With many states launching multi-million dollar tobacco counter-advertising
campaigns, it is prudent that we seek answers to the basic research
questions that will inform us whether tobacco counter-advertisements
are effective over time, which ones work best, and what the limiting
parameters are that govern their effectiveness. Further, anti-smoking
communications have the potential to backfire and strengthen initial
pro-smoking attitudes, especially among young smokers. In the first
article of this issue, the tobacco counter-advertising literature is
reviewed as it relates to basic process questions concerning what makes
counter-advertisements effective. Limitations in addressing (a) counter-advertisement
content and the psychological mediators targeted, (b) counter-advertisement
style and the affective reactions targeted, (c) prior smoking experience,
and (d) other audience factors are enumerated. A theoretical model based
on alcohol advertising research is presented to address these limitations.
By applying a model that
examines the independent influence of each of these enumerated factors,
as well as how their effects qualify each other, one can examine the
more practical research question of when tobacco counter-advertising
will work (e.g., do certain contents or styles of tobacco counter-advertisements
work better for individuals of differing smoking experience or for
different audiences?). By also applying a model that addresses the how
question, identifying the mediating processes that underlie qualified
findings, tobacco counter-advertisers can be better informed on how
to more effectively design counter-advertisements to influence more
of their intended audience more of the time. Agostinelli,
G., and Grube, J.W. Tobacco Counter-Advertising: A Review of the Literature
and a Conceptual Model for Understanding Effects (p. 107).
Successful anti-marijuana messages can be hypothesized to have two types
of effects, namely persuasion effects, that is, a change in people’s
beliefs about using marijuana, and priming effects, that is, a strengthened
correlation between beliefs and associated variables such as attitude
and intention. The second article in this issue examines different
sets of anti-drug advertisements for persuasion and priming effects.
The ads targeted the belief that marijuana is a gateway to stronger
drugs, a belief that is often endorsed by campaign planning officials
and health educators. A sample of 418 middle and high school students
was randomly assigned to a control video or one of three series of ads,
two of which included the gateway message in either an explicit or implicit
way. Results did not support the use of the gateway belief in anti-marijuana
interventions. Whereas no clear persuasion or priming effects were found
for any of the ad sequences, there is some possibility that an explicit
gateway argument may actually boomerang. In comparison to the control
condition, adolescents in the explicit gateway condition tended to agree
less with the gateway message and displayed weaker correlations between
anti-marijuana beliefs and their attitude toward marijuana use. The
boomerang effect was most indicative of adolescents who were likely
to have used marijuana in the past. Possibly, the gateway argument was
contradicted by these adolescents’ immediate experience that their
marijuana use did not lead to the use of stronger drugs. Thus, using
a message about negative consequences of unhealthy behavior carries
the risk that it may backfire when it runs counter to people’s
experience. In general, the results suggest that the gateway message
should not be used in anti-drug interventions. Yzer,
M.C., Cappella, J.N., Fishbein, M., Hornik, R. and Ahern, R.K. The Effectiveness
of Gateway Communica-tions in Anti-Marijuana Campaigns (p. 129).
Patient noncompliance with doctors’ orders and drug instructions
is a serious problem, increasingly recognized as such in the medical
and public policy fields, and may result in huge physical and financial
costs. The third article in this issue considers this issue of compliance
with pharmaceutical drug instructions by exploring communication-based
ways in which intention to comply might be improved. Specifically, this
research investigates the impact of (1) providing instructions that
include information about the consequences of instruction noncompliance,
(2) the frame (positive or negative) of the instruction and, (3) the
language (i.e., plain versus medical jargon) of the instruction, on
intention to comply. The results of a lab experiment suggest that compliance
intentions may be enhanced when instruction content is structured in
a negative frame and is communicated in plain language. Further, results
suggest communicating such that potential consequences are presented
in a negative frame rather than positive frame. This research considered
subject compliance intention rather than actual patient behavior. While
this does qualify the present research as exploratory, significant effects
on com-pliance intention suggest the value of future behavioral research,
as extant research shows that intention is not only an antecedent of
actual behavior, but also a strong predictor of that behavior. Therefore,
by demonstrating an effect on intention, this research supports the
value of future research investigating the effect of plain language
and negative frames on actual patient behavior. In addition to extending
this research to actual patient behavior, future research should also
examine the generalizability of these findings across a variety of patient
populations. Bower, A.B., and
Taylor, V.A. Increasing Intention to Comply with Pharmaceutical Product
Instructions (p. 145).
Beliefs and behaviors that predict college students’ alcohol use
are in development as young as third grade. Because both media messages
and parents are important influences, the fourth article of this issue
examines how college students’ (N ¼ 300) recollections of
parental reinforcement of media messages associated with their current
alcohol-related beliefs and behaviors. Structural equation modeling
showed that college students who recalled more positive reinforcement
of media messages (‘‘positive mediation’’) from
their parents were less skeptical of advertising and found alcohol advertising
more desirable. They also expected more positive benefits from drinking
alcohol. The more they found alcohol advertising portrayals desirable,
the more likely they were to think most college students drink. The
less skeptical they were, and the more they believed that college students
drink, the more they expected social benefits from drinking. More positive
expectancies about the social benefits of drinking alcohol predicted
heavier current drinking behavior. That students’ perceptions of
social norms were predicted only by desirability, and not by parental
communication or by skepticism, suggests that perceptions of social
reality develop in part as a result of wishful thinking instead of through
purely logical evaluation processes. Prevention programs can respond
by incorporating strategies that acknowledge the importance of emotion-based
thinking in adolescents’ decision making. This means that college-based
anti-alcohol campaigns may need to present an equally glamorous alternative
to alcohol consumption while also attempting to deglamorize alcohol
consumption. The results also suggest that campaigns need to target
parents, because while parents can help children learn useful, prosocial
messages, parents also can make adolescents more receptive to media
influences that lead toward more risky beliefs and behaviors. Austin,
E.W. and Chen, Y.J. The Relationship of Parental Reinforcement of Media
Messages to College Students’ Alcohol-Related Behaviors (p. 157).
Dental phobia is regarded as one of the greatest obstructions to adequate
dental care. It has long been established that fearful dental patients
are particularly sensitive to dentists’ behavior and performance
of dental care. Although the dentist-patient relationship has received
considerable attention during the past two decades, little research
has focused on clinical encounters between dentists and dental phobic
patients. The final article of this issue studied dentists’ perceptions
of how they thought, felt, and what they did during the actual consultation
with fearful patients. Interview questions focused on what constitutes
a patient-centered consultation and what are the characteristics of
a patient-oriented dentist. Five dentists specialized in treating dental
phobic patients were interviewed. One core category, ‘‘Holistic
perception and understanding of the patient’’, and two main
sub-categories: ‘‘The dentist’s positive outlook on people’’
and ‘‘The dentist’s positive view of patient contact’’
were identified. The latter were separated into six further sub-categories.
Findings support previous models of patient-centered medicine and contribute
to a better understanding of how patient-centered dentists interact
with dental phobic patients. Kulich,
K.R., Berggren, U., Hallberg, L.R.-M. A Qualitative Analysis of Patient-Centered
Dentistry in Consultations with Dental Phobic Patients (p. 171).
Prescriptions
Agostinelli and Grube review the tobacco counter-advertising literature
and present a conceptual model for understanding counter-advertising
effects. They recommend the following for public health campaign planners
and researchers:
-
To determine whether or not tobacco counter-advertising
itself is effective, experimental research must isolate the
effects of exposure to tobacco counter-advertising in a more
controlled manner than is typically done in evaluation studies
that examine the effectiveness of multi-component anti-tobacco
campaigns.
-
A firmer understanding of the processes that underlie effective
tobacco counter-advertising would benefit from applying a
model that incorporates both affective and cognitive mediators
of counter-advertising effects.
-
Identification through content analysis of the assumed psychological
mechanisms that tobacco counter-advertisements target is needed,
with recognition that a single counter-advertisement may target
multiple mechanisms.
-
Identification of counter-advertising styles and the assumed
affective reactions they target is needed, along with examining
how those affective reactions can further affect the cognitive
processing of the counter-advertisements (i.e., attention
effects).
-
Documenting how individual differences in smoking experience
can selectively bias the processing of varying counter-advertisements
is needed, with the goal of identifying those counter-advertising
contents and styles that short-circuit defensive reactions
in smokers, yet maintain anti-smoking attitudes in non-smokers.
-
Exploration of other audience factors (i.e., media dependency)
that may qualify exposure effects, because of differential
attention to information in the media, is also needed.
—G.
Agostinelli, J. W. Grube
|
Yzer, Cappella, Fishbein, Hornik, and Ahern studied the effectiveness
of the message that marijuana use is a gateway to the use of stronger
drugs. The results suggested the following recommendations for health
campaigns and research:
-
The gateway message should not be used in anti-drug interventions
because of its
potential boomerang effects on adolescents.
-
Health communication research should compare the effectiveness
of intervention strategies that address a single health belief
versus a set of multiple related health beliefs.
-
An intervention can affect health behavior not only by changing
health beliefs, but also by increasing the importance of positive
health beliefs in guiding people’s perceptions and behavior.
-
Since messages about negative consequences of unhealthy
behavior may backfire when they run counter to people’s
experience, health interventions should address positive consequences
of healthy behavior.
—M.
C. Yzer, J. N. Cappella, M. Fishbein, R. Hornik, and R. K. Ahern
|
Bower and Taylor studied the issue of compliance with pharmaceutical
drug instructions by exploring communication-based ways in which intention
to comply might be improved. From their research they offer the following
recommendations:
-
Results suggest that compliance intentions may be enhanced
when instruction content is structured in a negative rather
than positive frame.
-
Results suggest that compliance intentions may be enhanced
when instruction content is communicated in plain language
rather than medical terminology.
-
Results suggest the value of future research that extends
these findings to actual patient behavior.
-
Future research should also examine the generalizability
of these findings across a variety of patient populations.
—A.
B. Bower, V. A. Taylor
|
Austin and Chen examined how college students’ recollections of
parental reinforcement of media messages associated with their current
alcohol-related beliefs and behaviors. They conclude that prevention
programs should consider the following:
-
Campaign designers should consider that college students
arrive on campus with well-developed beliefs and decision-making
patterns, for which parents are an important influence.
-
Parents need to become more aware that their endorsement
of media messages can lead adolescents to interpret media
messages less skeptically, which makes adolescents more receptive
to pro-drinking messages.
-
Campaigns also should consider that decisions about drinking
are not entirely logical and can be influenced by wishful
thinking, which advertising messages encourage.
-
To compete with commercial messages, campaigns may need to
present an equally glamorous alternative to alcohol consumption
while also attempting to deglamorize alcohol portrayals in
the media.
—E.
W. Austin, Y. J. Chen
|
Kulich, Berggren and Hallberg studied the dentist-patient interaction
in a specializedclinic for the treatment of dental phobic patients.
From their research the following conclusions can be drawn:
-
Semi-structured interviews with dentists and video-recorded
dentist-patient consultations are useful tools to generate
rich qualitative data. The theoretical models generated from
the data contribute to a better understanding of the dynamics
and
interpersonal processes involved in the dentist-patient interaction.
-
Future qualitative research should generate theoretical
models from the dental phobic patient’s perspective.
It should be explored whether the dentist’s and patient’s
perspective reveal concordance or difference regarding the
view on the characteristics of patient-centered dentistry.
-
A systematic theory of the dentist-patient communication
requires research in different dental clinic settings and
in various dental patient populations.
—K.
R. Kulich, U. Berggren, and L.R-M. Hallberg
|
__________
The Up Front section is edited by Wendy Meltzer, Managing Editor,
Journal of Health Communication: International Perspectives.
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