Communicating about the social determinants of health: development of a local brand.

BACKGROUND: Successful comprehensive population-based approaches to chronic disease prevention leverage mass media to amplify messages and support a culture of health. We report on a community-engaged formative evaluation to segment audiences and identify major themes to guide campaign message development for a transformative health communication campaign. METHODS: Four key phases of campaign development: (I) Formative evaluation to identify priorities, guiding themes, and audience segments (interviews/focus groups with residents, N = 85; representatives of community-based partner organizations, N = 10); (II) Brand development (focus groups and closed-ended surveys; N = 56); (III) Message testing approaches to verbal and visual appeals (N = 50 resident intercept interviews); (IV) Workshop (N = 26 participants representing 15 organizations). RESULTS: Residents were engaged throughout campaign development and the resulting campaign materials, including the campaign name and visual aesthetic (logo, color schemes, overall look and feel) reflect the diversity of the community and were accepted and valued by diverse groups in the community. Campaign materials featuring photos of county residents were created in English, Spanish, and Hmong. Plain language messages on social determinants of health resonate with residents. The county was described as a sort of idyllic environment burdened by inequality and structural challenges. Residents demonstrated enthusiasm for the campaign and provided specific suggestions for content (education about disease risks, prevention, management; information about accessing resources; testimonials from similar people) and tone. CONCLUSIONS: Communication to support a policy, systems, and environmental change approach to chronic disease prevention must carefully match messages with appropriate audiences. We discuss challenges in such messaging and effectiveness across multiple, diverse audiences.

Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD.

OBJECTIVE: High rates of substance-use disorders (SUD) have been found in samples of adolescents and adults with attention-deficit/hyperactivity disorder (ADHD). Predictors of SUD in children with ADHD who are at risk for the development of SUDs remain understudied. The main aims of this study were to identify clinically meaningful characteristics of children that predicted the future development of SUDs and to see whether the role of these characteristics varied by sex. METHOD: Subjects were children and adolescents with (n = 268; mean age ± standard deviation = 10.9 ± 3.2 years) and without (n = 229; mean age 11.9 ± 3.3 years) DSM-III-R ADHD followed prospectively and blindly over a 10-year follow-up period onto young adult years. Subjects were assessed with structured diagnostic interviews for psychopathology and SUDs. RESULTS: Over the 10-year follow-up period, ADHD was found to be a significant predictor of any SUD (hazards ratio 1.47; 95% confidence interval 1.07-2.02; p = .01) and cigarette smoking (2.38; 1.61-3.53; p < .01). Within ADHD, comorbid conduct disorder (2.74; 1.66-4.52; p < .01) and oppositional defiant disorder (2.21; 1.40-3.51; p < .01) at baseline were also found to be significant predictors of SUDs. Similar results were found for cigarette-, alcohol-, and drug-use disorders. There were few meaningful sex interaction effects. No clinically significant associations were found for any social or family environment factors or for cognitive functioning factors (p > .05 for all comparisons). CONCLUSIONS: These results indicate that ADHD is a significant risk factor for the development of SUDs and cigarette smoking in both sexes.

Variation in health blog features and elements by gender, occupation, and perspective.

This study explores whether there are gender and occupational differences in the health blogosphere and whether there are differences by blogger perspective. Data were derived from content analysis of 951 health blogs identified between June 2007 and May 2008. Results indicate that male, physician bloggers were more likely to have blogs that feature a SiteMeter, sponsorship, and advertising, which also were more prevalent among those blogging from a professional perspective. Women, bloggers in non-health-related employment, and patient/consumer and caregiver bloggers were more likely to blog about disease and disability; men, bloggers in health-related employment, and professional bloggers were more likely to blog about provider experiences, health research/news, and health policy, business, law, and technology. Because the Internet is becoming a primary source of health information, establishing normative guidelines regarding information quality, patient privacy, and conflicts of interest is essential. Future research should build on these findings using national surveys of health bloggers and textual analysis of blog content.

Do executive function deficits predict later substance use disorders among adolescents and young adults?

OBJECTIVE: There is increasing interest regarding the risk and overlap of executive function deficits (EFDs) in stable cigarette smoking and substance use disorders (SUD). Therefore, we examined whether earlier EFD was a risk factor for subsequent cigarette smoking and SUD and further explored the relationship between EFD and SUD. METHOD: We assessed 435 subjects at the 5-year follow-up (232 subjects with attention-deficit/hyperactivity disorder [ADHD], mean age ± SD: 15.4 ± 3.43 years; and 203 controls: 16.3 ± 3.42 years) and again 4 to 5 years later as part of a prospective family study of youth with ADHD. Individuals were assessed by structured psychiatric interview for psychopathology and SUD. EFD was categorically defined in an individual who had abnormal results on at least two of six neuropsychological tests of executive functioning. RESULTS: At the final follow-up period, ADHD was found to be a significant predictor of stable cigarette smoking (p < .01) and SUD into late adolescence and young adult years (p < .01). However, EFDs were not associated with an increase in subsequent substance use outcomes. New-onset stable cigarette smoking, but not SUD, was associated with subsequent EFD (p < .01). CONCLUSIONS: Our results do not support the hypothesis that EFDs predicts later stable cigarette smoking or SUD in children with ADHD growing up. However, stable cigarette smoking is associated with subsequent EFD.

Impact of executive function deficits in youth with bipolar I disorder: a controlled study.

Although psychometrically-defined executive function deficits (EFDs) and ecologically valid functional outcomes have been documented among youth with bipolar I (BP-I) disorder, little is known about their association. We hypothesized that EFDs would be associated with significant ecologically valid impairments beyond those predicted by having BP-I disorder. Youth with BP-I disorder were ascertained from psychiatric clinics and community sources. We defined EFDs as having at least two out of eight EF measures impaired from a battery of six tests. Significantly more youth with BP-I disorder had EFDs than controls (45% versus 17%). Comparisons were made between controls without EFDs (N=81), controls with EFDs (N=17), BP-I youth without EFDs (N=76), and BP-I youth with EFDs (N=62). EFDs were associated with an increased risk for placement in a special class and a decrease in academic achievement (WRAT-3 reading and arithmetic). EFDs in BP-I subjects were associated with an increased risk for speech/language disorder (as assessed in the K-SADS-E) relative to BP-I subjects without EFDs. Youth with BP-I disorder and EFDs are at high risk for significant impairments in academic functioning.