UP FRONT

Volume 6, Number 1
January-March 2001

Vol. 6, Num. 1: 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

Past research has demonstrated that both pro-tobacco marketing and anti-tobacco media campaigns may influence adolescent smoking. However, there are a number of different ways to assess which aspects of the campaigns may affect smoking behaviors.  In the first article in this issue, Unger, et al. analyze data collected from 8th graders in California (n=5,870) to determine whether various measures of pro- or anti-tobacco marketing exposure would cluster into meaningful factors, and to determine if whether these factors were associated with smoking status.  Students answered questions on a number of measures, including perceived pervasiveness of pro-tobacco marketing, perceived pervasiveness of anti-tobacco marketing, exposure to pro-tobacco marketing, recognition of specific anti-tobacco ads, and their own smoking status. The findings indicate that perceived pervasiveness of pro-tobacco marketing was highest among established smokers, but not significantly different from the other three groups. Similarly, perceived pervasiveness of anti-tobacco marketing was also highest among established smokers, and then followed by never smokers and those considered susceptible to becoming smokers.  This pattern occurred as well for recognition of specific anti-tobacco ads.  The results from this study demonstrate that tobacco-related marketing exposure is a multidimensional construct, and that evaluations of marketing exposure need to include multiple measures. The findings have numerous implications, for both tobacco companies and health agencies planning anti-tobacco campaigns. Unger, J. Cruz, T.B., Schuster, D., Flora, J.A., and Johnson, C.A. Measuring Exposure to Pro- and Anti-Tobacco Marketing among Adolescents. (p.11-29)

The next article discusses an evaluation of the effectiveness of promoting the “5 a Day” fruit and vegetable message through a typically, less-used communication channel.  In this study, the “5 a Day” message was disseminated through in-store public service announcements (PSAs) and audio tapes.  The authors hypothesized that since supermarkets already contain visual stimuli that can influence shoppers’ choices, audio messages, that are either broadcast in-store or taken away to be played while driving, cooking, or engaged in other activities may be a more effective channel through which to convey nutrition information designed to change knowledge, attitudes, and behavior.  Six supermarkets, divided into three pairs matched by geographic area and median household income of the shoppers, participated in the study. Using a single-sample, pretest-posttest control group design, the researchers interviewed a sample of regular shoppers both before and after the intervention period. The intervention in the non-control group stores included PSAs on eating more fruits and vegetables broadcast through the in-store audio system in the supermarket as well as audio tapes on eating well that were distributed to shoppers to take home. The shoppers from the control stores were given audio tapes on stress reduction to take home.  Among intervention group participants, there was a significant increase in knowledge about the facts presented on the audio tapes, and a significant increase in self-reported fruit and vegetable intake compared to the control group.  The authors suggest that these findings support the further exploration of the use of audio tapes in nutrition education interventions. Connell, D., Goldberg, J.P., Folta, S.C. An Intervention to Increase Fruit and Vegetable Consumption Using Audio Communications: In-Store Public Service Announcements and Audio Tapes. (p.31-43)

In the third article of this issue, the authors detail the process of conducting an impact evaluation on an adolescent pregnancy prevention program and the importance of including an evaluation component when developing a health intervention.  Incorporating elements of social learning theory and consumer information processing theory, the “Not Me, Not Now” pregnancy prevention campaign promoted messages about the consequences of teen pregnancy, the issues of peer pressure, and the benefits of open parent-child communication through a variety of media channels. The campaign targeted youth ages 12 and under. Using a cross sectional time series design, the evaluation process contained three components: impact on program awareness and beliefs among middle school age children, impact on self-reported behaviors among high school students, and impact on adolescent pregnancy rates. Findings from the evaluation 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.  The authors discuss broader implications of these findings and suggest that a well-designed and competently implemented adolescent pregnancy prevention communication can have a measurable community impact. Doniger, A., Riley, J.S., Utter, C.A., and Adams, E. Impact Evaluation of the "Not Me, Not Now" Abstinence-Oriented, Adolescent Pregnancy Prevention Communications Program, Monroe County, NY. (p.45-60)

In the Forum article in this issue, Edwards, et al. examine the findings from a comprehensive review of the literature on the effects of framing risk information in different contexts within a clinical setting.  Past reviews have been conducted on information framing, but most of this literature comprises studies conducted in a laboratory setting.  The authors assert that framing variations in a clinical setting have different effects, largely due to the influence of contextual factors such as stresses, previous personal experiences, and different ways that risk information may be used or shared. Conducting an extensive search on the subject, the authors gave each relevant paper a “Method Score”—a compilation of scores for content, nature of intervention, and methodological quality of the study, as well as categorized each paper depending on what type of information framing was discussed. The authors identified some specific trends in respect to the type of information framing that occurred in the intervention and discussed why an analysis on risk information has implications for the health communication field. Most importantly, if one wants to move towards more patient-centered approaches to the medical consultation and the promotion of patient choice for a range of health care options, it is crucial to understand if treatment decisions depend on how the risk information was framed. Edwards, E., Elwyn, G., Covey, J., Matthews, E., and Pill, R.  Presenting Risk Information—A Review of the Effects of Framing and Other Manipulations on Patient Outcomes. (p.61-82)

From Other Sources

Many young people feel uncomfortable discussing sexual issues with their parents or other adults and prefer exploring these issues in private.  As Internet use among young people is increasing, many may increasingly turn to the Internet with questions regarding sexuality.  In a study published in Health Education and Behavior, Smith, et al. describe web sites with sex education material and assess the accessibility of specific information on the Internet.  The authors conducted two studies: the first as a general search for the quantity of sites on the subject of sex education, and the other as a specific information search, examining how quickly participants could find particular items regarding sexual health on the Internet. While the study yielded almost 6 million web pages associated with sexual health, this seemingly large amount of sexual health information on the Internet was not as obtainable as it seemed.  Only 41 pages were classified as sex education pages, while 63 percent of the identified web pages were classified as pornography sites.  Many sites may have included educational information on the subject, but the accuracy of this information was dubious.  A more efficient way to obtain sex education information on the Internet involved looking for specific pieces of information such as condom usage rather than broad concepts such as sex education. The authors suggest indexing functions on the Internet should develop and assimilate search strategies tailored for particular topics.  In addition, health educators need to become familiar with the various Internet search engines, and parents should become involved in the process of helping their children navigate this inherently unstructured medium. Smith, M., Gertz, E., Alverez, S., and Lurie, P. (2000) “The Content and Accessibility of Sex Education Information on the Internet,” Health Education and Behavior 27(6), 684-694.

In another recent article concerning health information on the Internet, Griffiths and Christenson evaluate quality of web based information on treatment of depression and identify potential indicators of content quality. Since only a minority of people with depressive disorders receive treatment, websites are potentially useful for encouraging depressed people to seek help. The highest ranked mental health sites identified by popular search engines were included in the analysis. The sites were analyzed for characteristics (such as purpose, scope, ownership, country of origin and for involvement of a certain industries or professional organizations), content (based on guidelines on the clinical practice for treating depression published by the Agency for Health Care Policy and Research (AHCPR)), and accountability (measures of authorship, disclosure, and level of evidence).  The quality of most of the websites was considered poor; however many sites did provide specific information about the authors and affiliations, and all sites promoted consultation with a health professional for diagnosis or treatment,. The authors conclude that there is a need to improve the accuracy and coverage of information about depression on the web with regard to the relative effectiveness of different treatments, the main indications for particular treatments, important management issues such as duration of treatment, reviewing and changing treatments, and the relevance of professional expertise and patient preferences. Griffiths, K.M. and Christensen, H.. (2000) “Quality of Web Based Information on Treatment of Depression: Cross Sectional Survey,” British Medical Journal 321(7275), 1511-1515.

In a recent issue of Adolescence, Clowers examines adolescent females’ preferences in regard to medical communication, so that care providers in a number of disciplines can make their interactions with young females more satisfactory and successful.  Adolescent female patients is a group in particular that has received little attention in terms of their medical experiences and needs.  For example, health care providers can learn to avoid communication or behavior that young patients find offensive, potentially preventing problematic interactions. In this study, 185 urban high school female students, ages 14-19, were surveyed about their experience with medical conversations.  Over three-fifths of the students gave examples of positive physician-patient communication.  Instances where the physician joked, were understanding, provided explanations and made them feel comfortable, were cited.  Nearly half of the students did not provide an example of negative physician-patient communication. Among those that did, three themes arose: the doctors were rude, were rushing, and were “too personal.” From these findings, the author concludes that health care providers must determine what is important to their patients and the implications of these findings should not be ignored.  Relational communication skill development must be fostered in the curricula used to train care providers.  Clowers, M. (2000) “Urban Female Teenagers’ Perceptions of Medical Communication,” Adolescence 35(139), 571-585.

Upcoming Conferences and Events

The National Communication Association is sponsoring a Call for Papers for their November 2001 Convention in Atlanta. The theme of the convention, “Radical(izing) Roots,” aims to revisit traditional assumptions and examine how they continue to inspire us, as well as look into alternative views that offer new directions and interpretations of the field. Detailed information on submitting materials for a panel or program can be found on NCA’s website at http://www.natcom.org.

The European Forum on Quality Improvement in Health Care conference is taking place on March 29-31, 2001 in Bologna, Italy. The Forum aims to inspire those in health care to make improvements in their work and to give them the practical skills to do so. For  more information on the Forum, visit the website http://www.quality.bmjpg.com  or email quality@bma.org.uk

The National Conference on HIV/AIDS and Children, Youth, and Families will take place May 4-8, 2001 in Washington, DC at the Renaissance Hotel.  For more information contact Chip Heath at cheath@aids-alliance.org or (202) 785-3564.

The National Council on Patient Information and Education (NCPIE) is sponsoring their 13th National Conference and Exhibits Showcase on May 16-18, 2001 at the Hyatt Regency in Bethesda, MD. Typical conference participants include health care professionals, patient advocates, and representatives from government and the pharmaceutical industry.  The forum will be a place to discuss the latest research and innovations to improve medical communication.  For more information, visit NCPIE’s website at http://www.talkaboutrx.org

A conference on the “Trends and Innovations in Medical Education” is taking place June 13-16, 2001in the Netherlands at the Maastricht Facult of Medicine. The major themes of the conference will be curriculum development, clinical skills training, student participation, and quality assurance.  More information, including the Call for Abstracts and registration form, are found online at  http://www.unimaas.nl/time.

Internet Sources

The Andalusian School of Public Health at the Universitario de Cartuja in Granada, Spain is sponsoring a new health discussion list-serv for Spanish-speaking health workers involved in developing projects  Interested parties are invited to post information on courses, seminars,  books, web pages, etc. on the list at euridice@mailgw.easp.es (preferably in Spanish).

Publications

UNAIDS has published two informational documents for public health practitioners working in HIV/AIDS and social marketing or entertainment-education.  “The Essential Handbook. Radio and HIV/AIDS: Making a Difference. A Guide for Radio Practitioners, Health Workers and Donors” (128-page guide) and “Social Marketing: Expanding Access to Essential Products and Services to Prevent HIV/AIDS and to Limit the Impact of the Epidemic” (6-page brochure) can both be downloaded as a pdf file from the UNAIDS website at http://www.unaids.org/whatsnew/newadds/index.html.

The report of the fourth seminar in the Cambridge International Health Leadership Programme, “Transforming Health: Beyond Ideas to Action,” can now be found at the following website: http://www.cpi.cam.ac.uk/courses/Health.html.  The site also gives details of the next seminar, which will be held in April 2001.  For additional information, contact Francesca Barraud by phone at 44 (0) 1223 342107 or by email at francesca.barraud@cpi.cam.ac.uk.

Complimentary copies of the 2000 Summer Public Health Research Videoconference on Minority Health (presented June 12-16, 2000) are being distributed by the National Center for Health Statistics from the Centers for Disease Control and Prevention (CDC). Tapes may be ordered through the web site: http://www.minority.unc.edu. The Videoconference Agenda and other information are also available from the site. For any questions, contact the Minority Health Project at the University of North Carolina-Chapel Hill  School of Public Health at Minority_Health@unc.edu.

Announcements

ERRATA: There was an incorrect byline published in a past UpFront section of the Journal of Health Communication.  The following byline for UpFront, 5(3), p. 195-202 should have appeared: Lisa Shusterman, Assistant Editor of the Journal of Health Communication and Research Associate in Domestic Health at the Academy for Educational Development in Washington, DC.

The U.S.-based Population Institute, a private, not-for-profit public interest group, announced the winners of its 21st annual Global Media Awards for Excellence in Population Reporting at a ceremony at the Presidential Palace in Manila, Philippines,
on Dec. 4.  Philippines President Estrada presented a number of awards for publications and individuals, including the International Herald Tribune for Best International Daily, Real Lives, International Planned Parenthood Federation’s South East Asia Region Quarterly for Best Population Journal, syndicated columnist Ellen Goodman for her column dealing with women's issues and reproductive health, Tanzania's "Twende na Wakati" (Let Us Move with the Times) for Best Radio Program, and Turner Broadcasting System's "People Count:  Six Billion" for Best TV Documentary, among other recipients.

Prescriptions

Using an exploratory factor analysis to analyze multiple measures of tobacco-related marketing exposure among adolescents, Unger, Cruz, Schuster, Flora, and Johnson developed these conclusions from their study:

• Researchers should match their measures of tobacco-related marketing exposure to the constructs they are trying to assess (e.g., perceived pervasiveness, recall, receptivity, etc.)

• Because receptivity to tobacco marketing is so strongly associated with adolescent smoking behavior, researchers should include measures of receptivity in studies of the effects of tobacco marketing on smoking.

• Anti-tobacco media campaigns should focus on susceptible nonsmokers, those adolescents who have not yet tried smoking but are considering the possibility of doing so in the future.

• Media literacy education programs should be developed to teach adolescents how they are targeted and manipulated by tobacco industry marketing.

-J. Unger, T.B. Cruz, D.  Schuster, J.A.  Flora and C.A. Johnson

Connell, Goldberg, and Folta conducted a study that was designed to evaluate the effectiveness of two audio formats on knowledge, attitudes, and beliefs about fruit and vegetables and on intake of these foods.  Their results suggest the following:

• Interventions to increase produce consumption must go beyond and emphasis on their positive contributions to health and include skill-building information that will enable increased intake.

• Take-home audio tapes that provide actionable nutrition information may be an effective way to increase knowledge and change behavior in supermarket customers.

• Public service announcements containing actionable nutrition information may not be as effective as take-home audio tapes at increasing knowledge and changing behavior in shoppers. They may compete directly with visual cues and other distractions in the supermarket.

 -D. Connell, J.P. Goldberg, and S.C. Folta

Doniger, Riley, Utter, and Adams report on an evaluation of an abstinence oriented, adolescent pregnancy prevention integrated communications program developed by Monroe County, NY. From their experience, they offer these suggestions for future researchers and program planners:

• A well-designed and competently implemented adolescent pregnancy prevention communication can have a measurable community impact.

• Findings from health communication campaign evaluations can assist in justifying expenditure of public resources.

• It is important to have community involvement and feedback at numerous levels—government, community-based organizations, local media, etc.—when developing a targeted youth campaign.

-A. Doniger, J.S. Riley, C.A. Utter, and E. Adams

Edwards, Elwyn, Covey,  Matthews, and Pill conduct a comprehensive review of the literature on manipulations of risk and benefit information in a clinical setting and conclude the following:

• Though there is a paucity of evidence in this field at present, 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’.

• When patients are presented with more information, and which is more understandable, this may promote greater wariness to take treatments or participate in trials.

-E. Edwards, G. Elwyn, J. Covey, E.  Matthews, and R. Pill

Call for Information

You are enthusiastically invited to suggest items for inclusion in "Up Front!"

Please adhere to our guidelines by providing the following information:

Summaries of key results from health communication research Name and purpose of study or protect; key data or findings; sponsorship; name of principal investigator or other primary contact; full citation and/or source of original document with contact information. Please include e-mail, gopher, and World-Wide Web URL addresses where available.

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Conferences (Upcoming) Name, location, and dates of conference; sponsoring institution; key program themes; deadline and address for submitting abstracts; deadline and address for registration; contact information for further information.

Conferences (Completed) Name, location, and dates of conference; sponsoring institution(s), key themes, presentations, and recommendations; contact information for further information.

Upcoming Reports Full title, authors, sponsoring institution; one-sentence description of report; projected or actual release date; contact/ordering information.

Other Major Developments These could include announcements of changes affecting important institutions; developments in the field of health promotion, disease prevention, managed care systems, medical care, or other activities that impact health communication.

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Please send suggestions to:

Journal of Health Communication The GW Center for International Health Department of International Public Health School of Public Health and Health Services The George Washington University 2175 K Street, NW, Suite 820 Washington, DC 20037 Phone: 202-416-0426 Fax: 202-467-2290/202-994-0900

 The UpFront section is 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.