UPFRONT

Volume 7, Number 3
May-June 2003

Vol. 7, Num. 3: Contents | Editorial | Up Front | Abstracts

From This Issue | Upcoming Conferences and Events | Internet Sources | Publications | Prescriptions

Vital Data

From This Issue

Global epidemiological trends reveal that mortality from lifestyle-related diseases in Western and other industrialized nations has been declining while the converse is true in developing nations and in various Newly Independent States of the Former Soviet Union. In the latter societies as well as former Communist countries, the transition to a market
economy without the necessary social support mechanisms has exacerbated the trend toward poor lifestyl e and a high prevalence of coronary heart disease, cancers, and other chronic diseases. The situation in Poland is complex - total mortality attributed to car-diovascular disease has decreased while cancer mortality has increased. Also, alcohol-related
problems have increased. Therefore, steps are needed to ameliorate various lifestyle-relate d diseases. Various international and local organizations have attempted to address the health crisis in Central and Eastern Europe. Among these, a Washington-based nonprofit organization promoting communications, health, and a cleaner environment
has provided health promotion programs on both health training and mass media production. It commissioned a TV series that featured the scientific basis for the lifestyl e and disease connection. The series differentiated fact from fallacy, and suggested practical ways to lower the risk of heart disease, certain cancers, and other major lifestyle
related disabilitie s by tracking four families through the cycle of a year and their efforts to live healthier lives. In the ®rst article of this issue, a study by Chew and her colleagues reports the impact of this TV series on health knowledge and the key factors of the health belief model (HBM) that have led to health behavior in Poland (exercising, losing weight,
changing eating habits, and not smoking/quiting smoking). The HBM examines five basic factors influencing disease prevention behaviors: perceived susceptibilit y of getting the disease or being harmed; perceived seriousness of the consequences of the disease, such as a disability; perceived benefits of the recommended behavior, such as feeling
healthier; perceived barriers to the suggested actions, such as cost; and finally, cues to action, such as a physician’s advice or TV program. Benefits and barriers combined to form efficacy. Data from a post - test comparison field study with 151 viewers and 146 nonviewers, analyzed with hierarchical regression, showed stronger support for efficacy,
susceptibility , seriousness, and salience (interest in good health) in their contribution towards health behavior among TV viewers compared to nonviewers. Cues to action variables (including TV viewing) and health knowledge boosted efficacy among viewers. Without the advantage of receiving health information from the TV series, nonviewers relied on their basic disease fears on the one hand, and interest in good health on the other to take steps towards becoming healthier. The researchers concluded that a health promoting TV series can increase health knowledge and enhance health beliefs,
which in turn contribute to healthy behaviors. Study limitations included social desirability response bias and memory dependence, which may characterize self-reported measures. In addition, self - selection bias may be present among the program viewers. Finally, the results are derived from more demographically upscale participants and may
not be generalizable to the larger Polish population. Chew, F., Palmer, S., Slonka, Z., Subbiah, K. Enhancing Health Knowledge, Health Beliefs and Health Behavior in Poland through a Health Promoting Television Program Series. (p. 179)

In the second article of this issue, Mizuno, Kennedy, Weeks-Norton, and Myllyluoma studied a sample of sexually active adolescents aged 15 to 18 years (n = 521) from Sacramento, CA to examine the characteristics of those who were and were not exposed to an HIV prevention project. The project was called Teens Stopping AIDS (TSA) aimed to reduce sexual risk among adolescents and involved coalitions of volunteers in designing and launching a social marketing intervention. TSA was mounted in 15 zip codes in Sacramento where teen STD and pregnancy rates were high, and delivered HIV prevention messages for one year through various communication channels (e.g., ratio spots, posters, skills-building workshops). Anonymous telephone interviews were conducted with a random sample of adolescents from the 15 target zip codes to evaluate TSA. Sixty-seven percent of the sexually active adolescents surveyed reported exposure to TSA. In order to inform future refinements in the intervention, this study examined factors associated with exposure to the program by estimating a logisti c regression model. The results indicate that 18 year-olds were less likely than their younger counterparts to report exposure to TSA (OR [odds ratio] = .54, p < .05). Also, adolescents
living in zip codes where a concentrated effort had been made to hold workshops, display posters, and organize peer outreach were more likely than adolescents living outside of these zip codes to report any kind of program exposure (OR = 2.57, p <.01). Although some adolescents have traditionall y been viewed as hard to reach (i.e., males, minorities, and those with a history of high-ris k behavior), the results indicate that these teens were no less likely than other adolescents to report exposure to TSA. These findings made it possible to offer practical suggestions for expanding the
reach of the program. Future TSA exposure rates may be enhanced if the program provides more of its available products and services in currently underserved zip codes, and develops new exposure strategies (and perhaps new products) for the 18 year-olds. Mizuno, Y., Kennedy, M., Weeks-Norton, K., Myllyluoma, J. An Examination of Adolescents Who Were and Were Not Exposed to Teens Stopping AIDS Program: Reaching the Hard-to-Reach. (p. 197)

Over the past decade, overall cancer incidence and death rates have declined steadily. Although cancer survival rates are improving for most patients, the Department of Health and Human Services has identified cancer as one of six areas in which racial and ethnic minorities experience serious disparities in health access and outcomes. Although many factors contribute to poor cancer survival rates among racial and ethnic minorities, health - related behaviors remain a powerful factor in cancer incidence and mortality rates among all groups. As such, additional research is needed to identify behavioral factors associated with poor health outcomes in African American cancer patients, particularly in those realms that may be amenable to intervention. Medical information seeking and engagement in treatment decision-making may be two important contributors to health outcomes among African American cancer patients. In the third article of this issue, qualitative research methods were used to explore factors that may affect medical information seeking, treatment engagement and emotional adjustment among Afrioah American cancer patients. Focus group findings suggest that an array of cultural and socio-economic factors play important roles in the behavior of African American cancer patients. Participants described a number of important barriers and facilitators of medical information seeking and treatment participation. Emphasis was placed on limited knowledge and misinformatio n about cancer, mistrust of the
medical community, concerns about privacy, lack of insurance, religious beliefs, and emotional issues such as fear and stigma associated with help - seeking as factors linked to the health care - related behaviors and adjustment of African American cancer patients. Limitations of the study should be noted and include the generalizability of the
sample and the importance of replicating study findings with a larger sample. Recommendations are made that may assist mental and physical health provides in improving patient information and mental and physical health outcomes of African American cancer patients. Specifically, medical professional s working with African-American patients may need to devote extra effort to addressing informationa l needs and emotional concerns, asking about sources of emotional support and offering referrals to mental health professionals when appropriate. Matthews, A. K., Sellergren, S. A., Manfredi, C., Williams, M. Factors In¯uencing Medical Information Seeking Among African American Cancer Patients. (p. 205)

The final article of this issue broadly uses the language and concepts of public relations to analyze the global AIDS/HIV phenomenon at three levels. First, it applies models of public relations practice to analyze power differentials between various stakeholders (publics) involved in the pandemic. This part of the analysis shows that those who are most impacted by the pandemic at the everyday level are least empowered to shape rhetoric and policy on global AIDS/HIV. The next level of analysis draws upon international and intercultural public relations research. Literature in this area teaches us that when it comes to practicing publi c relations across cultures and national borders, practitioners should avoid working against local conceptualizations of how public relation is understood and practiced. Similarly, in the case of global AIDS/HIV, public relations efforts and prevention campaigns should be sensitive to local and cultural interpretations of the epidemic. Third, in public relations, the manner in which an issue is framed through the news media can shape the responses and opinions of significant stakeholders, thereby influencing future signification and courses of action. Therefore, it is important to understand how news about global AIDS/HIV gets created, and how various stakeholders respond to these news representations. In order to understand this, reporters who cover AIDS/HIV at four leading transnational wire services were interviewed. In order to understand how various publics interpret news, two groups of stakeholders (people living with AIDS/HIV or engaged in AIDS/HIV related work, and policy makers working at the global level) were interviewed. These interviews resulted in a data set of narratives that were qualitatively coded and analyzed. The main finding from the reporters’ narratives was that the global AIDS/HIV story has lost its spike and
become routine. Therefore it is hard to keep it on the news agenda. People living with AIDS/HIV or engaged in work that relates to AIDS/HIV were mostly of the opinion that global representations are simplistic and do not adequately include the voices and experiences of those intimately affected by the paridemic. The policy makers were of the opinion that coverage is mostly uncritical and that enough attention is not paid to prevention issues. The author concludes that AIDS/HIV is a polycultural phenomenon that involves the agendas, interactions and interpretations of various cultural groups/stakeholders. In this sense, it is also an intercultura l as well as public relations phenomenon. Hence, those individuals who operate at boundary spanning transition nodes along the global/local continuum, and the etic and emic (intra as well as inter) dimensions that connect different cultural groups/stakeholders play a crucial communicative
relationship building role that requires cultural sensitivity and open minded creativity, initiative, superior leadership qualities and a finely balanced understanding of the top - down and ground up intersections and subjectivities of AIDS/HIV communication. Bardhan, N. R. Accounts From the Field: A Public Relations Perspective on
Global AIDS/HIV. (p. 221)

Upcoming Conferences and Events

The International Conference on Gender and Health will be held in Vienna, Austria from September 16-18, 2002. The conference is aimed at promoting the integration of the gender perspective in the health care field and in health sciences, and at stimulating collaboration between researchers, practitioners, and policy makers. The main objectives of the conference include examining sex differences in health status, diagnostic and health care delivery, discussing the relationship between sex role stereotypes and clinical judgment. critically examining the current systems and structures for health care services in women’s and men’s health, and identifying effective models for health care delivery.
For more information, visit www.genderandhealth.at

The International Conference on Communication in Healthcare 2002 is the first international conference organized by EACH, the newly formed European Association for Communication in Healthcare, in partnership with: The Program in Communication and Medicine, Northwestern University, Chicago, NIVEL, the Netherlands Institute for Health Services Research, The Forum on Communication in Healthcare of the Royal Society of Medicine, and ETHOX, the Oxford Institute for Ethics and Communication in Health Care Practice. The conference will be held at the University of Warwick, UK September 18-20, 2000. The aim of the conference is to bring together teachers, researchers, consumers, policy makers, and practitioners interested in all aspects of communication in healthcare, to create networks, to share new work and new ideas, and to provide an enjoyable and motivating experience for all participants. For more information, visit http://www.each2002.com

The 88th Annual Meeting of the National Communication Association, ``Communication in Action’’, will be held November 21-24, 2002 in New Orleans, Louisiana. The conference includes a seminar series on a variety of topics. One example is HIV/AIDS, STDs & Sexual Behavior: Conversations Leading to Action led by Stuart Schrader, Indiana
University-Purdue University, Indianapolis , and Thomas Steinfatt, University of Miami. The seminar intends to foster a dialogue that centers on how study within this topic area can positively contribute to other applied communication and/or health communication scholarship. Brief position papers are requested from participants who wish to contribute to the seminar. Submissions may address any issue related to HIV/AIDS, STDs, or sexual behavior. For more information on both the conference and seminar series visit http://www.natcom.org/convention/.

Internet Sources

``An Extraordinary Opportunity : Cancer Communications’’ is a new 10-minute vide featuring The Communications Opportunit y Leadership Team (COLT) members sharing their views on the importance of the Extraordinary Opportunity in Cancer Communications (EOCC). The video emphasizes the research potential in cancer communications. The video includes interviews conducted at, and proceedings of, the March 13 COLT meeting. Footage from David Gustafson’s March 23 presentation and from the March 24 NCI Board of Scientific Advisors meeting also is included. http://cancercontrol.cancer.gov/eocc/video.html

Publications

The Johns Hopkins University Center for Communication Programs website links to their online database service The Media/Materials Clearinghouse (M/MC), an international resource for health professionals who seek samples of pamphlets, posters, videos, and many other media/materials designed to promote public health. Visit the site at http://www.jhuccp.org/mmc/index.stm

Prescriptions

Chew, Palmer, Slonska and Subbiah assessed the application of the Health Belief Model (HBM) to promote healthy lifestyles via television in Poland. From their research they offer the following recommendations:

A health television series can function as an effective cue to action in promoting healthy behaviors by having clearly stated objectives, presenting easy health promotion steps, and focusing on persons/characters with whom viewers could identify. Television can be used to enhance health knowledge, health beliefs and healthy behavior. Researchers should further examine the relationship between television messages and the perceptions of disease susceptibility and seriousness. The HBM (susceptibility , seriousness, barriers, benefits, cue to action) is a heuristic framework for understanding the influence of television on health behaviors. Its application in Poland attests to its universality. Researchers should focus on assessing other sources of information and their impact on health behaviors. -F. Chew, S. Palmer, Z. Slonska, and K. Subbiah

Mizuno, Kennedy, Weeks-Norton, and Myllyluoma studieds adolescents who were and were not exposed to a condom social marketing campaign. On the basis of their research, they made the following observations .

Audience research and segmentation and the multiple intervention strategies employed by an HIV prevention program can successfully reach adolescents who are often considered hard to reach, e.g., males, minorities, and those with a history of high-risk behavior. Characterizing segments of a target audience that were not exposed to a program may help the program achieve optimum exposure rates. It may be necessary to use different channels to reach 18 year-olds than to reach other teens.

Matthews, Sellergren, Manfredi, and Williams explored factors that may affect medical information seeking, treatment engagement and emotional adjustment among African American cancer patients. From their research they make the following recommendations to assist mental and physical health providers in improving patient information and mental and physical health outcomes of African American cancer patients:

Discuss personal experiences with cancer in order to determine if a patient has fears, misinformation, or attitudes about the illness that may impair adjustment in his or her disease. Discuss knowledge about cancer treatments and ensure adequate understanding of purpose of treatments, expected side effects, and pros and cons of treatment option. Explore availability of adequate support and refer for supportive mental health services if appropriate. -A. Matthews, S. Sellergren, C. Manfredi, M. Williams

Bardhan conducted a qualitative study of the global AIDS/HIV phenomenon from a public relations, specifically media relations, perspective. The focus of this article is on the news media and it includes a theoretical and empirical exploration of how AIDS/HIV is framed as well as represented at the global level. Based on the findings, following are
four practical suggestions to public relations practitioners involved in AIDS/HIV campaigns and initiatives worldwide:

Keeping the AIDS/HIV issue on the news agenda is currently a challenge, but it can be accomplished through creative and proactive media relations Traditionally excluded stakeholders need to be increasingly included in designing campaigns and positioned as credible news sources Overall, prevention is a theme that needs to be emphasized in media relations efforts Context specific research is necessary for designing campaigns and media relations strategies that are primarily sensitive to local realities and simultaneously mindful of macro global -N. Bardhan

If you would like to suggest materials for this section, please send your suggestions with your name, e-mail address, fax and phone numbers to:

Journal of Health Communication
The GW Center for International Health
Department of International Public Health
School of Public Health and Health Services
The George Washington University
2175 K Street, NW, Suite 810
Washington, DC 20037,
Telephone (202) 416-0426

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The Up Front section is edited by Wendy Meltzer, Assistant Editor, Journal of Health Communication.