UPFRONT

Volume 8, Number 3
May-June 2003

Vol. 8, Num. 3: Contents | Editorial | Up Front | Abstracts

From This Issue | Prescriptions

Vital Data

From This Issue

Rates of colorectal cancer (CRC) screening are too low to achieve significant public health effects. Efforts to motivate screening have at times relied on affecting people’s perceptions of their CRC risks. Lacking are studies that attempt to motivate screening by examining the joint effects of manipulating both perceptions of CRC risk and severity (i.e., perceived threat). As part of a small pilot study, the researchers recruited 119 men and women aged 50 and older who were off schedule for having a fecal occult blood test (FOBT). They were randomized to one of four groups of a pre-post longitudinal design that varied whether the participant received information about CRC risks (no/yes) and severity of CRC treatment and illness consequences (no/yes). We assessed whether these manipulation affected CRC screening intentions (i.e., FOBT/sigmoidoscopy) and FOBT screening at a six-month follow-up. Although perceptions of CRC risks were not affected by the experimental manipulations, perceived severity increased screening intentions for FOBT and lowered ambivalence towards FOBT. Participants who received severity information were significantly more likely to report having had a FOBT. Weaknesses of this design included having a small sample size of primarily White and well-educated participants. These results suggest that more attention needs to be given to developing strategies to affect perception of CRC threat and increasing the perceived severity of CRC to increase screening. Lipkus, I. M., Green, L. G., Marcus, A. Manipulating Perceptions of Colorectal Cancer Threat: Implications for Screening Intentions and Behaviors. (p. 213).

In the United States and other countries, anti-smoking advertising has become more common as part of efforts to reduce smoking prevalence. Debate about the required extent of funding and the efficacy of different anti-smoking advertising themes has been intense. In recent years, tobacco companies have begun to use advertising strategies to promote to youth a message not to smoke. These developments raise questions about the circumstances under which anti-smoking advertising may have greater or lesser effects on youth smoking. In the second article of this issue, Wakefield and colleagues review field experiments, evaluate studies of government-funded anti-smoking campaigns, studies of anti-smoking advertising themes, and comparative studies of anti-smoking advertising and cigarette advertising in to assess the effects of anti-smoking advertising on teenagers. They conclude that anti-smoking advertising appears to have more reliable positive effects on those in pre-adolescence or early adolescence by preventing commencement of smoking. It is unclear whether this is due to developmental differences, a reflection of smoking experience, or a combination of the two. In addition, it is evident that social group interactions, through family, peer, and cultural contexts, can play an important role in reinforcing, denying, or neutralizing potential effects of anti-smoking advertising. Although there is some research to suggest that advertising genres that graphically depict the health effects of smoking, emphasize social norms against smoking, and portray the tobacco industry as manipulative can positively influence teenagers, these findings are far from consistent. Finally, the effects of anti-smoking advertising on youth smoking may be enhanced by the use of other tobacco control strategies, and may be dampened by tobacco advertising and marketing. Overall, the findings of this review indicate that there is no single ‘‘recipe’’ for anti-smoking advertising that leads to reductions in youth smoking. Anti-smoking advertising can influence youth smoking, but whether it does in the context of individual anti-smoking campaigns needs to be the subject of careful evaluation. Wakefield, M., Flay, B., Nichter, M., and Giovino, G. Effects of Anti-Smoking Advertising on Youth Smoking: A Review. (p. 229).

Public figures are often conferred celebrity status, consequently gaining access to the media and the attention of the American public. The commercial (celebrity endorsement) and prosocial (celebrity advocate) functions of celebrity communication are widely recognized and utilized. However, the function of celebrity disclosures—public revelations of personal information—has received less attention. The third article in this issue examines the impact of celebrities on the perception of disease and treatment. One instance of celebrity disclosure of a health-related issue, namely Earvin ‘‘Magic’’ Johnson’s disclosure that he was HIV positive, garnered enough attention to produce a body of research appropriate for synthesis to gain a glimpse of the nature and influence of celebrity disclosure of health-related issues. When Johnson, an African American basketball player for the Los Angeles Lakers, announced that he was HIV positive, a shock wave ran through the United States. A number of investigations examined the impact that the announcement had on the behavior, attitudes, and knowledge of individuals regarding HIV and AIDS. A quantitative summary of the research finds that after Johnson’s announcement, the level of accurate knowledge about HIV increased, the number of persons tested for HIV increased, and the desire to obtain more information increased. For adults, the impact of the announcement increased their perception of vulnerability. For children/adolescents, the announcement diminished the perception of risk (i.e., increased knowledge made it clear they were not at risk through casual contact, hugs, etc. — the exposure was due to ‘‘adult’’ activities). This meta-analysis reaffirms the impact that celebrity disclosures may have on the perception of a disease. Such effects are not universal as the individual’s degree of identification with the celebrity influences the persuasive process. Casey, M. K., Allen, M., Emmers-Sommer, T., Sahlstein, E., DeGooyer, D., Winters, A. M., Wagner, A. E., Dun, T. When a Celebrity Contracts a Disease: The Example of Earvin ‘‘Magic’’ Johnson’s Announcement That He Was HIV Positive. (p. 249).

Peer education can be a very effective approach to HIV/AIDS prevention and a way of empowering people of all ages. As a concept, it is well known and used internationally among practitioners and policy analysts in the AIDS education field. In the fourth article in this issue, Hope assesses the impact and outcome of the Peer Education HIV/AIDS Prevention Program (PEHAPP) at the workplace in Botswana — the country which currently has the highest HIV/AIDS prevalence rate in the world at 35.8 percent. The study is based on a knowledge, attitudes, behavior, and practices (KABP) survey and focus group discussions conducted in Botswana workplaces in 1999. The article reviews the perceptions of impact and outcome by respondents and analyzes the implications for controlling the spread of HIV/AIDS in Botswana. The KABP survey was conducted with a sample coverage of peer educators (n = 73), managers (n = 23), and peers (employees) (n = 439) encompassing workplaces in selected urban and rural locations spanning all ten of the country’s administrative districts. Three separate questionnaire instruments were administered. Q1 was used for management and included components on type of organization, number of employees, number of peer educators, year peer education program commenced, selection procedures for peer educators, training of peer educators, and outcomes and impact. Q2 was used for peer educators with components on demographic characteristics, peer education training, nature and frequency of peer education activities, management and peer support for such activities, and perceived outcomes and impact. Q3 was used for the peers. Its components included demographic characteristics, duration of participation in peer education programs, nature and frequency of participation in peer education programs, behavioral indicators, peer educator influence, and perceived outcomes and impact. Study results revealed that the PEHAPP has been rather successful in the key areas of improving knowledge, attitudes, and practices related to risky sexual behavior. These findings confirm the consensus emerging in the literature that peer health education is a culturally appropriate and very effective method of responding to the HIV/AIDS epidemic. That, in turn, suggests that peer health education is an effective tool for information dissemination. The author recommends an increase in the allocation of national resources for the PEHAPP and points to the importance of full management support for successful outcomes of peer education in workplaces. Hope, K. R. Promoting Behavior Change in Botswana: An Assessment of the Peer Education HIV/AIDS Prevention Program at the Workplace. (p. 267).

Political campaigns offer a unique opportunity for voters and the public to learn about significant health issues facing Americans and to use that information to differentiate between candidates. The final article of this issue examines how often national media reported key aspects of Senator Bill Bradley’s and Vice President Al Gore’s proposals for health insurance reform during the 2000 Democratic primary campaign. Two hundred three news stories from newspapers, broadcast sources, and magazines were coded for mentions of health insurance coverage, costs, and funding and explicit comparisons of these features. Results from this study show that news media reported on Bradley’s plan and major features of his plan significantly more often than Gore’s. Additionally, few reports contained explicit comparisons that explained which plan would have covered more people or cost more. The author concludes that public health and media professionals need to work together to improve the quality of information the public depends on to develop views about and support for the uninsured. Mebane, F. Bradley vs. Gore: How Media Covered Proposals for Health Insurance Reform in the Context of the 2000 Presidential Campaign. (p. 283).

Prescriptions

Lipkus, Green, and Marcus studied whether affecting perceptions of colorectal cancer threat among men and women aged 50 and older influenced their perceptions of colorectal cancer risk and severity, intentions to be screened, and screening, using the fecal occult blood test. The following are their findings and recommendations for colorectal cancer screening:

Colorectal cancer risk perceptions were not affected. Perceived severity increased screening intentions to have a fecal occult blood test (FOBT) and lowered felt ambivalence towards having a FOBT. Participants who received severity information were significantly more likely to report having had a FOBT. Improved methods are needed to affect perceived colorectal cancer risk. Interventions should consider providing severity information about colorectal cancer, perhaps through the use of patient testimonials. —I. M. Lipkus L. G. Green A. Marcus

Wakefield, Flay, Nichter and Giovino conducted a review of studies of the effects of anti-smoking advertising on youth smoking. They conclude that:

Anti-smoking advertising can positively influence youth smoking. Anti-smoking advertising appears to have more reliable positive effects on those in pre-adolescence or early adolescence by preventing commencement of smoking. Social group interactions can play an important role in reinforcing, denying, or neutralizing potential effects of anti-smoking advertising. Effects of anti-smoking advertising on youth smoking may be enhanced by the use of other tobacco control strategies and may be dampened by tobacco advertising and marketing. —M. Wakefield B. Flay M. Nichter and G. Giovino

Casey, Allen, Emmers-Sommer, Sahlstein, DeGooyer, Winters, Wagner, and Dun synthesized the research on the impact of Earvin ‘‘Magic’’ Johnson’s disclosure of his HIV status. The results suggest the following in relation to celebrity disclosures of health-related issues:

Celebrities that share personal health information can influence disease-related attitudes, knowledge, beliefs, and behaviors. The extent to which the audience identifies with the celebrity influences the potency of the disclosure as a persuasive health message. The effects of celebrity disclosures may be transient for some outcomes (attitudes toward an affected group) while more enduring for others (knowledge). Three key persuasive elements contributed to the impact of Johnson’s announcement: personal identification with the celebrity, narrative form, and heightened issue saliency. —M. K. Casey M. Allen T. Emmers-Sommer E. Sahlstein D. DeGooyer A. M. Winters A. E. Wagner T. Dun

Hope conducted an assessment of the Botswana Peer Education HIV/AIDS Prevention Program (PEHAPP) at the workplace to determine its impact and outcome on promoting behavior change. The findings suggest the following:

The Peer Education HIV/AIDS Prevention Program at the workplace has been rather successful in the key areas of improving knowledge, attitudes, behavior, and practices related to risky sexual behavior. For any workplace or organizational initiative to succeed in promoting behavior change, it must be fully supported by the management. Peer health education is a culturally appropriate and very effective method of responding to the HIV/AIDS epidemic. Peer health education is an effective tool for information dissemination and the efficient utilization of local resources for influencing behavior change. —K. R. Hope Sr.

Mebane examined how often national media reported key aspects of Senator Bill Bradley’s and Vice President Al Gore’s proposals for health insurance reform during the 2000 Democratic primary campaign. Results suggest the following:

Scant reporting of key aspects of health policy proposals during political campaigns are a lost opportunity for voters and the public to learn about important health care issues, such as lack of health insurance for millions of Americans. More research is needed to further understand news coverage of health policy issues during political campaigns and the impact of this coverage on voter and public knowledge and support of candidates and proposals. Health policy experts, health care professionals, and journalists need to discuss and develop guidelines for what voters should know about health policy issues during political campaigns and how news coverage can incorporate this information. Health policy experts should work with journalists to improve the quality and balance of news coverage of the uninsured and other health policy issues during political debates. —F. Mebane

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The Up Front section is edited by Wendy Meltzer, Managing Editor, Journal of Health Communication: International Perspectives.