Volume 3, Number 2
April-June 1998

Vol. 3, Num. 2: Contents | Editorial | Up Front | Abstracts

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

Up Front 3.2
Vital Data

From This Issue

In keeping with the Journal of Health Communication's international perspective, the first article evaluates the impact of the North Karelia (Finland) project on smoking cessation attempts.  The study used data from annual surveys to evaluate the project's effectiveness.  The smoking cessation attempts of 1,694 adult current and former smokers were studied.  Reported exposures to mass-media and interpersonal health communication were examined as possible determinants of smoking cessation.  Weekly exposure to a mass-media health message was significantly associated with cessation attempts among men only.  Interpersonal health communication was a  significant determinant of cessation attempts among both sexes.  Exposure to both mass-media and interpersonal health communication had an even stronger impact on cessation attempts. Thus, interpersonal communication appears to be an important catalyst in community smoking cessation programs, and its inclusion should be emphasized to achieve a greater impact.  Korhonen, T., Uutela, A., Korhonen, H.J., & Puska, P.  Impact of Mass-Media and Interpersonal Health Communication on Smoking Cessation Attempts: A Study in North Karelia 1989-1996. (p. XX-XX)

The second article also explores effective aspects of health communication campaigns. The Elaboration Likelihood Model (ELM), which suggests that some communication elements are processed differently depending on the receiver's involvement with the message topic, served as a basis for the study.  It was hypothesized that women with high levels of breast cancer involvement would be more influenced by a mammography message's arguments than by the message's peripheral cues.   Conversely, it was hypothesized that women with low levels of involvement would be more influenced by a mammography message's peripheral cues than by its arguments.  Eighty-nine  low-income African-American women aged forty to sixty-five were exposed to two repetitions of a public service announcement (PSA) promoting mammograms. High involvement women reported stronger intentions to seek additional mammography information than did low involvement women, regardless of argument strength or cue favorability.  Low involvement women reported stronger intentions to seek more mammography information only when exposed to the favorable cue condition.  The analysis showed that argument strength had no effect in either high or low involvement women. Since many women have low breast cancer involvement, health communicators should use mammography promotion messages with favorable peripheral cues to stimulate mammography information.  Kirby, S.D., Ureda, J.R., Rose, R.L. & Hussey, J.  Peripheral Cues and Involvement Level: Influences on Acceptance of a Mammography Message. (p. XX-XX)

The third article examines how tobacco billboards target minorities. This study was a longitudinal comparison of the frequency and content of tobacco ads along  thoroughfares in four types of Los Angeles ethnic neighborhoods.  Tobacco ad density, concentration, and content in the four neighborhood types were compared at multiple time points from 1990 to 1994. African-American and Hispanic neighborhoods contained greater tobacco ad concentration than did White neighborhoods.  Initial differences in tobacco ad frequency decreased significantly over time.  However, the age, race, and gender of billboard characters remained different among the different ethnic neighborhoods, with greater ethnic specific content in African-American neighborhoods than in other neighborhoods. These data are consistent with the assertion that tobacco companies target ethnic minorities with higher rates of advertising and ethnically tailored campaigns. Stoddard, J.L., Johnson, C.A., Sussman, S., Dent, C., & Boley-Cruz, T. Tailoring Outdoor Tobacco Advertising to Minorities. (pp. XX-XX)

The Forum article looks at stigmatized conditions in public health.  The article considers the paradox that health communication approaches to prevent injury may portray people with disabilities in a stigmatizing way.  The psychosocial consequences of  stigma  heighten the stakes for people with disabilities who strive for fair treatment in employment, social interaction, and policy outcomes.  In an era in which health communication is hailed as a remedy for an unprecedented array of health conditions, this articles poses a starting point for critically examining how health communication may better prevent the many ailments of humankind.  Wang, C. Portraying Stigmatized Conditions: Disabling Images in Public Health. (pp. XX-XX)

From Other Sources
Several articles in other sources explore aspects of smoking in the United States.  The February 19, 1998 JAMA  contains an article about how the tobacco industry use adolescents' suggestibility to advertisements to get them to start smoking.  The longitudinal study documents a causal link between such promotional activities and smoking behavior.  Through telephone interviews in California in 1993, the investigators identified 1,752 adolescents who had never smoked and said they did not intend to do so.  About forty-five percent were twelve to thirteen years old.  In a follow-up interview three years later, 16.6% said they would not rule out the possibility of smoking, 29.5% had experimented with cigarettes, and 3.6% had smoked at least 100 cigarettes.  There were not sex differences.  The higher the baseline receptivity to advertising and promotional activities, the greater the likelihood of progression along this smoking continuum.  Being able to name a favorite cigarette advertisement was a predictor of future smoking, but willingness to use a promotional item (e.g., a T-shirt) was an even greater predictor.  Adolescents highly receptive to promotional items were almost three times as likely to progress toward smoking as their unreceptive counterparts.  Pierce J.P. et al. Tobacco industry promotion of cigarettes and adolescent smoking.  JAMA  Feb 18, 1998; 279:511-515.
 
The December 26, 1997 MMWR  describes adult patterns of smoking.  The most recent government statistics indicate that tobacco is a firmly entrenched national health hazard among U.S. adults.  The Centers for Disease Control and Prevention (CDC) surveyed a nationally representative sample of more than 17,000 adults in 1995.  Overall, 24.7% of adults were current smokers, for an estimated total of 47 million.  Smoking was more common among men than women (27% vs. 22.6%) and among adults living below the poverty level than others (32.5% vs. 23.8%).  It was far less common among college-educated adults than high school dropouts (14% vs. 37.5%).  About twenty-six percent  of both Whites and Blacks smoked.  Smoking was less prevalent among Asians/Pacific Islanders and Hispanics (16.6% and 18.3%) and more prevalent among Native American and Alaskan populations (36.2%).  Roughly twenty-five percent of adults under age sixty- five smoked compared with only about thirteen percent of adults older than sixty-five. Cigarette smoking among adults -- United States 1995.  MMWR  1997 December 26; 46:1217-20.

At a time when adult use of tobacco in the U.S. is declining, the opposite trend is  occurring among children.  A study conducted by Sargent et al. suggests that a major  reason for increased smoking among middle- and high-school students is the tobacco industry's massive marketing of cigarette promotional items (CPIs) such as clothing,  lighters, backpacks, camping gear, and electronics.  Researchers surveyed students in  grades six through twelve from five rural New Hampshire and Vermont public schools  or  CPI ownership.  One-third owned CPIs, with an approximately even distribution across  grade levels and sexes.  Most CPIs were obtained from a family member or another adult.  Students who owned CPIs were more than four times as likely to smoke as students who did not own them.  Other risk factors for smoking included poor-to-average school performance and having friends or family who smoked.  Sargent, J.D., et al. Cigarette promotional items in public schools.  Arch Pediatr Adolesc Med 1997 Dec; 151:1189-96.

On December 4, 1997, European Union (EU) Health Ministers reached a Common Position on an eight-year phase-out of tobacco advertising in the EU.  Advertising of tobacco products on television has been banned in the EU since 1989, and all EU countries currently restrict advertising of tobacco products in other media to some extent including, in some cases, a total ban.  However, the different national approaches have impeded the proper operation of the single market and have undermined efforts to protect young people from tobacco promotion.  After eight years of effort and compromise, the Commission's proposal for a total ban on tobacco advertising finally achieved a qualified majority in the Council, ensuring a common EU approach on the issue.  Under the agreement, most tobacco advertising must be phased out within three years, print media advertisements within four years, and tobacco sponsorship of most sports and arts events within six years.  The Common Position, which still requires the European Parliament's approval will permit tobacco trade publications, advertising at point of sale, presentation of tobacco products, and the import of third country publications containing tobacco advertising.  It will also allow member states to maintain stronger national rules if they wish.  EURECOM, December 1997; 9(11): 2.

Internet Resources
The Community Breast Health Project's extensive online site is a good place to go for breast cancer information that includes psychosocial information as well as clinical information. The Project's mission is to improve the lives of people affected by breast cancer by acting as a clearinghouse for information and support, providing volunteer opportunities for breast cancer survivors and friends, and serving as an educational resource and a community center for all who are concerned about breast cancer and breast health.  The site includes a variety of resources including practical information, personal accounts from breast cancer patients, medical issues, psychosocial information, links to relevant sites, volunteer opportunities, information about the Project, and articles from their newsletter.  This site is aimed at patients and their families, however it is also a good resource for practitioners who are interested in helping their patients on more than just the clinical level.  The address for the site is http://www.med.stanford.edu/CBHP/.

MedicineNet is a consumer-oriented site that presents credible information that helps consumers understand their health.  The main sections of the site are Diseases and Treatments, Pharmacy, Ask the Experts, Medical Dictionary, Medical News, and Body Rhythms.  The Diseases and Treatments section provides easy-to-use information about almost every disease. The Pharmacy section has an alphabetical index of both over-the- counter and prescription drugs.  Ask the Experts has a review of over 6,000 questions and answers, plus users can ask their own questions.  This site is a good place for consumers to find the answers to their health care questions.  The site is located at http://www.medicinenet.com/.

The Health Care Financing Administration has a new Internet site designed solely with the Medicare beneficiary in mind.  It contains information for Medicare beneficiaries and their families to help them make informed choices about their health care.  Special features of this site include Medicare Compare, a database which provides comparative cost and benefit information for Medicare managed care plans customized to the beneficiaries location; information on all the HCFA health promotion activities; and a "Who to Contact" section with information on who a beneficiary should call with questions.  The site is located at http://206.161.111.13/www_medicare_gov/index.html/.

Upcoming Conferences and Events
The 14th Annual Meeting of the International Society of Technology Assessment in Health Care will take place June 7-10 in Ottawa, Ontario, Canada.  The topics of the sessions are alternative and complementary medicine and Mad Cow Disease and Prions: dealing with unknown future risks.  The topics of the panel sessions include communication of the results of health technology assessment, what developing and developed countries can learn from each other about health technology assessment, and methodological issues in health technology assessment.  For more information, please contact Glenna Gosewich, Program Coordinator, Clinical Epidemiology Unit, F6, Ottawa Civic Hospital, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9; Tel: 613-798- 5555 ext. 6788; Fax: 613-761-5351; E-mail:ISTAHC-OTTAWA98@1ri.ca.

The National Communication Association's International Conference will be held July 15-18 in Rome, Italy. The theme of the conference is "Communication: Organizing for the Future."  The purpose of the conference is to promote dialogue among  communication scholars from Europe and the United States.  The conference is designed to provide an understanding of the philosophical, epistemological, and methodological assumptions of communication scholars in the represented countries.  For more information, please contact Sherry Morreale at 703-750-0533.
 
Former Israeli Prime Minister Shimon Peres will speak at the 48th annual International Communication Association conference July 20-24 in Jerusalem.  The theme of the conference is "(Mis)Communicating across Boundaries."  One topic that has been scheduled is media coverage surrounding the August 1997 death of Princess Diana.  For more information, contact ICA Headquarters, P.O. Box 9589, Austin, TX 78766 USA or visit the conference website at http://www.icahdq.org/conference/conference.html.

The 1998 Multicultural Marketing Conference sponsored by the Academy of Marketing  Science and Concordia University will be held in Montr al, Canada on September 7-20. The purpose of the conference is to increase the knowledge base of multicultural marketing issues as they impact marketing strategies and operations in all facets of marketing in diverse market settings.  The conference also aims to bring together marketing academicians and practitioners from many countries to explore the complexities of and solutions to multicultural issues in marketing theory and practice.

Other conferences in 1998 include:

• National Communication Ethics Fifth Conference, May 7-10, Gull Lake, MI.  For more information, please contact James A. Gilchrist at 616-387-3130.

• Communication in Health Care, Netherlands Institute of Primary Health Care,   June 10-12, Free University, Amsterdam. For more information, please contact  Peter Verhaak at 31-30-2319946 or p.verhaak@nivel.nl.

• 8th Annual Conference in Social Marketing in Public Health, June 10-13, Clearwater Beach Florida.  To have your name added to the mailing list, fax  813-974-7860 or e-mail gphillip@com1.med.usf.edu.

• National Communication Association Summer Conference on Public Relations,  July 9-12, Washington DC. For more information, please contact Sherry  Morreale at 703-750-0533.

• Society for Public Health Education 49th Annual Meeting: Improving Health  Through Advances in Education, Policy, Science, and Technology, November  13-15, Washington, DC.  For more information, please contact the Society for  Public Health Education, 1015 15th St., NW, Suite 410 Washington, DC  20005; Tel: 202-408-9804; E-mail: sopheauld.aol.com.

• National Communication Association 84th Annual Convention, November 20-24, New York Hilton/Marriott Marquis. Contact Sherry Morreale at 703-750-0533.

Publications
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recently published updated fact sheets entitled Diabetes in African Americans  and Diabetes in Hispanic Americans.  The fact sheets compile data from a variety of epidemiological resources including the recently revised Diabetes in America, published by NIDDK.  Both fact sheets review the prevalence of diabetes in these subgroups, cover the genetic and environmental risk factors that contribute to the high prevalence of diabetes, discuss the increase morbidity and mortality from diabetes-related complications, and mention NIDDK's efforts in addressing the growing problem of diabetes in these subpopulations. One copy of each fact sheet is available through the Internet at the NIDDK home page (http://www.niddk.nih.gov).  You can also receive copies by contacting NIDC, ATTN: AAHA, 1 Information Way, Bethesda, MD  20892-3560; Tel: 301-654-3327; Fax: 301-907-8906; E-mail: ndic@info.niddk.nih.gov.

The Health Improvement Institute recently published a workshop report entitled Quality of health information on the Internet -- enabling consumers to tell fact from fraud.  The report is the result of a workshop held on November 17, 1997 to examine the quality of health information on the Internet.  The report summarizes workshop results and list the steps the Health Improvement Institute is prepared to pursue toward enabling consumers to evaluate the quality of health information on the Internet.  To obtain a copy of the workshop workbook, please contact the Health Improvement Institute at 4340 East West Highway, Suite 105, Bethesda, MD  20814-4411; Tel: 301-652-1818; Fax: 301-652- 1250; E-mail: hii@mcman.com. Grant Opportunity The American Cancer Society has established a new grant program, Targeted Research Project Grants in Prostate Cancer, and has made available $7.5 million per year in funding. Two grant areas that relate to health communication are Behavioral, Psychosocial, and Quality Life research and Health Policy research.  Within the area of behavioral, psychosocial, and quality life, research is needed in areas including, but not limited to: studies in the emotional, psychological, cultural, racial, and gender factors influencing decision-making regarding early detection, screening, treatment selection, compliance, and coping strategies, particularly focusing on high-risk groups; the impact of social support groups; and the psychosocial impact of prostate cancer on the family.  Health Policy research investigates the creation and effects of laws and public policies that affect people who are making decision related to prostate cancer prevention and control. Deadlines for the grants will be October 15, 1998; April 1, 1999; and October 15, 1999.  Questions concerning the grants should be directed to Dr. Frank Baker at 404-329-7795.

Prescriptions
Korhonen, Uutela, Korhonen, and Puska from the National Public Health Institute in Finland conducted a study in North Karelia to analyze the impact of mass-media and interpersonal communication on smoking cessation attempts.  Results based on the data collected during eight years suggest the following:

• Mass-media health communication alone may not be effective enough to lead to behavioral changes, such as smoking cessation attempts.

• Interpersonal communication between a smoker and a lay person may be as effective as communication by health professionals to encourage cessation  attempts.

• Professional and lay person networks can and should be used as valuable instruments in community programs to enhance the effects of mass media.

Kirby, Ureda, Rose, and Hussey studied the application of the Elaboration Likelihood Model (ELM) to mammography promotion messages.  From their research they developed the following recommendations for public health campaign planners and
researchers:

• Researchers should study various health issues and population groups to  determine the robustness of the ELM for health communication applications.

• Applied health communication researchers should ensure that relevant and irrelevant arguments as well as favorable and unfavorable peripheral cues are identified during formative research.

• Program planners should segment populations on intrinsic involvement with  health problems and behaviors.

• Health message designers should utilize relevant arguments and favorable  peripheral cues in health messages for high and low involvement audiences.

Stoddard, Johnson, Sussman, Dent, and Boley-Cruz studied how outdoor tobacco advertising was targeted to minorities.  Their recommendations for tobacco research and control activities are the following:

• To neutralize the impact of ethnically targeted tobacco messages, researchers must continue to monitor tobacco marketing activity and counter it with  appropriate tobacco control activities.

• Tobacco control activities must address new and varied forms of tobacco  promotions (e.g. event sponsorship, bar promotions) and also consider the  special audience characteristics when designing and placing its messages.

• By becoming apprised of new tobacco marketing development, researchers will  be poised to respond to strategies that are designed to entice new or vulnerable markets, such as youth and or minority cultures.

In her forum article, Wang discusses the unintended psychosocial consequences of health communication about disabilities.  The article recommends that to create ethical and effective public health campaigns, health advocates should ask the following questions:

• What works?

• How might there be unintended consequences?

• Who are the stakeholders who might be affected by the portrayal of a stigmatized condition?

• Who are the stakeholders who can help us to evaluated health communication  approaches in a critical fashion?

The Up Front section is edited by Scott C. Ratzan and Amy Chadwick of Emerson College, Boston, MA.  Amy Chadwick is also the electronic edition editor.