From This Issue
In the first piece appearing in this issue, Barbara Rimer, Director
of the Office of Disease Prevention and Population Sciences of the National
Cancer Institute, reflects on the communication issues discussed in
the articles on breast cancer by Yanovitzky & Blitz and Shaw, McTavish,
Hawkins, Gustafson, & Pingree. While these studies concentrate
on the effects of specific communication tools—the media and the computer—can
have on breast cancer screening and social support, Rimer illuminates
on the importance of the integration of multiple communication tools
in dealing with information on cancer, as well as other health issues.
In the Internet era, we must not forget the significance of interpersonal
communication, specifically the doctor-patient interaction. Rimer
explains that we should aim to build an “evidence-based foundation”
that can be used to develop more effective interventions and inform
communication decisions. Rimer,
B. Use of Multiple Media and Breast Cancer Screening: An Introduction.
The first research article in this issue examines the influence of
media coverage and physician advice on the decision of women of 40 years
and older to obtain a mammogram. Exploring the various degrees
to which mass and interpersonal communication channels promote health
information to specific groups of women, Yanovitzky and Blitz
present five possible models to explain the relationship between mass
media, physician advice, and health-seeking behavior. The authors
analyzed data from the BRFSS questionnaire on women’s utilization of
mammograms as well as conducted a content analysis of mass media coverage
of mammography-related news stories. Results of their analysis
illustrate that the statistically significant effect of physician advice
on mammography-seeking behavior was limited to women with regular access
to a physician, while no impact of physician advice on mammography-seeking
behavior was found with women who have no regular access to a physician.
Similarly, for women with no regular access to a physician, mammography-related
media coverage is a strong and significant predictor of mammography-seeking
behavior. The authors conclude that integrating mass and interpersonal
channels of communication into interventions is important for reaching
diverse target populations with similar health risks. Yanovitzky,
I. and Blitz, C. L. Effect of Media Coverage and Physician Advice on
Utilization of Breast Cancer Screening by Women 40 Years and Older.
The second article in this issue, also on breast cancer, discusses
how a communication tool can bolster the support system of those women
with breast cancer. Previous research has noted that social
support is associated with positive health outcomes; the Comprehensive
Health Enhancement Support System (CHESS) breast cancer module is an
interactive computer program that provides information, social support,
and decision-making assistance to women with breast cancer. Shaw,
et al. conducted in-depth, semi-structured interviews with women using
CHESS to gain insight on how the program was used and how the users
viewed its effectiveness. The authors discuss the unique characteristics
that distinguish computer-mediated communication from other forms of
communication. For example, the anonymity of using the program
empowers women to feel more open and be inclined to share their thoughts
more than in a face-to-face interaction. The authors conclude that participants
in computer-mediated support groups appear to benefit from receiving
social support. They discuss the specific benefits received by
the women using CHESS as well as how computer-mediated support could
work with other populations. Shaw,
B. R., McTavish, F., Hawkins, R., Gustafson, D. H., and Pingree, S.
Experiences of Women with Breast Cancer: Exchanging Social Support over
the CHESS Computer Network.
In the third research article in this issue, Basil, Basil, and Schooler
investigate whether cigarette advertising in magazines is purposely
placed to promote cues during the withdrawal period for those trying
to quit smoking as a New Year's Resolution. The beginning of the
year is the most popular time for people to attempt to quit smoking.
Research has shown environmental cues may entice people to experiment
and reduce their resolve to quit, particularly since withdrawal symptoms
peak approximately one month after quitting. The authors conducted
two studies to investigate whether tobacco advertising—as an attempt
to make it more difficult for quitters—increases during this withdrawal
period, specifically in January and February. Study 1, using magazines
from 1965-1989, revealed that only after 1984 do magazines show a higher
rate of advertising cigarettes in January and February. The authors
discuss that this phenomenon may not have occurred in earlier years
because of the time lag of the effects of the Surgeon General's Report
and research on nicotine withdrawal. Limiting the time frame from 1980-1995,
Study 2 also reviewed cigarette advertising in popular magazines, albeit
different magazines to increase reliability, and found a statistically
significant increase in cigarette advertising on the back cover of magazines
in January and February. The authors discuss possible explanations
for this increase, including that cigarette marketers may be attempting
to preempt quitting by cueing smoking behavior. Basil,
M. D., Basil, D. Z., and Schooler, C. Cigarette Advertising to Counter
New Year’s Resolutions.
The Forum article in this issue evaluates a church-based telephone
counseling intervention to promote mammography screening. Three
distinct ethnic groups were recruited—African-American, Latino, and
White—to be trained as counselors to communicate information to participants
about their need for regular mammography and about mammography facilities
in their communities. The study, a randomized trial, tests barrier-specific
communication strategies for motivating women ages 50-80 to initiate
and maintain breast cancer screenings. The three groups of women counselors
received 8-12 hours of workshop training, as well as 8-12 hours of additional
on-site training at the phone centers. Culturally-specific and small
group interactions were most effective for training, including role-plays
and practice interviews. For the participants in the counseling intervention,
African American and White participants were overall more knowledgeable
and adherent with screening guidelines than Latinas. Latinas tended
to have more access barriers—56 percent reported that they did not have
any form of health insurance. Although the intervention did not
train the peer counselors to intervene with women beyond the telephone
counseling, counselors in smaller churches were more likely to know
and see participants regularly, which facilitated spontaneous follow-up
to the counseling call. Latina counselors overall took a much
more proactive role and shared information with their broader social
network. The authors discuss implications for specialized community
interventions, issues that arise with lay health workers, and additional
interventions, such as face-to-face, that may be effective. Derose,
K.P., Fox, S. A., Reigadas, E. and Hawes-Dawson, J. Church-Based Telephone
Mammography Counseling with Peer Counselors.
From Other Sources
In Archives of Family Medicine, Lang, et al. present a taxonomy of
clues to help physicians recognize patients’ subtle disclosures of their
feelings concerning illness symptoms. The authors examine this
issue because most patients who experience illness symptoms develop
an explanatory model, yet only a minority of patients spontaneously
disclose or offer their ideas, concerns, and expectations about their
medical conditions. Often patients suggest or imply their ideas
through “clues.” Active listening is a skill for recognizing and
exploring patients’ clues; without this communication skill, patients’
real concerns often go unrecognized by health care professionals.
The authors employed qualitative techniques—such as videotape analysis,
postinterviewing debriefing, and interpersonal process recall—to identify
types of clues. They developed a taxonomy of clues that includes
(1) expression of feelings, especially concern or worry, (2) attempts
to understand or explain symptoms, (3) speech clues that underscore
particular concerns of the patient, (4) personal stories that link the
patient with medical conditions or risks, and (5) behaviors suggestive
of unresolved concerns or unmet expectations. Lang, F., Floyd,
M. R., and Beine, K. L. Clues to Patients’ Explanations and Concerns
About Their Illnesses. Archives of Family Medicine 9(3), March
2000, 222-227.
In Health Education and Behavior, Buller, et al. evaluate the Arizona
5-a-Day project, a peer health educator program for public sector employees.
The program was implemented in ten public-sector work sites and involved
peer educators to engage in nutrition education of their coworkers for
about two hours per week. Peer educators also distributed a series
of 5-a-Day materials, including a resource guide, newsletter, and gifts
such as a recipe book. The evaluation of the program was measured
by implementation of peer education from peer educators’ logs, the programs’
reach from employee surveys, and employees’ use in terms of their dietary
change. Outcome analysis showed that groups receiving peer education
increased their awareness of the program, knowledge of the 5-a-Day concept
(eating five daily servings of fruits or vegetables), attitudes toward
fruit and vegetable intake, and the number of daily servings of fruits
and vegetables consumed. Although the analysis was merely correlational,
conversations between the peer educators and employees appeared to be
instrumental for immediately improving employees’ fruit and vegetable
consumption. They may have been more important for achieving dietary
change than readership of the printed 5-a-Day materials. The authors
conclude that interpersonal communication may affect dietary behavior
than formal printed health communication. Buller, D., Buller,
M.K., Larkey, L., Sennott-Miller, L., Taren, D., Aickin, M., Wentzel,
T. M., and Morrill, C. Implementing a 5-a-Day Peer Health Educator
Program for Public Sector Labor and Trades Employees. Health Education
and Behavior 27(2), April 2000, 232-240.
Upcoming Conferences and Events
The Health Sciences Communications Association (HeSCA) and Association
of Biomedical Communications Directors (ABCD) are sponsoring the Annual
Meeting for Health Sciences Communications, “Linking to the Future,”
on June 28-July 2, 2000 in Asheville, NC. For more information, visit
the website at http://hesca.org/asheville/meet.htm.
The XIII International AIDS Conference takes place in Durban, South
Africa from July 9-14, 2000. Over 10,000 delegates from around
the world are expecting to attend, making it the largest international
medical conference to be hosted in Africa. The Journal of Health Communication’s
special HIV/AIDS 2000 supplement issue, Communications for HIV/AIDS
Prevention, Care, and Support: Contexts for Individual and Social Change
will be presented. For more information on the International AIDS Conference,
visit the website at http://www.aids2000.com.
The MEDICOM telemedicine conference entitled “Emerging Technologies
and Life Sciences: Medicine and Communication” will take place September
28-29, 2000 in Bonn/Remagen, Germany. The conference will bring
together scientific, medical, and application experts from university,
clinical, and commercial sites from both medicine and communication.
For more information, visit the website http://www.rheinahrcampus.de/medicom/home.html.
The National Communication Association’s 86th Annual Convention will
occur November 9-12, 2000 at the Washington State Convention Center
in Seattle, WA. This year’s conference theme will be “Communication:
The Engaged Discipline.” For more information, visit the NCA Convention
website at http://www.natcom.org/convention.htm
The American Public Health Association’s 128th Annual Meeting, “Eliminating
Health Disparities,” will occur on November 12-16, 2000 in Boston, MA.
For more information, visit the conference website at http://www.apha.org/meetings/.
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/.The
Centers for Disease Control and Prevention has developed an online resource—HealthComm
KEY—to search health communication research. HealthComm KEY is
a database of health communication literature, focusing on communication
research and practice in the context of public health. The database,
developed by CDC's Office of Communication, is designed for researchers
and program staff within CDC, and also for professionals, students,
and others outside of CDC who are interested in health communication.
HealthComm KEY contains comprehensive summaries of more than 200 articles.
The articles selected for the database focus on public health interventions
that have communication as a major component. It can be accessed at
http://www.cdc.gov/od/oc/hcomm/index.htm.
Announcements
The World Health Organization is seeking submissions. The author for
a revised WHO document on lessons learned in IEC for public and reproductive
health is seeking synopses, sample materials, findings, methods, and
current information on projects, programs, and successful initiatives,
especially for non-U.S. funded or designed, relating to safe motherhood
and other reproductive issues. Please contact: eclift@sover.net
or send relevant materials to: E. Clift, PO Box 299, Saxtons River,
VT 05154 USA or fax to 802-869-2687. (Short submissions only).
Prescriptions
Yanovitzky and Blitz studied the role of mammography-related news coverage
and physician advice in promoting mammography-seeking behavior among
women 40 years and older between 1989 and 1991. Their findings
suggest the following:
Mass and interpersonal channels of communication complement one
another in influencing mammography-seeking behavior; physician advice
is important for women who have regular access to physicians while
mass media is important for underserved women.
Attempts to increase mammography-seeking behavior among underserved
women through the mass media should be complemented with programs
that offer these women increased access to free or affordable cancer
screening services.
Integrating mass and interpersonal channels of communication into
interventions is important for reaching diverse target populations
with similar health risks.
