ABSTRACTS

Volume 6, Number 1
January-March 2001

Vol. 6, Num 1: Contents | Editorial | Up Front | Abstracts

Measuring Exposure to Pro- and Anti-Tobacco Marketing among Adolescents
Unger, J.B., Cruz, T.B., Schuster, D., Flora, J.A. and Johnson,C.A.

Exposure to tobacco-related marketing has been implicated as one of the risk factors for tobacco use among adolescents. However, tobacco-related marketing exposure has been measured in different ways in different studies, including perceived pervasiveness, receptivity, recognition, recall, and affect. It is not known whether these measures represent one or more underlying constructs, and how these underlying constructs are associated with adolescent smoking status. This study analyzed data from 5870 8th-grade students in California, collected in 1996-1997 as part of the Independent Evaluation of the California Tobacco Control, Prevention, and Education Program. An exploratory factor analysis of multiple measures of tobacco-related marketing exposure revealed four distinct factors: perceived pervasiveness of pro-tobacco marketing, perceived pervasiveness of anti-tobacco marketing, recognition of specific anti-tobacco advertisements, and receptivity to pro-tobacco marketing. Receptivity to pro-tobacco marketing showed the strongest association with smoking status; higher levels of receptivity were associated with higher levels of smoking. Two measures of exposure to anti-tobacco marketing (perceived pervasiveness of anti-tobacco marketing and recognition of specific anti-tobacco ads) were highest among established smokers and lowest among susceptible nonsmokers.  The same pattern was evident for perceived pervasiveness of pro-tobacco marketing. Results suggest that exposure to tobacco-related marketing is a multidimensional construct, and each dimension may have a unique contribution to the process of smoking initiation. Because adolescents are exposed to numerous pro- and anti-tobacco messages, it is important to develop anti-tobacco media campaigns that can successfully counter pro-tobacco marketing efforts.  Potential strategies include targeting the susceptible nonsmokers who are at high risk for smoking and developing messages to decrease receptivity.

An Intervention to Increase Fruit and Vegetable Consumption Using Audio Communications: In-store Public Service Announcements and  Audio Tapes
     Connell, D., Goldberg, J. and Folta, S.

     Consumers make an estimated 70% of their food purchase decisions as they shop. Effective presentation of information about healthier food selections at the point-of-purchase should have an impact on their decisions. This study was designed to evaluate the effectiveness of two audio formats on knowledge, attitudes and beliefs about fruits and vegetables and on intake of these foods. Participants in three intervention stores (n=374), identified as “regular shoppers” were recruited as they entered. They provided baseline demographic data, answered questions about their knowledge and beliefs about fruits and vegetables, and completed a checklist to assess fruit and vegetable intake.  They were given two one-hour audio tapes and asked to play them within the next four weeks. In-store public service announcements with information about fruits and vegetables were rotated every 30 minutes for four weeks.  A control group (n=378), recruited in three other stores matched by demographic characteristics, provided the same information.  They received an audio tape with stress reduction information.  At post-test, the original series of questionnaires were re-administered in telephone interviews with 87.7% of the original intervention group and 93.7% of the original control group.  Knowledge scores in the intervention group increased significantly over baseline and as compared to the control group.   Self-reported fruit and vegetable intake increased significantly in both groups, perhaps due in part to a seasonal effect. The increase from baseline was significantly higher in the intervention group and compared to controls.  These findings support the further exploration of the use of audio tapes in nutrition education interventions.

Impact Evaluation of the "Not Me, Not Now" Abstinence-Oriented, Adolescent Pregnancy Prevention Communications Program, Monroe County, NY
Doniger, A., Riley, J.S., Utter, C.A., and Adams, E.

 “Not Me, Not Now” is an abstinence oriented, adolescent pregnancy prevention integrated communications program developed by Monroe County, NY. The evaluation utilized a cross-sectional time series approach in the analysis of items from several waves of youth surveys administered to two different age groups: (1) a survey of 7th and 8th graders on awareness, attitudes and intended behavior, and (2) the Youth Risk Behavior Survey administered to 9th through 12th graders. The trends found in the surveys demonstrated high levels of awareness of the program, changing attitudes and intended behaviors consistent with the program’s messages. Analysis of pregnancy rates for 15-17 year-olds in the county were compared to reductions found in similar geographic areas. Pregnancy rates in Monroe County declined faster than in comparison areas. The authors conclude that there is a strong likelihood that the program had independent effect on the outcome of pregnancies in the population exposed to the program.

FORUM
Presenting Risk Information—A Review of the Effects of Framing and Other Manipulations on Patient Outcomes
Edwards, A., Elwyn, G., Covey, J., Matthews, E., and Pill, R.

Discussing risks and benefits of treatments or care options is becoming an increasingly important part of modern health care.  This paper reviews the literature about manipulations of risk and benefit information in the clinical setting.  There is a paucity of evidence in this field, particularly when examining specific manipulations.  Only three categories of manipulation had three or more studies. The available evidence shows that the way information is presented can have significant effects on decisions made.  The largest effects are evident when relative risk information is presented, as compared with absolute risk data.  In addition, ‘loss-framing’ is more effective in influencing screening uptake behaviors than ‘gain-framing’ (odds ratio 1.18 (95% confidence interval 1.01-1.38)).  There is also a pattern of evidence from studies comparing simpler with more complex information, more data with less, and those comparing numerical with verbal descriptions of risks.  These studies suggest that providing more information, and which is more understandable to the patient, is associated with improved patient knowledge and a greater wariness to take treatments or participate in trials.  These findings can contribute to efforts to improve communication between professionals and patients.

BOOK REVIEW
Explaining Illness: Research, Theory, and Strategies
Bryan B. Whaley (Editor)
Review by McNeilis, K.