United States and Puerto Rico: Employing Formative Research to Lay the Foundation for National Birth Defects Prevention Campaigns
    Authors: Lisa L. Massi Lindsey a; Heather C. Hamner b; Christine E. Prue b; Alina L. Flores b; Diana Valencia c; Elia Correa-Sierra c; Jenifer E. Kopfman d

a Michigan State University, College of Communication Arts & Sciences, East Lansing, Michigan, USA
b Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Prevention Research Branch, Atlanta, Georgia, USA
c Puerto Rico Department of Health, San Juan, Puerto Rico
d Department of Communication, College of Charleston, Charleston, South Carolina, USA

Neural tube defects (NTDs) are serious birth defects of the brain and spine that affect approximately 3,000 pregnancies in the United States each year and affected 404 pregnancies in Puerto Rico from 1996 to 2002. Consuming the B vitamin folic acid can reduce the incidence of NTDs 50%-70%, and recent efforts to reduce NTD rates have focused on increasing the number of childbearing-aged women who take a vitamin containing folic acid every day. As the first stage of formative research in campaign planning, two exploratory, qualitative studies were conducted in order to (a) understand the complexity of vitamin use among women in the United States and Puerto Rico and (b) serve as a foundation on which to develop national communication and education interventions. Also, this information shed light on theories that might be used to guide campaign development. Results indicated that campaign messages designed to increase folic acid use through multivitamin supplementation in the United States must address women's barriers to vitamin use (e.g., cost, time), increase women's perceived need for multivitamins (e.g., identify immediate, tangible results from taking a daily multivitamin), and address the relationship between daily food choices and the need for supplementation. Future campaign messages in Puerto Rico must focus on many of these same issues, in addition to increasing women's knowledge about when folic acid should be taken in relation to pregnancy and addressing women's perceptions that vitamins cause weight gain (an undesirable outcome for most participants). The practical and theoretical implications of these results are discussed in terms of their contribution to the development of a creative new approach to increase multivitamin consumption among women of childbearing age in the United States and Puerto Rico.

Immunization in the Print Media - Perspectives Presented by the Press
   Authors: Felicity Goodyear-Smith a; Helen Petousis-Harris a; Colleen Vanlaar a; Nikki Turner a; Stephen Ram a

a Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand

New Zealand (NZ) has low immunization coverage for a Western country. Media coverage, including views and content expressed on editorial pages, can affect immunization uptake both positively and negatively. The objectives of this research were to analyze the content of written media in 2001 and 2003 throughout NZ in terms of vaccination and vaccine preventable diseases from a supporting, neutral, or opposing perspective; how vaccination and vaccine-preventable diseases are presented to their target audiences; and changes over time with possible influences on these changes. Print media clippings were analyzed from 400 national publications in 2001 and 2003 for references to immunization and vaccine-preventable diseases. Articles were coded as supportive, neutral, or opposing immunization. During two 12-month periods, 2,113 articles, including letters to the editor and opinion columns were analyzed: 1,228 from 2001; and 885 from 2003. Thirty-three percent (704) were classified as "supportive," 17% (362) as "opposing," and 51% (1,081) as "neutral." Articles and perspectives in the media opposed to immunization were significantly more plentiful in 2001 than in 2003 (328/1,228; 27% vs. 34/885; 4% of all immunization media; 2 = 189.46; p = <0.0001; df = 1). References to specific vaccines and disease were examined. During this study period there were high-profile infectious disease and vaccine issues that may have shaped the differences observed in the media clippings. This study indicates an overall positive trend toward reduction in alarmist anti-immunization messages in media. Strategies implemented by the Immunization Advisory Centre to counter misinformation may have contributed to reduction in anti-immunization messages.

Messages From Moms: Barriers to and Facilitators of Behavior Change in a Lead Poisoning Preventive Education Project
   Catherine M. Jordan a; Patricia A. Lee b; Ruth Olkon c; Phyllis L. Pirie d

a Children, Youth and Family Consortium, University of Minnesota, Minneapolis, Minnesota, USA
b North Memorial Medical Center, Robbinsdale, Minnesota, USA
c Jewish Family Service of St. Paul, St. Paul, Minnesota, USA
d Division of Health Behavior and Health Promotion, The Ohio State University, Columbus, Ohio, USA

Qualitative focus group data from participants of an intensive, culture-specific, lead poisoning preventive education research project were analyzed to assess success of communication strategies, and, specifically, to identify barriers to and facilitators of adopting behavior changes encouraged in the project. Effectiveness of education in preventing lead poisoning is addressed elsewhere. Education focused on housecleaning, hygiene, water, and nutrition. Ninety-five participants (89% of 107 eligible) of six ethnicities agreed to participate in focus groups. Seventy-eight (82%) actually attended. Barriers to behavior change included the effort required or unpleasantness of a prevention strategy, presentation of familiar information, denial of the problem, busyness, perceived lack of control, lack of social support, cultural traditions, and misunderstandings. Requiring one-time behavior changes; teaching simple, easy strategies; making less appealing tasks fun; demonstrating concepts; and presenting novel material that piques interest were features of the education that facilitated behavior change. Factors internal to the participant, such as love of the child or cultural practices, also served to motivate the participant to change behavior or to facilitate adoption of a prevention strategy. We offer recommendations to assist others in designing effective health education and risk communication prevention or intervention programs.

Women Seeking Health Information: Distinguishing the Web User
  Dorothy Warner a; J. Drew Procaccino b

a Rider University Libraries, Lawrenceville, New Jersey, USA
b Department of Computer Information Systems, College of Business Administration, Rider University, Lawrenceville, New Jersey, USA

Given the advantages of using the Web for health information-seeking and a survey result that women are more likely to use the Web as a channel to locate health information, the authors explored the health information-seeking process and behavior of women who use the Web to seek such information. Although based on previously collected data, this article represents an extension of the earlier analysis with its focus on women who, at least to some extent, seek health care information via The Web (herein, Web user), a topic not thoroughly addressed in the earlier study. A comparison of female Web users and non-Web users who seek health information revealed that Web users sought health information at a higher rate than non-Web users. Web users were more likely to communicate with medical professionals about the health information found and claimed that their decisions about health treatments were influenced by the health information. In most cases, Web users expressed a higher awareness of resources, regardless of format. Web users did not report that finding health information, from any channel, however, was noticeably easier.

Book Review

A Review of: "Haider, M. (2005). Global public health communication: Challenges, perspectives, and strategies."
Sudbury, MA: Jones and Bartlett Publishers. ISBN: 0-7637-4776-9 (paper back) .
Author: Kami J. Silk