Vol. 5, Num. 4: Contents | Editorial | Up Front | Abstracts

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

Vital Data

From This Issue

In the first article of this issue, Tillgren Eriksson, Guldbrandsson, and Spiik examine a variety of recruitment methods for a smoking cessation program.  The program consists of a Quit and Win contest, offering attractive prizes for successful participants and giving support to smokers in their efforts to quit.  The contest targeted smoking mothers of children aged 0-6 in a stipulated medical care district in Sweden.  Three different recruitment strategies were selected for the Quit and Win contest. The main recruiting strategy was a direct-mail technique using personally addressed letters containing a contest entry form; additional recruitment strategies included: (1) local newspaper coverage of the contest and printed application form, (2) key informants and personal communication, and (3) an informational brochure provided at a number of popular locations. The majority of the 238 contestants signed up through the direct mail effort (78%).  At the 12-month follow-up of the contest, a total of 34 participants (14.3%) were still smoke-free. Among the women smokers recruited via direct mail efforts, 15.1% of them were smoke-free, while 11.5% of those recruited through the local newspaper and key informants were smoke-free. The authors conclude that the direct mail strategy reaches a larger population, and that people are more likely to respond to a direct mail strategy relating to health issues than a direct mail concerning commercial products.  However, the direct mail strategy may be most effective when additional strategies are employed as well in order to reiterate the message in many locations. Tillgren, P., Eriksson, L., Guldbrandsson, K., and Spiik, M.  Impact of Direct-Mail as a Method to Recruit Smoking Mothers to a “Quit and Win” Contest.

The second article describes the four-year Nuclear Risk Management for Native Communities (NRMNC) project that combines community-based hazards management with a scientific research partnership to deal with the health impacts of nuclear fallout.  The NRMNC project utilizes conventional participatory research strategies to accomplish its environmental health objectives.  Quigley and colleagues highlight their four major goals as (1) providing resources and assistance to Native communities in building a community-based environmental health infrastructure; (2) developing a community exposure profile that provides a summary of technical studies conducted on the site’s contamination and a narrative of community experiences and observations of the overall holistic impacts of the site’s contamination; (3) implementing an educational program on the contamination impacts of the site through developing a series of educational modules and developing and disseminating educational materials; and (4) developing a community-based hazards management plan for ongoing community and technical interventions in managing the health impacts of the contamination.  From evaluating the NRMNC project, positive outcomes were identified as: improvements in the scientific database through participatory research activities, the development of equitable relationships between scientists and community members, and the creation of a sustaining program intervention for long-term community needs.  The authors discuss some key ingredients for developing and sustaining a successful community, participatory risk management project. Quigley, D., Handy, D., Goble, R., Sanchez V. and George P.  Participatory Research Strategies in Nuclear Risk Management for Native Communities.

Following Quigley’s study on ways to increase participation and empowerment of certain population, Mattson discusses another aspect of empowerment—incorporating a more client-centered protocol in HIV test counseling by applying tenets of Harm Reduction Theory (HRT). While the CDC counseling protocol has been revised to promote more client-centered interactions, the author argues that current counseling sessions are too brief, subject the client to a battery of standard, irrelevant questions, and do not emphasize risk-reduction behaviors.  Mattson suggests reframing HIV test counseling using HRT to empower clients and focus on risk reduction as well risk elimination.  In counseling sessions using HRT, all components of the HIV testing process would be more centered on the client—discussions would occur in complete privacy, counselors would be given a health history prior to sessions in order to tailor the conversation accordingly, counselors and clients would negotiate realistic risk reduction behavior changes, etc.  This approach offers a theory-driven alternative that emphasizes client-centered care through agency-promoting and empowering dialogue. While this framework is still in the conceptual stage, the author discusses directions for future research in order to test this new approach. Mattson, M.  Empowerment through Agency-Promoting Dialogue: An Explicit Application of Harm Reduction Theory to Reframe HIV Test Counseling.

As direct to consumer (DTC) prescription drug advertising increases substantially, Davis addresses the importance of examining how risk statements in advertising influence people’s perceptions of these advertised prescription drugs and what that means to the pharmaceutical industry and public health field. Employing two different studies, Davis investigates how the completeness of the statement describing the drug associated side-effects (the “risk statement”) and consumers’ perceptions of the drug’s safety and appeal. The findings show that consumers are more likely to think a drug is safer and more appealing when an incomplete risk statement (only describing a few side effects) is shown rather than a complete risk statement (describing all potential side effects occurring at an incidence of 3% or higher.) Davis discusses how DTC drug advertising has the potential to serve the public good, but the poor quality of information presented in advertising can be problematic because consumers are unable to determine whether the risk statement accurately communicates the range and breadth of drug-related side effects.  It is possible for consumers to draw false conclusions from DTC advertising. For example, if two equivalent drugs provide risk statements with different levels of completeness, consumers may perceive differences in their safety or drugs may appear safer than they are because of the number or types of side effects included in their statements.  Based on the two studies’ findings, Davis discusses implications for regulation of DTC, implications for advertiser practices, and benefits of future research. Davis, J.  Riskier Than We Think? The Relationship between Risk Statement Completeness and Perceptions of Direct to Consumer Advertised Prescription Drugs

In the Notes from the Field article, Yingling describes the patterns of verbal responses found in the interactions between children who have cancer and their caregivers.  Past research has focused on the ability of the child to understand the illness rather than assessing the emotional and informational support they receive. Fifteen children with cancer participated in this study over a period of two months; discussions between children and informative or supportive adult partners were recorded and coded. Some results include the following: Regardless of the type of interaction, children were most likely to use edifications (statements of fact) and disclosures (revelation of speaker’s thoughts) with an adult.  Children most often chose nurses as their most informative speaker, although physicians, medical assistants, and social workers were often mentioned as well. Parents were most often chosen as emotionally supportive, but this role also included other providers such as physicians, medical assistants, and nurses.  Yingling discusses the details of these findings and how these descriptive data can provide a starting point for setting the standard for supportive health care professionals. Yingling, J.  Verbal Responses of Children and Their Supportive Providers in a Pediatric Oncology Unit.

From Other Sources

In the American Journal of Health Behavior, Bosworth, et al. investigate the relationship between participation in a computer-based, conflict resolution intervention and adolescents’ attitudes towards violence, self-efficacy, and aggressive behavior.  In the study, 558 middle school students were randomly assigned to either an intervention or control group and completed assessments before and after implementation.  A computer-based intervention was used because adolescents report a high rate of electronic media use (television, video games, etc.) and interactive computer-based multimedia interventions have been successful in the past in teaching complex interpersonal and prevention strategies for health-related behaviors.  Grounded in social learning theory, the intervention employed in the study has three major components: Anger Management, Perspective Taking, and Dispute Resolution.  After analyzing the surveys students completed immediately after participating in the intervention as well as four months after, the authors conclude that the intervention was successful in diminishing students’ beliefs supportive of violence and increasing their intentions to use nonviolent strategies.  No outcome differences were found for gender, race, or socioeconomic status.  Results indicate that multimedia might be useful in changing some of the mediating factors associated with violence.  Multimedia interventions may provide a unique delivery method to engage a population at risk for violence that may be disenfranchised from traditional prevention approaches.  Bosworth, K., Espelage, D., DuBay, T., Daytner, G., Karageorge, K. (2000). Preliminary Evaluation of a Multimedia Violence Prevention Program for Adolescents.  American Journal of Health Behavior 24(4), 268-280.

In Health Communication, Baur discusses the limiting powers of email in patient-physician relationships.  The author examined evidence from published literature on doctor-patient relationships and doctor-patient communication, empirical studies of uses of the Internet by doctors and patients, and commentaries about the Internet’s role in health care.  Past researchers have purported that email communication between doctors and patients could change communication practices; it has been conceptualized as a mechanism to extend the visit beyond the office, to clarify topics raised in face-to-face appointments, and to seek additional information.  In addition, email has been thought of as a way for patients and physicians to increase their interpersonal communication about values and beliefs. However, the author discusses that these conceptualizations may never be realized because of the current nature of the health care system.  Existing research does not adequately account for the technical, professional, and economic forces that are shaping doctor-patient use of email.  The author concludes that physicians’ preferences for technical, instrumental exchanges with patients and the market-driven model of health care will likely mitigate the positive influence that email could have on the doctor-patient relationship, and that doctor-patient communication is unlikely to improve as a result of the use of email.  Bauer, C. (2000). Limiting Factors on the Transformative Powers of E-Mail in Patient-Physician Relationships: A Critical Analysis. Health Communication 12(3), 239-259.

Upcoming Conferences and Events

The World Federation of Public Health Associations is sponsoring its 6th International Congress Session entitled, “Challenges for Public Health at the Dawn of the 21st Century” in Beijing, China from September 2-6, 2000.  Global health and its related themes—the economy, high tech communications, the role of the public and private sectors, and the environment—will be highlighted.  For more information, contact Brooke Lundquist of WFPHA in Washington, DC at brooke.lundquist@apha.org or 202-777-2506.

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/2000/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

The CDC has launched its Spanish language website, CDC En Español, on the Internet at http://www.cdc.gov/spanish.  It is also accessible from the left navigation side bar of the CDC home page. CDC En Español is not a translation of the English language website, but is a site tailored to Latino populations.  It provides health-related information to Latino health professionals and the Spanish-speaking community.  The site also includes information directed at special groups, such as adolescents, students, teachers, patients, health-care providers, women, and men.  Questions related to CDC En Español can be sent to spanish@cdc.gov.

The Health Advocates Guide to the Internet is a resource sponsored by the National Health Law Program (NHeLP).  The guide describes the Internet and its functions in basic terms, as well as providing a number of web site resources on various health issues such as reproductive health, consumer resources, cultural issues, and immigrant health.  The resource can be downloaded from the National Health Law Program’s website at http://www.nhelp.org.

Publications

The Alliance for Health Reform has published a sourcebook for journalists entitled Covering Health Issues: Campaign 2000 & Beyond.  The resource provides substantial discussion of health policy issues in the context of this election year and various polls and surveys that reveal health care as a top concern for the American public. Chapters include: “Health Care as a Campaign Issue,” “Is Demography Destiny?” and “Story Ideas.”  The publication can be obtained on-line at http://www.allhealth.org/sourcebook or by contacting the Alliance for Health Reform.

Prescriptions

Tillgren, Eriksson, Guldbrandsson and Spiik studied the effects of direct-mail recruitment of smoking mothers of children ages 0-6 on the success of the Quit and Win (Q&W) contest to reduce female smoking.  The results of their studies suggested the following for successful recruitment strategies:

• The direct mail strategy is an effective approach for recruitment since it reaches a large population.  People are more likely to respond to a direct mail strategy relating to health issues than a direct mail concerning commercial products.

• Exposing the message in several places may work as a reminder to those who may not have received or noticed the personally addressed letters.

• Personally addressed letters should be addressed only to the target audience so that those who do not fit the profile do not feel prohibited from the contest and prizes for already maintaining a healthy lifestyle.

• To optimize recruitment for Q&W contests, a combination of recruitment strategies should be applied.

-P. Tillgren, L. Eriksson, K. Guldbrandsson, and M. Spiik

Quigley, Sanchez, Handy, Goble, and George report on the success of a participatory research model with Native communities in managing the health impacts of nuclear contamination.  Key features of that model include:

• Sharing health research funding with the community, recruiting and training community staff and an advisory committee, and valuing the collection and integration of local (community knowledge) about contamination impacts as well as technical data.

• Training Native researchers to conduct interviews and gather data on their own people’s culture, lifestyle and subsistence during the time of contamination which proved to be essential to improved exposure assessment analyses, community involvement and community-based strategic planning.

• Two-way communication of knowledge bases (nuclear risk curriculum topics and cultural context of contamination) which provides equity in the research and education process between scientists and community members.

• Utilizing health research funding to not only provide quantitative analyses but also build community capabilities in environmental health, strengthen and preserve cultural knowledge and bring educational and training opportunities to environmental justice populations.

-D. Quigley, R. Goble, D. Handy, V. Sanchez, and P. George

Mattson examined and critiqued current approaches to HIV test counseling and offered an alternative approach that applies the tenets of Harm Reduction Theory.  Implications of this research suggest:

• A Harm Reduction Theory perspective accepts the inevitability of unsafe sexual behaviors and advocates interventions that reduce the harms associated with risky behaviors rather than emphasizing the categorical and immediate elimination of all unsafe sex.

• Individuals unsafe sexual behaviors are based on their version of reality formed from the knowledge and resources available to them.  HIV test counseling Interventions require an alternation of the knowledge/resource base through empowering dialogue rather than the imposition of a routinized counseling session.

• Individuals have the capacity to define their own concerns regarding HIV/AIDS instead of those concerns being defined by the HIV test counselor.  Counseling communication should focus on sharing available knowledge about HIV/AIDS so that clients can decide what, if any, of that information is relevant and can be incorporated into their complex lives.

• Individuals must be offered a hierarchy of choices (e.g., abstinence, sex with condoms, condomless sex with a monogamous partner, non-sexual options) to reduce their risk of HIV/AIDS.

• HIV test counselors need to recognize, through recurrent training and self-reflexivity, that they may have personal biases about counseling and may make judgments about individuals who practice unsafe sex.  After recognizing these biases, they need to consciously alleviate their impact during counseling sessions.

-M. Mattson

Davis investigated the relationship between risk statement completeness in direct to consumer prescription drug advertising and consumers’ perceptions of the safety and appeal of the advertised drug.  Davis recommends that physicians identify those drugs most likely to be requested and do the following:

• Physicians should be prepared to discuss a request for the drug from the patient perspective, understanding that patients are making the request with incomplete information, typically believing that the requested advertised drug is more risk-free than it actually is.

• Physicians should be aware of the claims made in the drug’s advertising, paying particular attention to the advertisement’s description of the drug’s risks and side-effects.  Copies of the advertising should be readily available for use as a “jumping-off” point for a discussion of the drug’s appropriateness and safety.

• Physicians should have printed materials available to counter the impressions left by advertising.  These materials should clearly communicate the risks and benefits associated with the requested drug.

-J. Davis.

Yingling studied the verbal response modes used in interaction between children in treatment for cancer and the  providers they chose as most supportive. Based on the resulting descriptive data, she makes the following suggestions for health care providers working in pediatric oncology and to researchers examining health communication:

• Health care providers and parents should informally coach children in long-term treatment to ask questions and disclose their concerns.

• Health care professionals who wish to provide informational support to children in their care should acknowledge, reflect,  and interpret children's concerns.

• Medical assistants working with children may be in the best position to give emotional support when parents cannot.  Therefore, they should be trained to accept complaints and advice from their charges, as well as to give direction to them.

• Health communication researchers should examine not only the verbal response modes used in health care interaction, but identify the specific message behaviors perceived as supportive in a variety of health care contexts.

-J. Yingling

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