JHC Link Newsletter Summaries

Volume 13, Issue 1 (Jan/Feb 2008)

Article Summaries:

Intentions of Becoming a Living Organ Donor Among Hispanics
- Jason T. Siegel; Eusebio M. Alvaro; Andrew Lac; William D. Crano; and Alexander Dominick

Every day, approximately 17 more people die due to a shortage of transplantable organs. Living organ donation, the transplantation of an organ from a living donor to a recipient, is a relatively unexplored option for increasing the number of donors, especially in the Hispanic community. This is unfortunate as living donation is devoid of many of the barriers that impede non-living donation among Hispanics. In response to deficiency in this research area, the goal of the present effort is to begin building a knowledge base to which future health communication campaigns seeking to increase living organ donation rates among Hispanics can refer for guidance. A greater understanding of current perceptions must be attained before health communication campaigns can affect the rate of organ donation in the Hispanic community. This research examines perceptions concerning living (n = 1253) and non-living (n = 1259) organ donation among Hispanic adults. Two different, albeit complementary, theoretical rationales are used to guide our research: Theory of Planned Behavior (Ajzen, 1991) and Vested Interest Theory (Crano, 1983, 1997). Surprisingly, only 36.3% were aware that living donors could choose their recipients. Respondents asked about living donation in comparison to those asked about non-living donation differed in mean scores with respect to their perceptions of intentions, subjective norms, attitudes, and immediacy. Also, each theory uniquely contributed to predicting intentions in both forms of organ donation. Theoretically-driven empirical research that focuses on understanding donation-relevant factors could facilitate the increase in living organ donation among the Hispanic population.
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Risk Perceptions and Worry About Cancer: Does Gender Make a Difference
- Amy McQueen; Sally W. Vernon; Helen I. Meissner; and William Rakowski
Greater awareness and perceived risk of cancer are expected to motivate individuals to engage in cancer screening behaviors; therefore, risk perceptions are used to inform the development and evaluation of cancer screening interventions. Cognitive risk perceptions are hypothesized to be associated with affective constructs, such as cancer worry, and both are expected to have independent direct effects on behavior. Understanding the determinants of perceived risk and cancer worry could help improve health communications and cancer screening interventions. The determinants of perceived risk and worry are expected to differ, and gender may moderate these associations. Observed gender differences may indicate that different intervention messages or strategies are needed to influence males’ and females’ perceived risk of developing cancer and increase cancer prevention behaviors. Additionally, the determinants of risk perceptions and cancer worry may vary by cancer type, which may have implications for health care providers’ recommendations or intervention messages that promote screening tests for more than one type of cancer. In their paper, McQueen, Vernon, Meissner, and Rakowski used the Health Information National Trends Survey data to explore gender differences in the magnitude of, and associations with, perceived risk and worry by cancer type. They explored whether the correlates differed by gender, by cancer type (gender-specific vs. non gender-specific), and by measure of perceived risk (absolute vs. comparative)? Results showed small mean differences suggesting that men perceived greater risk of developing cancer, whereas women reported more frequent worry about cancer. Both males and females reported less perceived risk and worry for colon cancer compared with non gender-specific cancers. Correlates of perceived risk and worry varied, and several associations were moderated by gender. Prospective studies are needed to confirm these observed associations and to examine the temporal relations between cancer information seeking, perceived risk and worry, and cancer screening behavior.
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Increasing Mental Health Literacy via Narrative Advertising
- Chingching Chang

Depression affects 9.5% of Americans a year (Robins & Regier, 1990) and 11.7% of Taiwanese a year (Tung Foundation, 2003). Depression has become more serious among young people, who are less likely to seek help and have less knowledge about what help is available than their elders (Fisher & Goldney, 2003). In a survey of college students, Ker (2005) found that 10.2% of college students in Taiwan tried to commit suicide in 2004, and 90% of those who actually committed suicide suffered from depression. Therefore, developing mental health literacy among young adults in Taiwan is an important public health goal. This paper identifies three important objectives of an advertising campaign for increasing depression awareness: first, to generate more supportive attitudes or sympathy toward people with depression; second, to increase the willingness of people who suffer from depression to seek help; and finally, to enhance public efficacy in identifying individuals who suffer from depression. This study argues that narrative advertising is more effective at achieving these objectives than argument advertising. As expected, findings of the experiment showed that narrative advertising was more effective than argument advertising at engaging participants in experiential immersion, leading participants to express greater sympathy toward those suffering from depression. In addition, narrative advertising better involved participants in issue elaboration and increased willingness to seek professional help. Finally, in comparison to argument advertising, narrative advertising was rated as more vivid, resulting in an increase in participants’ perceived efficacy in recognizing friends or family suffering from depression.
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The Role of Emotion and Issue Involvement in Predicting Entertainment-Education Viewers’ Intention to Register as Cornea Donors: A Test of the Elaboration Likelihood Model and the Theory of Planned Behavior
- Hyuhn-Suhck Bae
Since the success of the BBC radio series The Archers in 1951 (see Singhal & Rogers, 1999) and Miguel Sabido’s (2004) telenovelas, E-E has been used extensively around the world to promote health and human rights (see Singhal, Cody, Rogers, & Sabido, 2004). In the United States, systematic efforts have been made to advance an E-E agenda for developed nations, paralleling E-E work in developing nations (Beck, 2004; Greenberg, Salmon, Patel, Beck, & Cole, 2004; Murphy & Cody, 2003; Salmon, 2001). This study examined the role of emotional responses and viewer’s level of issue involvement to an Entertainment-Education show about cornea donation in order to predict intention to register as cornea donors. Results confirmed that sympathy and empathy responses operated as a catalyst for issue involvement, which emerged as an important intermediary in the persuasion process. Issue involvement was also found to be a common causal antecedent of attitude, subjective norm, and perceived behavioral control, the last two of which predict intentions unlike attitude which does not. The revised path model confirmed that involvement directly influences intention. The findings of this study suggest that adding emotion and involvement in the Theory of Planned Behavior enhances the explanatory power of the theory in predicting intentions, which indicates the possibility of combining the Elaboration Likelihood Model and the Theory of Planned Behavior in the prediction of human behaviors.
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A Comprehensive Analysis of Breast Cancer News Coverage in Leading Media Outlets
- Charles K. Atkin; Sandi W. Smith; Courtnay McFeters; and Vanessa Ferguson

A comprehensive content analysis described news media coverage of breast cancer in nine leading newspapers, newsmagazines, and TV networks in 2003 and 2004. The 231 stories dealt with treatment (38%), prevention (35%), prevalence of the disease (30%), and detection (23%). Very few items specifically addressed risks related to controllable lifestyle practices such as pre-pubertal obesity or chemical contaminants in the environment. The prevention content tended to focus narrowly on use of pharmaceutical products; little information described risk reduction via other individual preventive behaviors (e.g., diet, exercise, and smoking), parental protective measures for daughters, or collective actions to combat contamination sites.
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Volume 13, Issue 2 (March 2008)

Article Summaries:

Cancer News Coverage and Information Seeking
- Jeff Niederdeppe; Dominick L. Frosch; and Robert C. Hornik

Niederdeppe, Frosch, and Hornik examined the relationship between cancer news coverage and information seeking by combining data from a large news database with a national survey of American adults. Results suggest that a notable segment of the population actively responds to periods of elevated cancer news coverage by seeking additional information. However, study findings also raise concerns about the potential for widened gaps in cancer knowledge and preventive behaviors between large segments of the population over time. Many adults, particularly those with fewer years of education, may require continued active efforts by public health advocates and medical practitioners to disseminate cancer prevention information. As patients are increasingly expected to play a more active role in making healthcare decisions, innovative interventions may be warranted to help a greater part of the population become more informed healthcare consumers.
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The 2005 British Columbia Antismoking Mass Media Campaign and Short Term Changes in Smokers Attitudes
- Lynda Gagne

The effect of the 2005 British Columbia smoking cessation mass media campaign on a panel (N = 1,341) of 20-30 year old smokers attitudes is evaluated. The five weeks campaign consisted of posters, television, and radio ads about the health benefits of cessation. Small impacts on the panel's attitudes towards the adverse impacts of smoking were found, with greater impacts found for those with no plans to quit smoking at the initial interview. As smokers with no plans to quit increasingly recognized the adverse impacts of smoking, they also increasingly agreed that they use smoking as a coping mechanism. Smokers with plans to quit at the initial interview were already well aware of smoking's adverse impacts. Respondents recalling the campaign poster, which presented a healthy alternative to smoking, decreased their perception of smoking as a coping mechanism and devalued their attachment to smoking. Evidence was found that media ad recall mediates unobserved predictors of attitudes towards smoking.
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The Perceived Effectiveness of Persuasive Messages: Questions of Structure, Referent, and Bias
- James Price Dillard, Sun Ye

To gain a sense of the persuasive efficacy of a message prior to implementation of a campaign, researchers often gather judgments of perceived effectiveness (PE). At present, they do so without much knowledge of the conceptual meaning or empirical properties of PE. In the spirit of construct explication, this paper reports a study intended to address a series of questions about PE. Using student (N = 155) and community samples (N = 100), it was found that: (a) PE is a two-dimensional judgment involving global evaluations of message impact and specific judgments of message attributes, but it may be reducible to a single second-order factor, (b) most individuals reporting using more than one referent (i.e., person or group) when making PE judgments, but the choice of referents varies by message and judge, and (c) judgments of PE are biased upward as a function of the number of referents chosen. From this effort, we gained insight into several key features of PE. First, PE may be conceived of as a two-dimensional construct consisting of global evaluations of message impact and specific judgments of message attributes. However, it is possible that these two dimensions can be viewed as indicators a single, more abstract concept. Second, for most people, PE judgments naturally involve the use of multiple referent groups. The choice of those groups is susceptible to the influence of both message and individual factors. Third, PE judgments are associated with an upward bias as a function of the number of referents used in the judgment. Although the direction of the bias is not yet established, previous research suggests that it probably reflects a tendency to overestimate the effect of the message on others rather than the reverse. Additional research is needed to ascertain whether or not the bias can be corrected through some combination of statistical and experimental control.
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Alternate Methods of Framing Information About Medication Side Effects: Incremental Risk Versus Total Risk of Occurrence
-- Brian J. Zikmund-Fisher; Angela Fagerlin; Todd R. Roberts; Holly A. Derry; and Peter A. Ubel

Communications of treatment risk, such as medication package inserts, commonly report total rates of adverse reactions (e.g., 4% get heartburn with placebo, 9% with medication). This approach, however, requires people to do mental arithmetic to figure out just how much risk was caused by the medication (here, 5%). In two Internet-administered survey experiments (N=2,012 and 1,393), we tested whether explicitly reporting the incremental risk and framing it as the "additional risk" of complications would change people's impressions of adverse event risks. Results showed that incremental risk formats (both textual and graphical) significantly lowered participants' worry about complications. In addition, Study 2 showed that it is incremental risk framing, rather than sequential presentation of risk statistics, that causes the reductions in both perceived likelihood and worry. Using this approach also reduced biases caused by varying the risk denominator from "X out of 100" to "Y out of 1000," making risk perceptions more consistent. Explicitly reporting incremental risk statistics appears to facilitate recognition of how much risk already exists at baseline. Presenting adverse reaction risks in this manner may improve patient comprehension of the effects of treatment decisions and support effective risk communication.
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Getting to Know the Competition: A Content Analysis of Publicly and Corporate Funded Physical Activity Advertisements
--Tanya R. Berry; Ron E. McCarville; and Ryan E. Rhodes

Berry, McCarville and Rhodes examined the content of all advertisements in top circulation Canadian magazines that contained references to physical activity for features designed to gain attention. They found a paucity of publicly funded health promotion advertisements and a large number of commercially sponsored advertisements that used physical activity to sell a product. The commercial advertisements were those most likely to contain features that would draw attention. This research underlines the importance of examining the many sources and purposes behind advertisements that compete with health promotion initiatives.
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Volume 13, Issue 3 (April/May 2008)

Article Summaries:

Formative research to develop a mass media campaign to increase physical activity and nutrition in a multiethnic state
-Jay Maddock, Alice Silbanuz and Bill Reger-Nash

Poor nutrition and physical inactivity are the second leading causes of preventable morbidity and mortality in the US. Mass media campaigns have tremendous promise for reaching large segments of the population to influence these behaviors. However, there is still insufficient evidence in the literature to recommend mass marketing campaigns for physical activity and nutrition. Successful mass media campaigns should have a formative research base which includes conducting preproduction research with the target audience, using theory as a conceptual foundation of the campaign, segmenting the audience into meaningful subgroups, and using a message approach that is targeted to and will likely be effective with the audience segment. In this study, these formative research steps were addressed to develop a mass media campaign based on the Theory of Planned Behavior to increase physical activity and fruit and vegetable consumption in 35-55 year old adults in the state of Hawaii. For the walking campaign, our results identified time, a control belief, as the major barrier. For fruits and vegetable, the data suggested social norm (if others around me ate them) and control (if they were available). These data were then used to develop a mass media campaign based on these principals.
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Experimental Pretesting of Public Health Campaigns: A Case Study
- Jill Whittingham
In practice, most new health campaign materials are only tested after they have been distributed using non-experimental or quasi-experimental designs. In cases where materials are pretested prior to distribution, pretesting is usually done using qualitative research methods such as focus groups. Although these methods are useful, they cannot reliably predict the effectiveness of new campaign materials in a developmental phase. We suggest when pretesting new materials, not only qualitative research methods but also experimental research methods must be used. The aim of the present study is to demonstrate the merits of evaluating new public health campaign materials in the developmental phase using an experimental design. This is referred to as experimental pretesting. We pretested new campaign materials intended for distribution in a national STI/AIDS prevention campaign in the Netherlands. The campaign material tested was the storyline of a planned television commercial on safe sex. A storyboard that consisted of drawings and text was presented to members of the target population, namely students between the ages of 14 and 16 enrolled in vocational schools. The results show that exposure to the storyline of the television commercial produced a positive effect on risk perception. Unfortunately, this effect was restricted to girls. The storyline also had a positive effect on the intention to buy and carry condoms and on the intention to take initiative in discussing condom use before having sex. These findings suggest a positive effect of the exposure of the television commercial on important determinants of safe sex behavior among young people. The advantages, practical implications and limitations of experimental pretesting are discussed.
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Adolescents' Responses to Peer Smoking Offers: The Role of Sensation Seeking and Self-Esteem
- Kathryn Greene and Smita Banerjee
Greene and Benerjee classified adolescent reports of their responses to cigarette smoking offers utilizing four drug refusal strategies of Refuse, Explain, Avoid, and Leave (REAL) and explored how personality factors explain adolescents’ use of cigarette refusal strategies. Results revealed that the strategy of explain was reported most frequently for initial and follow-up smoking offers. Adolescents with greater number of friends who smoked were more likely to use the avoid strategy for initial smoking offers. Sensation seeking was positively related with the use of leave and avoid strategies for initial smoking offers and leave strategy for follow-up smoking offers. No association was found between self-esteem and use of smoking refusal strategies.
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Randomized Trial on the 5 a Day, the Rio Grande Way Website: A Web-based Program to Improve Fruit and Vegetable Consumption in Rural Communities
- David Buller, et. al.
The Internet is a new technology for health communication in communities. The 5 a Day, the Rio Grande Way website intended to increase fruits and vegetables (FV) consumption was evaluated in a rural region enrolling 755 adults (65% Hispanic, 9% Native American, 88% female) in a randomized pretest-posttest controlled trial in 2002-2004. A total of 473 (63%) adults completed a 4-month follow-up. The change in daily intake on a food frequency questionnaire (control: mean=-0.26 servings; intervention: mean=0.38; estimated difference=0.64, SD=0.52, t(df=416)=1.22, p=0.223) and single item (13.9% eating 5+ servings at pretest, 19.8% posttest for intervention; 17.4%, 13.8% for controls; OR=1.84, 95% CI=1.07, 3.17) was in the expected direction but significant only for the single-item. Website use was low and variable (logins: M=3.3, range=1 to 39.0; total time: M=22.2 minutes, range=0 to 322.7), but positively associated with fruit and vegetable intake (total time: Spearman r=0.14, p=0.004 for food frequency; Spearman r=0.135, p=0.004 for single item). A nutrition website may improve FV intake. The comparison on the food frequency measure may have been undermined by its high variability. Websites may be successful in community settings only when used enough by adults to influence them.
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The Contribution of Anti-Smoking Advertising to Quitting: Intra-and Inter-Personal Processes
- Sally Dunlop and Melanie Wakefield
Dunlop, Wakefield and Kashima used a population survey to explore the roles of transportability – the tendency to become absorbed in a narrative – and interpersonal discussion in the use of televised anti-smoking advertising in attempts to quit smoking. The results indicated that smokers and ex-smokers who were more transportable were more likely to recall anti-smoking advertising and to report that they such advertising helped in their attempts to quit smoking. Results also showed that smokers and ex-smokers who reported talking about the advertisement that they recalled were more likely to have made an attempt to quit smoking than those who recalled an advertisement but did not talk about it.
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Health Literacy of HIV-Infected Individuals Enrolled in an Outreach Intervention: Results of a Cross-Site Analysis
- Mari-Lynn Drainoni
This paper examines health literacy among a group a HIV-positive persons at risk for receiving sub-optimal health care due histories of substance abuse, mental illness, incarceration and unstable housing or homelessness. Participants receiving services from three Outreach programs funded as part of a multi-site demonstration project were screened for health literacy using the TOFHLA at program enrollment. The goal of this analysis was to identify demographics, risk factors and health indicators associated with different levels of health literacy. Results indicated that although less than 30% of the sample scored in the marginal or inadequate range for health literacy, participants with these lower levels of health literacy were more likely to be African American or Latino/a, heterosexual, speak Spanish as their primary language, and have less than a high school education. The disparities in health literacy found in this study point to a need to assess level of health literacy and provide culturally-sensitive health literacy interventions for persons with chronic diseases such as HIV. In addition to offering these services within HIV health care settings, other potential venues for health literacy assessment and intervention include substance abuse treatment and community-based social service, education, and training programs. Health care and support service providers must also become aware of the importance of health literacy when caring for all patients with HIV, particularly those most likely to have low health literacy.
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