ABSTRACTS

Volume 5, Number 4
October-December 2000

Vol. 5, Num 4: Contents | Editorial | Up Front | Abstracts

Impact of Direct-Mail as a Method to Recruit Smoking Mothers to a “Quit and Win“ Contest
Tillgren, P., Eriksson, L., Guldbrandsson, K., and Spiik, M.

In the early 1980´s the concept of a Quit and Win (Q&W) contest was developed in the Minnesota Heart Health Program as a population-based smoking cessation strategy. The Q&W model has since spread and been applied in a large number of countries around the world. Different communication strategies have been applied for recruiting participants for Q&W.  In the Q&W contest in 1995 in Stockholm County, Sweden, direct mail was used as the main recruitment strategy among daily smoking mothers with children aged 0-6 years. Two additional strategies were employed to recruit participants, i.e. ads in a local newspaper and through personal communication. The target group was estimated to approximately  4,300 women. In total  5.5 percent of the target group was recruited, and of those, 4.3 percent were recruited by direct mail. After 12 months, 14.3 percent of the women were sustained smoke-free, and the corresponding percentage for those women who were recruited by direct mail was 15.5 percent. In comparison with several other Q&W contests employing other strategies, the direct-mail technique seems not only to have been successful in recruiting participants, but also successful in aiding remained sustained smoke-free women after 12-months. To optimize recruitment for Quit and Win contests, a combination of recruiting strategies should be applied.

Participatory Research Strategies in Nuclear Risk Management for Native Communities
Quigley, D., Sanchez, V., Handy, D., Goble, R., and George, P.

The Nuclear Risk Management for Native Communities (NRMNC) Project is a collaborative academic, community-based and tribal project, conducting the three essential elements of participatory research: research, education and community action, titled here as “community-based hazards management”.  This article describes the goals and outcomes of this effort in assisting Native American communities in Nevada, Utah, and Southern California affected by nuclear fallout from U.S. weapons testing in the 1950’s and 1960’s.  The Project sought to create new models for dealing with health research and risk communication needs in an environment justice setting.  The following results of this four-year project are discussed: (1) building a community-based environmental health infrastructure, (2) building community capacities through workshops and educational materials (3) conducting both technical and community research and (4) facilitating community-based hazards management planning. We describe such positive outcomes as the improvements in the scientific data-base through participatory research activities; the development of equitable relationships between scientists and community members and the creation of a sustaining program intervention for long-term community needs.  The project’s outcomes are presented as an expansion to limited scientific risk management outcomes in the environmental health field that are often solely quantitative and lack relevance to community concerns about environmental health impacts from contamination

Empowerment Through Agency-Promoting Dialogue: An Explicit Application of Harm Reduction Theory to Reframe HIV Test Counseling
     Mattson, M.

The counseling that accompanies HIV testing can be an important prevention tool for encouraging people to practice safer sex in order to avoid AIDS but there is scant research about how HIV test counseling operates in practice. This essay critiques the current Centers for Disease Control and Prevention (CDC) protocol for HIV test counseling for not being genuinely client-centered and ignoring the unique needs of clients and offers an alternative approach that adapts and explicitly applies the tenets of Harm Reduction Theory (HRT). Excerpts from actual HIV test counseling sessions illustrate both the weaknesses in the current approaches to HIV test counseling and project how the alternative theoretical perspective offered could provide counseling that encourages agency-promoting and empowering dialogue. The implications for the development of HRT as a health communication heuristic and a practical training and evaluation strategy are discussed along with limitations and future research directions.
The counseling that accompanies HIV testing can be an important factor in influencing people to practice safer sex in order to avoid AIDS, but there is scant research on how HIV test counseling is practiced (Beardsell & Coyle, 1996; Chamot, Laborde, & Rice, 1995; Higgins et al., 1991; Kamb, Dillon, Fishbein, & Willis, 1996; Otten, Zaidi, Wroten, Witte, & Peterman, 1993). According to the dominant model of HIV test counseling endorsed by the CDC (1994), the practitioner is to be “client-centered” while conducting a behavioral risk assessment, discussing routes of HIV transmission, and educating the client about risk reduction. The primary objective of this interaction is realistic behavior change. Counter to protocol design, however, Mattson (1999) and Elovich (1996) found that during HIV test counseling the client’s voice was usually passive and the counselor’s discourse was characterized as agency-robbing or disempowering. Similarly, Bayer, Stryker, and Smith (1995) reported a “wide gap between official aspirations and clinical practice” (p. 1298). This essay addresses the ineffectiveness of the current HIV test counseling protocol not from a traditional outcome perspective but through a qualitative critique of the communicative dynamics and forwards an alternative approach grounded in the tenets of Harm Reduction Theory (HRT).

FORUM
Riskier Than We Think?:  The Relationship Between Risk Statement Completeness and Perceptions of
Direct to Consumer Advertised Prescription Drugs
Davis, J.

Direct to consumer (DTC) prescription drug advertising is one of the fastest growing categories of advertising.  Expenditures have increased from about $25 million in 1992 to nearly two billion dollars in 1999.  Given strong evidence of consumer-driven demand for advertised prescription drugs, research was conducted to assess the extent to which DTC prescription drugs advertising provides consumers with the information they need to make an informed evaluation of an advertised drug’s relative benefits and risks. Two studies explored the relationship between the completeness of the statement describing drug-associated side effects (the “risk statement”) and consumer’s perceptions of a drug’s safety and appeal.  The research manipulated risk statement completeness with regard to the incidence levels of side effects mentioned in the statement (which in turn affected the number of side effects mentioned) and the presence or absence of a numeric indicator of side effect incidence.  The research strongly suggests a direct relationship between risk statement completeness and consumers’ perceptions of drug safety and appeal.  Consumers rate the safety and appeal of drugs described with an incomplete risk statement significantly more positively than comparable drugs described with a more complete risk statement. Implications of the research for the regulation and presentation of DTC prescription drug advertising and advertiser communication practices are discussed.

NOTES FROM THE FIELD
Verbal Responses of Children and Their Supportive Providers in a Pediatric Oncology Unit.
Yingling, J.

BOOK REVIEW
Surviving Modern Medicine
Clarke, P. and Evans, S. H.
Review by Gillotti, C.