UP FRONT

Volume 5, Number 1
January-March 2000

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

Vital Data

From This Issue

The first article in this issue assesses the effect alcohol advertising has on children’s perception of drinking and on their future decisionmaking concerning alcohol.  While the majority of children do not begin drinking alcohol until the preteen or teen years, precursors of substance use behavior are well under development by the third grade.  Austin and Knaus surveyed 273 children in the third, sixth, and ninth grade on 1)their identification with people appearing in television advertisements, 2)the degree to which people in alcohol advertisements served as positive role models, 3)their self-reported risky behavior, and 4)their alcohol predrinking behavior.  The extent to which children viewed alcohol advertisements increased steadily from the third to ninth grade, while identification with media portrayals leveled off after the sixth grade.  The desirability of messages and identification with portrayals of alcohol use positively predicted expectancies, which the authors conclude, could predict future use of alcohol products. In addition, predrinking behavior and self-reported risk behavior of the children were positively correlated.  Because of the age trends, the authors conclude that interventions intended to prevent early use of alcohol should begin by the third grade and should aim to reduce the extent to which media portrayals serve as positive role models to children.  Austin, E. W. and Knaus, C. Predicting the Potential for Risky Behavior among Those “Too Young” to Drink as the Result of Appealing Advertising.

Bringing an international perspective to the Journal of Health Communication, the second article looks at how knowledge of an issue does not necessarily correlate with acceptance.  Jallinoja and Aro studied the attitudes and knowledge towards gene tests among the Finnish population by surveying a random sample of 2,000 people.  Of the 1,216 respondents, a majority accepted that gene tests should be available to everybody who wants to take them voluntarily, and that gene tests may improve people’s quality of life.  However, half of all respondents worried that gene test may lead to eugenics.  Those with a higher level of knowledge of gene tests were more concerned about this issue than those with a low level of knowledge.  While enthusiasm and suspicion of gene tests have decreased slightly since 1993, those with a higher level of knowledge on the issue still exerted more enthusiasm and more skepticism than among those with the lowest level of knowledge. Many of those with a low level of knowledge of genetics were less likely to express an opinion, positive or negative, on gene testing.  The authors suggest that steps should be taken to increase citizens’ capabilities to understand information of genetics through such venues as the media and school biology curriculum. Jallinoja, P. and Aro, A. R. Does Knowledge Make a Difference? The Association between Knowledge about Genes and Attitudes towards Gene Tests.

The authors in the third article examine the extent to which certain parents discuss sex with their adolescents.  Interviewing 486 pairs of mothers and adolescents, DiIorio, et al. asked mothers about two cognitive variables associated with sex-based communication—self-efficacy (confidence in their ability to discuss sexual issues with their adolescent) and outcome expectancy (beliefs about the outcomes associated with sex-based communication), as well as their self-reported level of communication about sex with the their adolescent, their education level and the importance of religion in their life.  The findings from the research were in line with social cognitive theory.  Results from a regression analysis showed that self-efficacy, outcome expectancies, age of the adolescent, and the importance of religious beliefs of the mother were significant.  Mothers who expressed higher levels of self-efficacy and more favorable outcomes associated with talking to their children about sex were more likely to do so.  Based on these findings, future HIV education and prevention activities may be inclined to extend beyond the adolescent to include parents in family-based prevention programs. DiIorio, C., Resnicow, K., Dudley, W., Thomas, S., Manteuffel, B., Wang, D. T., Van Marter, D. F., and Lipana, J. Social Cognitive Factors Associated with Mother-Adolescent Communication About Sex.

The fourth article in this issue focuses on the role of communication practices in a residential facility with people with AIDS.  People with AIDS have encountered both the collapse of the traditional community support structure and the mobilization of new forms of community support.  The residential facility for people with AIDS, which serves as a type of “community,” offers a social context for understanding how communicative practices help members cope with significant health issues.  Frey, et al. surveyed 59 members of a residential community for people with AIDS.  Questionnaire results show that everyday and special rituals influenced the residents’ perception of their health and well-being.  For example, participating in these rituals or not participating in them became a way of demonstrating both physical health and emotional connections to other members of the community. In addition, governance and support communicative practices, such as weekly house meetings, were found to be related to residents’ perceptions of the value of living at the residential facility.  Furthermore, the authors discuss the importance of communication practices in creating and sustaining such concepts as health and community. Frey, L. R., Adelman, M. B., Flint, L. J., and Query, J. L. “Weaving Meanings Together in an AIDS Residence: Communicative Practices, Perceived Health Outcomes, and the Symbolic Construction of Community.

The first two pieces in the Forum section relate to an earlier Forum article published in the Journal of Health Communication 4(2) entitled “A Critical Perspective on the Drug Czar’s Anti-Drug Media Campaign.”  The first Forum piece appearing in this issue is a letter written by Barry McCaffrey, Director of the Office of National Drug Control Policy, in response to the article’s critique of the ONDCP’s anti-drug media campaign.  The second piece featured in the Forum section is a response to General McCaffrey’s letter written by DeJong and Wallack, the original authors of the anti-drug media campaign critique in the Journal’s spring 1999 issue. McCaffrey, B. R. Response to DeJong and Wallack’s Article: A Critical Perspective on the Drug Czar’s Anti-Drug Media Campaign and DeJong, W. and Wallack, L. The Drug Czar’s Anti-Drug Media Campaign: Continuing Concerns.

The third piece in the Forum section focuses on the role of counteradvertising in anti-tobacco campaigns.  Like the third article in this issue, this article also uses social cognitive theory as the conceptual framework for the study.  Hawkins and Hane investigate adolescents’ perceptions of print cigarette advertising.  While there was no significant difference between adolescent smokers’ and nonsmokers’ recollections of print cigarette ads, smokers’ expressed a higher level of belief in the messages of advertisements than nonsmokers.  Social cognitive theory asserts that a behavior may be learned by mere observation of that behavior. Furthermore, the pervasive nature of media, especially television, has dramatically increased opportunities to engage in observational learning. From the findings in this study, the authors suggest that counteradvertising may be the most potent weapon against cigarette advertising’s influence on adolescents.  Hawkins and Hane suggest guidelines for an effective counteradvertising campaign directed against youth smoking.  Hawkins, K. and Hane, A. C.  Adolescents’ Perceptions of Print Cigarette Advertising: A Case for Counteradvertising.

From Other Sources

A recent article in the American Journal of Public Health discusses the success of a public radio broadcast of a workshop on managed care.  Previous research by the Community Service Society of New York (CSS) concluded that a large percentage of Medicaid recipients in the New York area were not adequately informed about the basic concepts of managed care.  After compiling a curriculum to help Medicaid recipients select and use a managed care plan, CSS broadcasted one of the workshops on a community public radio station serving the New York City metropolitan region. Several phone lines were open for callers to ask question.  While only four people called the managed care hotline during the two weeks before the broadcast, 95 called on or after the day of the broadcast.  Of those calls, 56 percent said they were more knowledgeable about how to select a managed care plan after hearing the broadcast and 63 percent said that they liked hearing the broadcast on the radio.  While the evaluation could not determine if those participants could read or not, radio health broadcasts could be an effective mechanism for disseminating information to those who are functionally illiterate. The authors concluded that public radio should be considered in health campaigns because of its low cost, accessibility, and effectiveness. Mason, et al. “Notes From the Field: using Public Media to Teach Medicaid Recipients About Managed Care,” American Journal of Public Health 90(1), January 2000, 34-35.

How much do physicians foster patient involvement in decision making?  This is the question that Braddock et al. in JAMA set out to examine in their study of encounters between primary care physicians or surgeons and patients.  The authors analyzed audiotaped patient-physician discussions for elements of informed decision making, with varied levels of complexity: basic (e.g., laboratory test), intermediate (e.g., new medication), or complex (e.g., procedure).  Criteria in the analysis included the physician discussing the nature of the decision with the patient and asking the patient to voice a preference.  More complex decisions consisted of more stringent criteria.  The 1057 audiotaped encounters analyzed contained 3552 clinical decisions.  Overall, nine percent of the decisions met the authors’ definition for informed decision making. Basic decisions were most often completely informed (17.2%), while no intermediate decisions were completely informed.  Only 1 (0.5%) complex decision was completely informed. In general, surgeons had more completeness of informed decision making than primary care physicians.  Among the characteristics of informed decision making, discussion of the nature of the intervention occurred most frequently (71%) and assessment of patient understanding occurred least frequently (1.5%).  These findings signal the need for efforts to encourage informed decision making in clinical practice.  Braddock, Clarence, et al. “Informed Decision Making in Outpatient Practice: Time to Get Back to Basics,” JAMA 282(24), December 22, 1999, 2313-2320.

Since the pharmaceutical care field is growing to include a higher level of interaction between pharmacist and patient and pharmacist and healthcare team, pharmacy schools were surveyed to see how their curriculum was responding to this change.  Of the responding schools, 87 percent reported having mandated communications courses, and more than 50 percent of respondents reported incorporating multiple aspects of communication in courses including: oral communication, written communication, patient counseling and/or interviewing, non-verbal communication, communication theory, professional communication, cultural diversity, and new technologies.  While the majority responded to incorporating communication courses into their pharmacy programs, the emphasis placed on communication courses varied from two credit hours of study required to ten.  The author concludes that providing pharmacy students and future pharmacists with enhanced communication skills may be the difference between the evolution of pharmaceutical care and its actual practice. Blaetz, E., “Communication Skills for Pharmacists,” GPPH Rounds, Fall 1999, 3.

Upcoming Conferences and Events

The 12th National HIV/AIDS Update Conference, “HIV/AIDS at the Crossroads: Confronting Critical Issues,” will be held in San Francisco, CA, March 14-17, 2000.  For more information, contact: Felicissimo and Associates, (514) 874-1998 or visit http://www.nauc.org.

Celebrate National Public Health Week 2000!  The American Public Health Association is sponsoring National Public Health Week, “Healthy people in Healthy Communities” from April 3-9, 2000. This national celebration provides an opportunity to recognize the contributions of public health to the nation's well-being as well as help focus public attention on major health issues in our communities. The event is celebrated in 46 states and by 60 percent of local health departments. For the planners’ guide, visit http://www.apha.org/news/press/guide.htm.

The American Association of Health Plans (AAHP) is sponsoring the conference, “Building Bridges VI—The Road to Quality Care: Using Research to Drive Quality Improvement” at the Grand Hyatt in Atlanta, GA. The conference will be held on April 6-7, 2000.  For more information, contact AAHP at (202) 778-3269 or visit http://www.aahp.org.

The “QHR2000: The Sixth Annual Qualitative Health Research Conference” will be held on April 6-8, 2000 in Banff, Alberta, Canada. The conference is sponsored by the International Institute for Qualitative Methodology and the University of Alberta.  For more information, visit http://www.ualberta.ca/~iiqm/qhr2000/index.html.

The 3rd Annual Regional Conference on Teaching Communication will be on April 7, 2000 at Johnson & Wales University, Providence, RI.  For more information, contact: Marsha Norwood, (401) 598-1462 or mnorwood@jwu.edu.

The University of Kentucky in Lexington will be hosting the Kentucky Conference on Health Communication on April 13-15, 2000.  For more information, contact (606) 257-3622 or jsbear0@pop.uky.edu or visit the website, http://www.uky.edu/CommInfoStudies/COM/kchc.

The conference, “Communication in the Age of Managed Care” will be held on May 5-6, 2000 in  College Station, TX.  For more information, contact: Katherine Miller (409) 862-6780 or kimiller@tamu.edu.

Friends of the National Library of Medicine’s fifth annual conference, “Health Information on the Net: The Good, The Bad, and The Deadly” will be held on June 5-7, 2000 in the Natcher Center at the National Institutes of Health campus in Bethesda, MD.

Internet Sources

World Health News is an online news digest from the Center for Health Communication at the Harvard School of Public Health.  This resource covers critical public health issues worldwide. Designed to be a resource for an international audience of policy makers and journalists as well as public health researchers, practitioners, and advocates, it can be found at http://www.worldhealthnews.harvard.edu/.

Health Improvement Institute (HII) is an educational organization dedicated to improving the quality and productivity of America's health care. The Institute's primary goal is to provide information to patients, providers, payers, purchasers, policy-makers, and the public about available alternatives to ensure that all Americans have the opportunity to make informed health care choices.  Furthermore, the Health Improvement Institute gives out the Aesculapius Awards of Excellence each year to producers of health-related video and radio PSAs (public service announcements) and Web sites that Health Improvement Institute judges consider excellent in communicating health information to the public.  More information on HII and the Aesculapius Awards of Excellence can be found at http://www.hii.org/.

School Health (DASH) is a website from the Centers for Disease Control and Prevention that includes material on school health program guidelines, comprehensive school health programs, funding opportunities in school health, and data from the Youth Behavioral Risk Survey.  Information on DASH can be found at http://www.cdc.gov/nccdphp/dash/.

Announcements

The Health Communication Unit of the Pan American Health Organization (PAHO), in collaboration with the Programme for the Prevention & Control of Tobacco, recently formed a new association—Association of Pan American Journalists and Communicators in Health—to support national and regional initiatives for tobacco prevention and control and to organize journalists and communicators specialized in this topic.  For more information, contact Dr. Gloria Coe at coegloria@paho.org.

ERRATA: There was an omission in a past article published in the Journal of Health Communication: Witte, K., Cameron, K., McKeon, J., and Berkowitz, J. (1996). Predicting Risk Behaviors: Development and Validation of a Diagnostic Scale. Journal of Health Communication, 1(4), 317-341.  "Note.  Susceptibility items were reflected prior to analysis" should have appeared under Table 3. Confirmatory factor analysis results for Risk Behavior Diagnosis Scale.

Prescriptions

Austin and Knaus surveyed children in the third, sixth, and ninth grade on the effects of alcohol advertising on children’s perception of drinking and future decisionmaking. Their results yielded the following suggestions for future substance abuse campaigns directed towards youth:

Interventions intended to prevent early use of risky substances should begin by third grade.

Prevention programs especially need to acknowledge and refute the desirability of appealing media messages which promote wishful thinking about the likely rewards of using substances

Prevention messages prior to sixth grade also should attempt to reduce the extent to which children want to be like individuals portrayed as drinkers and smokers, such as by refuting the messages directly and by endorsing alternative role models equal in appeal.

Prevention messages between sixth and ninth grade need to focus specifically and realistically on the likely rewards and consequences of using substances.

Prevention messages need to be as appealing as commercial messages tend to be.

Adults should avoid having merchandise adorned with alcohol logos as valued possessions in a child’s living environment.

-E . Austin and C. Knaus

Jallinoja and Aro conducted a study on the association of knowledge about genes and attitudes towards gene tests among Finns. The results of the association suggest the following:

The association between knowledge and attitudes is complex: for example, good knowledge is associated both to enthusiasm and scepticism.

Many of those who have low level of knowledge of basics of genetics also have difficulties in taking a stance towards attitude statements concerning genetic testing.

Steps should be taken to increase citizens’ capabilities to seek for and understand information of genetics and specific diseases when faced with a need for it.

Citizens should be provided with tools to perceive and discuss potential ethical and social problems, which development of gene technology, genetic testing and screening bring along.

Sites for these enterprises could be the biology school curriculum, genetic counseling, media, and health education and health communication in general.

-P. Jallinoja, and A. Aro

DiIorio, Resnicow, Dudley, Thomas, Manteuffel, Wang, Van Marter, and Lipana studied the role of two social cognitive variables, self-efficacy and outcome expectancies, in explaining sex-based communication between mothers and their adolescents.  Their recommendations for HIV prevention programs are the following:

HIV education and prevention activities can be extended beyond the adolescent to include parents as the educators in family-based prevention programs.

Social cognitive theory provides a useful framework for the development of HIV education and prevention programs.

Sex-based communication between mothers and their adolescents can be enhanced through fostering mothers’ confidence in talking about sex-based topics and accentuating the positive outcomes associated with talking about sex.

-C. DiIorio, K. Resnicow, W. Dudley, S. Thomas, B. Manteuffel,
D. Wang, D. Van Marter,and J. Lipana

Frey, Adelman, Flint, and Query studied how the perceived value of collective communicative practices engaged in by residents of an AIDS facility related to their perceived physical and emotional health, view of the residence as a community (as opposed to a facility or institution), and satisfaction with living there. The results suggest the following recommendations for administrators, staff, residents, and researchers of AIDS residences, and potentially other types of group residences:

Collective rituals that facilitate residents' grieving process need to be cultivated and their effects studied, for such rituals provide residents not only with a way of remembering others but also a way of "re-membering," a coming back together after the loss of one of its members.

Shared everyday—even mundane—activities, such as dish duty, need to be structured into group life for their practical, significance and, more importantly, for their symbolic ability to demonstrate members' commitment to the community.

Formal, once-a-week social support groups may not be as important to residents' physical and emotional health as are other periodic communicative activities, such as social events and rituals.

Collective governance practices, such as weekly house meetings, that enable group members to metacommunicate about the issues that pervade community life, and social support practices, such as support group participation, potentially help residents to be satisfied living there and to view a residence as community rather than a facility or institution.

Attention needs to be paid to the emergent metaphors that residents use to describe group living, for these metaphors may serve as social barometers for understanding individual members' group living experience and the collective spirit of a community.

-L. Frey, M. Adelman, L.  Flint, and J. Query

Hawkins and Hane studied adolescents’ recollections of and belief in print cigarette advertising.  Respondents were 843 middle school aged youth in urban and suburban areas of a large Midwestern city.  Results suggested the following guidelines for a counteradvertising campaign directed against youth smoking:

Counteradvertisements should raise adolescents’ awareness of the attention and retention strategies used in print cigarette advertising.

Counteradvertisements should assist adolescents in rejecting the association between smoking and implied rewards depicted in print cigarette advertising.

Counteradvertisements should remind adolescents that smoking is undeniably associated with sever negative consequences, in spite of advertisers’ depictions to the contrary.

The counteradvertising campaign design process should incorporate feedback from adolescents.

-K. Hawkins and A. Hane

The UpFront section was edited by Lisa Shusterman, Assistant Editor of the Journal of Health Communication and Program Associate in Health, Nutrition, and Population at the Academy for Educational Development in Washington, DC.
 

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