UP FRONT

Volume 4, Number 3
July-September 1999

From this Issue | From Other Sources | Upcoming Events and Conferences | Internet Sources | Publications | Prescriptions | Call for Information

Vital Data

From This Issue

The first article describes qualitative research conducted to determine the utility and impact of the Harvard Cancer Risk Index (HCRI).  The HCRI was developed to address the difficulty individuals face in assessing their cancer risk. Along with assessing modifiable and non-modifiable risks, the HCRI offers primary prevention strategies to help with behavior change. The research involved in-depth interviews to address wording and presentation and focus groups to address the meaning of risks, perceptions about cancer and interpretations of results.  The authors discuss their results and the changes made to the HCRI.  The authors conclude that a cancer-focused risk assessment tool may be a helpful strategy for influencing perceived risk and possibly for enhancing motivation for behavior change.  K. M. Emmons, S. Koch-Weser, K. Atwood, L. Conboy, R. Rudd, G. Colditz.  A Qualitative Evaluation of the Harvard Cancer Risk Index.

The second article examines a frequently used health communication tool – the public service announcement (PSA).  In particular, this study examines the relative appeal of advertisements and PSAs about alcohol among adolescents.  The researchers also examined the relationship of perceived message quality, production quality, and perceived persuasiveness to drinking behavior and skepticism toward persuasive messages.  College students rated a series of pro-social and commercial advertisements on a variety of criteria.  Results indicated that pro-social ads were rated as higher in quality than were commercial ads overall and on logic-based criteria.  However pro-social ads had weaker relationships to viewers’ beliefs and behaviors relevant to drinking alcohol.  Heavier drinkers rated commercial ads more positively than did lighter/nondrinkers.  They were less skeptical of persuasive messages and rated pro-social ads lower in effectiveness and commercial ads higher in effectiveness.  E.A. Austin, B. Pinkleton, Fujioka, Y.  Assessing Pro-Social Message Effectiveness: Effects of Message Quality, Production Quality, and Persuasiveness.

In the third article, the authors argue that the assumption of normalcy by television violence researchers makes understanding the issue more difficult.  They state that the assumption that subjects are the same psychologically yields data interpretations that fail to account for different psychological and behavioral responses.  The incidence of psychopathology may be higher than investigators suspect, which would lead to overestimates of the negative effects by TV on children.  Because pathological children are more vulnerable to commercial television's sociopathic effects than are normal children, they may bias study results toward sociopathic attitudes and behaviors, thus misleading researchers into believing that TV has a greater sociopathic effect on normal populations than it actually has.  The authors also argue that many researchers assume that because television can produce sociopathic effects in a laboratory that it does outside the laboratory.  L. Bergen, T. Grimes.  The Reification of Normalcy.

Following the Bergen and Grimes article is a critique by Murray and Wartella.  Murray and Wartella are troubled by the charge of scientific bias in television research.  The critique points out lessons learned from the history of television violence research.  They also address the idea of catharsis – that viewing television violence leads to fantasizing about violence rather than acting it out and thereby reduces violent or aggressive feelings.  In addition, the authors discuss what they feel are misconceptions by Bergen and Grimes.  J.P. Murray, E.A. Wartella.  The Reification of Irrelevancy: A Comment on "The Reification of Normalcy."

In the forum article, the American Council on Science Health (ACSH) provides a critical review of the recently published book The Breast Cancer Prevention Diet: Foods, Supplements, and Drugs That Can Save Your Life. The review, representing the official opinion of the ACSH, expresses concern about the advice the book offers to women hoping to reduce their risk of breast cancer.  ACSH believes that in the absence of sound, peer-reviewed evidence supporting such advice there is harm in recommending lifestyle modifications for the purpose of preventing breast cancer.   In the article, the ACSH refutes many of the book's assertions and offers their advice on understanding and reducing breast cancer risks.  J. Morgan, S. Sharma, A. Lukachko, G. Ross.  The Breast Cancer Prevention Diet by Dr. Bob Arnot: Unscientific and Deceptive – A Disservice to American Women.

From Other Sources

Reducing the availability of alcohol through alcohol control policies such as excise taxes and the minimum legal drinking age has been effective in reducing a wide range of alcohol-related problem, including traffic crashes, liver cirrhosis, and violence.  An article in the Journal of Public Health Policy describes public and institutional policies available to reduce alcohol-related problem.  Summaries of research evaluating specific alcohol control policies are also provided.  The authors classify alcohol control policies into two overlapping categories -- public and institutional policies.  The article describes policies such as alcohol server training that may be either mandated by governmental jurisdictions or voluntarily adopted by individual institutions, which include alcohol retail establishment, other businesses, worksites, schools, colleges/universities, law enforcement agencies, religious institutions, insurance agencies, and alcohol producers.  In addition, the authors discuss public policies that may be mandated by national, state/provincial, or local governments to regulate where, when and how alcohol is sold and consumed.  Toomey, T. L. and Wagenaar, A. C.  Policy Options for Prevention: The Case of Alcohol.  Journal of Public Health Policy 20(2): 192-213.

In a recent issue of Preventive Medicine, McDonald identifies communication variables that might enhance recruitment for community-based quit-smoking programs.  The author examines the effect of six variables on recruitment rate: the type of program sponsor, the type of program, program costs, use of participation incentives, whether message were segmented by state of change, and the type of channel used to send messages.  The only significant predictor of recruitment rate was channel type.  Studies that used interactive recruitment channels (telephone, interpersonal communication) were 66.5 times more effective than those using passive recruitment strategies (mass mail, direct mail).  Results examining the segmentation of messages by stage of change on recruitment were inconclusive.  Results suggest that researchers and practitioners interested in population-based smoking cessation programs should pay more attention to recruitment methods.  The use of interpersonal channels has been underused and appears to be particularly promising for improving the population impact of quit-smoking programs.  McDonald, P. W. Population-Based Recruitment for Quit-Smoking Programs: An Analytic Review of Communication Variables.  Preventive Medicine 28:545-557.

In Family Planning Perspectives, Whitaker, et al. report that teenagers’ communication with their partners about sex and their use of condoms may be influenced by the discussions teenagers have with their parents about sex.  The authors sought to learn more about the process of parent-teenager communication and to understand what parents discuss with their children and how they discuss it.  Interviews were conducted with 372 sexually active black and Hispanic youths aged 14-17 from Alabama, New York, and Puerto Rico.  Whitaker, et al. looked at the relationships between parent-teenager discussions about sexuality and sexual risk, likelihood of teenager-partner discussion about sexuality and sexual risk, teenager condom use, and parental communication skills.  The results indicate that the influence on teenagers of parent-teenage discussion about sexuality and sexual risk depends on both what parents say and how they say it.  Programs that foster parent-teenager communication about sexuality and sexual risk must emphasize both of these aspects.    Whitaker, D.J., Miller, K. S., May, D.C., and Levin, M.L.  Teenage Partners’ Communication about Sexual Risk and Condom Use: The Importance of Parent-Teenage Discussions.  Family Planning Perspectives 31(3): 117-121.

The Bulletin of the World Health Organization published a quasi-experimental study conducted in Shiraz, the Islamic Republic of Iran on 120 pairs of mothers and infants to determine the effects of breastfeeding education and rooming-in programs.  Fifty-nine mothers received face-to-face breastfeeding education after delivery and during a four-month follow-up period.  The remaining 61 mothers comprised the control group.  Exclusive breastfeeding rates were significantly higher in the study group (54%) than in the control group (6.5%).  But 5% and 18% of infants, in the study and control groups respectively, had stopped breastfeeding by the age of four months.  The mean number of days of diarrhea experienced by infants in the study group was significantly lower than in the control group.  At the end of four months, the mean weight and length of the infants were significantly higher in the study group than in the control group.  The findings indicate that rooming-in is very important for promoting exclusive breastfeeding and that there is a need for continuous breastfeeding education of mothers.  Froozani, M.D., Permehzadeh, K., Dorosty Motlagh, A.R., and Golestan, B.  Effect of breastfeeding education on the feeding pattern and health of infants in their first 4 months in the Islamic Republic of Iran.  Bulletin of the World Health Organization 77(5): 381-385.

Upcoming Conferences and Events

The National Communication Association 85th annual convention will be held at the Chicago Hilton and Towers November 3-7, 1999.  The convention theme is "Coloring Outside the Lines."  The 1999 Arnold Lecturer will be Kathleen Hall Jamieson, Dean of the Annenberg School at the University of Pennsylvania.  Some of the seminar topics are: Rethinking Structuration Theory in Communication, Redrawing Communication Ethics, Color Us Queer, British Public Address, Blurring the Boundaries, Rhetoric and Psychiatry, Interpersonal Communication Leaders, and Communication Approaches to the HIV/AIDS Epidemic.  For more information on the conference, visit the Internet site of the National Communication Association at www.natcom.org.

The 127th Annual Meeting of the American Public Health Association will be held November 7-11, 1999 in Chicago, IL.  The theme of the meeting is “Celebrating a Century of Progress in Public Health.”  The meeting will include over 1,000 scientific sessions, awards programs, poster sessions and workshops.  In addition, there will be the Exposition, Continuing Education Institutes, opportunities to earn CE credits, and the CareerMart.  Attendees will include national and international physicians, administrators, educators, epidemiologists, nurses and other specialists interested in and involved with public health issues.   For more information see the APHA Internet site at www.apha.org.

Other conferences and events that might be of interest to our readers include:

• Promoting Healthy Behaviors: Changing Institutions, Teachers and Learners on October 2-5, 1999 in Savannah, GA.  Sponsored by the Association for the Behavioral Sciences and Medical Education.  For more information, visit falcon.fcm.missouri.edu/~absame/Meeting.htm.

• Applied Research Methods on October 17-21, 1999 at the Westin Atlanta North at Perimeterin in Atlanta, GA.  Sponsored by the American Marketing Association.  For more information, e-mail Allison Tibetts at atibbetts@ama.org.

• Attitude and Behavioral Research on January 23-26, 2000 at the Pointe Hilton Resort at Squaw Peak in Phoenix, AZ.  Sponsored by the American Marketing Association.  For more information, call within USA: 800-AMA-1150, Outside USA: 312-648-0536, Email: Clara Nelson cnelson@ama.org.

• QHR 2000: The Sixth Annual Qualitative Health Research Conference on April 6-8, 2000, Banff, Alberta, Canada.  Sponsored by the International Institute for Qualitative Methodology and University of Alberta.  For more information, visit www.ualberta.ca/~iiqm/qhr2000/index.html.

Internet Sources

While there are hundreds of Internet sites providing health information, the Information Centers from JAMA stand out because of their focus on the scientific merit of the information provided.  There are six information centers: HIV/AIDS, Contraception, Women's Health, Sexually Transmitted Diseases, Asthma, and Migraine.  Each information center has five main sections: Newsline, Library, Treatment Center, Education & Support Center, and Best of the Net.  The Newsline contains daily updates.  The Library contains the latest peer-reviewed literature on the disease topic.  The Treatment Center has clinical guidelines and resources.  The Education & Support Center includes resources for patients and professionals.  The Best of the Net are top Internet sites selected by JAMA reviewers.  The HIV/AIDS Information Center also has a Policy section with reviews, references and resources and a Prevention section with facts, updates and references.  The Information Centers can be found at www.ama-assn.org/special/.

Publications

The National Safe Kids Campaign recently released a report on the use of child car seats.  The report, entitled “Child Passengers at Risk in America: A National Study of Car Seat Misuse” found that 85% of car seats are used incorrectly with an average of two errors per seat.  This is despite campaigns to promote the use of safety seats and child occupant protection laws.  For a copy of the report, contact the National Safe Kids Campaign at 202-662-0600.

Prescriptions

From their qualitative evaluation of the Harvard cancer risk index Emmons, et al. had these recommendations to make:

• Paper-and-pencil risk assessment measures requiring math skills are not optimal ways to assess risk.

• In communicating the risk about cancer, providing information about both modifiable and non-modifiable risk factors is important.

• In risk communications, providing explanations how risk factors affect risk is important.

As health communicators, we often wonder why pro-social messages appear to be less effective than commercial advertisements.  Austin, et al. studied college student responses to pro-social and commercial alcohol ads and concluded that:

• Pro-social messages demonstrate potential for strengthening college students' logical decision-making capabilities.

• Current strategies employed in pro-social ads appear to have little effect on decision-making variables.

• Commercial ads are more successful at communicating affective appeal, which may corrupt or supersede the logical decision-making processes.  Thus, commercial ads appear to be more effective at affecting behavior change.

• Campaign designers should take into account that college-age viewers' decisions about alcohol appear to be driven more by emotion or wishful thinking than by logical reasoning.

• The method by which college students make decisions suggests that individuals of different ages go through similar steps and processes to arrive at decisions.

• Ratings in focus groups that pro-social messages are "effective" may be misleading.  The alcohol-related pro-social messages in this study were generally less effective with college students than competing commercial advertisements, even though students reported that pro-social ads were more "effective."

• Researchers and practitioners need to pretest persuasive strategies and production values.

• A less skeptical individual may be more easily impressed by glamorous portrayals that make behaviors appear normal and desirable.

Bergen and Grimes suggest that many studies over the last 40 years that examine the effect of television violence on children unknowingly included children with psychopathologies.  Thus there is unnecessary concern that normal children may suffer long-term psychological damage on account of violent TV programming.  The authors feel that:

• Studies designed to examine normal children must not assume normality will be obtained through random selection.  Clinical screening and testing must take place to ensure that clinically normal children are being studied.

• Clinical and psychophysiological data, as well as some communication studies, suggest that violent TV is most likely to harm children with active psychopathologies, not normal children.

• More work should be focused on clinically vulnerable children.

• Media literacy interventions, although their efficacy is undocumented, hold the most promise for helping children consume all types of television responsibly.

The American Council on Science and Health (ACSH) conducted a scientific review of The Breast Cancer Prevention Diet, by Dr. Bob Arnot.  Based on the findings of this review, ACSH offers the following conclusions:

• The Breast Cancer Prevention Diet represents a disservice to women by recommending specific diet and lifestyle modifications for the purpose of preventing breast cancer in the absence of sound, peer-reviewed scientific evidence.

• Furthermore, Dr. Arnot's book is alarmist and promotes exaggerated perceptions of risk.

• Dr. Arnot claims that his diet offers health outcomes comparable to those of drugs "without the side effects," and that it allows women to "take control" of their breast cancer risk.  These hyperbolized messages may encourage women to neglect well-established recommendations for early, potentially life-saving breast cancer detection, such as routine physician evaluations and mammography.

• Dr. Arnot's implication that following his diet may shrink breast tumors may influence women who feel a lump to attempt to treat themselves with this diet rather than to seek reliable medical evaluation.  There is no evidence in the medical literature that following this diet will shrink human breast tumors.

• Dr. Arnot downplays the role of genetics and unknown factors in the development of breast cancer.  Indeed, most breast cancers are sporadic and not secondary to known risk factors.  Dr. Arnot's message may lead women who are suffering from breast cancer to feel personally responsible for their condition.

• The diet plans that Dr. Arnot recommends, with little or no scientific foundation, require major lifestyle changes-changes that could disrupt healthy eating habits for the entire family, especially children.

• While the potential benefits of some of the nutritional recommendations made in The Breast Cancer Prevention Diet appear promising, none have undergone the scrutiny and testing required to conclude that "their use saves your life."

The Up Front section is edited by Amy E. Chadwick, Emerson College-Tufts Medical School Program in Health Communication.

Call for Information

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Lisa Shusterman, Assistant Editor Journal of Health Communication Academy for Educational Development 1825 Connecticut Avenue, NW Washington, DC  20009