Social Support Functions During a Slowly-Evolving Environmental Disaster: The Case of Amphibole Asbestos Exposure in Libby, Montana.

Previous research concluded that victims of rapid-onset natural disasters (e.g., hurricanes) receive and provide high levels of instrumental support. However, different kinds of disasters (natural or human caused [technological, environmental, intentional/terrorism], rapid or slow onset, short or long duration) may create different stressors and thus influence the types of social support most needed and provided. We explored social support functions during an ongoing "slowly-evolving environmental disaster" in Libby, Montana due to widespread exposure to amphibole asbestos. Analyses of focus groups and in-depth interviews focused on the relative salience of support functions (emotional, informational, instrumental, and spiritual) identified as needed or provided. Dominant themes emerged around each function. Results indicated that informational support is particularly salient in this type of disaster. Although not all community members had experienced the disaster's health consequences (asbestos-related disease [ARD]), all had been affected by the disaster and had informational needs. The nature of those informational needs (e.g., medical vs. financial) varied based on experience with ARD. Experience with ARD was associated with awareness of disaster-related emotional and instrumental support needed or provided. Results have implications for future research on slowly-evolving environmental disasters and institutional and community responses to them.

The role of social toxicity in responses to a slowly-evolving environmental disaster: the case of amphibole asbestos exposure in Libby, Montana, USA.

Experiencing a disaster has significant negative effects on psychological adjustment. Case study accounts point to two consistent trends in slowly-evolving environmental disasters: (a) patterns of negative social dynamics, and (b) relatively worse psychological outcomes than in natural disasters. Researchers have begun to explicitly postulate that the social consequences of slowly-evolving environmental disasters (e.g., community conflict) have their own effects on victims' psychological outcomes. This study tested a model of the relationship between those social consequences and psychological adjustment of victims of a slowly-evolving environmental disaster, specifically those whose health has been compromised by the amphibole asbestos disaster in Libby, MT. Results indicate that experiencing greater community conflict about the disaster was associated with greater family conflict about the disaster which, in turn, was associated with greater social constraints on talking with others about their disease, both directly and indirectly through experiencing stigmatization. Experiencing greater social constraints was associated with worse psychological adjustment, both directly and indirectly through failed social support. Findings have implications for understanding pathways by which social responses create negative effects on mental health in slowly-evolving environmental disasters. These pathways suggest points for prevention and response (e.g., social support, stigmatization of victims) for communities experiencing slowly-evolving environmental disasters.

Threat, efficacy, and uncertainty in the first 5 months of national print and electronic news coverage of the H1N1 virus.

The authors conducted a content analysis, investigating the first 5 months of national print and electronic news coverage of the H1N1 virus. They collected all stories about H1N1 appearing in 6 national news outlets between April and September 2009. Of these stories meeting the analysis criteria, the authors randomly selected 200 for inclusion. Using models of fear appeal message processing, this study investigated the nature and prevalence of threat and efficacy messages in news coverage of the virus. Such models have traditionally been applied to strategic health message contexts (e.g., campaigns) rather than to health news coverage. Results suggest that most stories made reference to the threat of the H1N1 virus, sometimes overemphasizing and sensationalizing virus-related death. With regard to efficacy, approximately half mentioned actions individuals or organizations/communities could take to protect themselves from the virus, but almost none provided evidence that such methods are effective, and some explicitly questioned their effectiveness. In addition, a number of stories referenced uncertainty about the threat of the virus (38%) and/or solutions to the potential threat (18%). The authors discuss the implications from the perspective of fear appeal message processing models.

A Typology of Communication Dynamics in Families Living a Slow-Motion Technological Disaster.

With increasing numbers of communities harmed by exposures to toxic substances, greater understanding of the psychosocial consequences of these technological disasters is needed. One community living the consequences of a slow-motion technological disaster is Libby, Montana, where, for nearly 70 years, amphibole asbestos-contaminated vermiculite was mined and processed. Former mine employees and Libby area residents continue to cope with the health consequences of occupational and environmental asbestos exposure and with the psychosocial challenges accompanying chronic and often fatal asbestos-related diseases (ARD). Nine focus groups were conducted with Libby area residents. Transcripts were analyzed to explore patterns of family communication about ARD. The following five patterns emerged: Open/Supportive, Silent/Supportive, Open/Conflictual, Silent/Conflictual, and Silent/Denial. Open/Supportive communication included encouragement to be screened for ARD, information about ARD and related disaster topics, and emotional support for people with ARD. In contrast, communication patterns characterized by silence or conflict have the potential to hinder health-promoting communication and increase psychological distress.

Community-level social support responses in a slow-motion technological disaster: the case of Libby, Montana.

Social support is an important resource for communities experiencing disasters. However, a disaster's nature (rapid- versus slow-onset, natural versus technological) may influence community-level responses. Disaster research on social support focuses primarily on rapid-onset natural disasters and, to a lesser extent, rapid-onset technological disasters. Little research has addressed slow-onset disasters. This study explores social support processes in Libby, MT, a community experiencing a "slow-motion technological disaster" due to widespread amphibole asbestos exposure. A comprehensive social support coding system was applied to focus-group and in-depth-interview transcripts. Results reveal that, although the community has a history of normative supportiveness during community and individual crises, that norm has been violated in the asbestos disaster context. Results are interpreted as a failure to achieve an "emergent altruistic community." Specifically, community-level conflict appears to interfere with previously established social support patterns. The observed phenomenon can be understood as the deterioration of a previously supportive community.

Studying the process of clinical communication: issues of context, concepts, and research directions.

Much cancer-related health communication research has involved studies of the effects of media campaigns and strategies on secondary prevention. Cancer diagnosis rates, however, continue to affect millions of people. The need exists for communication studies to address the quality of the clinical interaction, the point of actual care delivery in addressing diagnosis, treatment, and survivorship. Using examples from a 6-year communication and behavioral oncology research program established at the Karmanos Cancer Institute (KCI) in Detroit, Michigan, we describe selected empirical issues; models, particularly the "convergence model" (adapted from Rogers & Kincaid, 1981); and associated constructs that are relevant and promising foundations for building future research in cancer clinical settings. Two examples from our empirical research program are described.

Parents' Empathic Responses and Pain and Distress in Pediatric Patients.

We investigated the relationship between parents' empathic responses prior to their children undergoing cancer treatment procedures and children's pain/distress during the procedures. We hypothesized: (1) parents' empathic distress would be positively associated with children's pain/distress, (2) parents' empathic concern would be negatively associated with children's pain/distress; and (3) parents' enduring dispositions and social support would be associated with their empathic responses. Parents completed: (1) measures of dispositions and perceived social support several weeks before their children underwent the procedures, and (2) state measures of empathic distress and empathic concern just before the procedures. Empathic distress was positively associated with children's pain; empathic concern was negatively associated with children's pain/distress. Predictions about dispositions and social support were also substantially confirmed.

Prescription drug abuse information in D.A.R.E.

This investigation was designed to examine prescription drug-related content and learning objectives in Drug Abuse Resistance Education (D.A.R.E.) for upper elementary and middle schools. Specific prescription-drug topics and context associated with content and objectives were coded. The coding system for topics included 126 topics organized within 14 categories. A two-dimensional coding system for context identified Use versus Abuse and Explicit versus Implicit references to prescription drugs. Results indicated that content and objectives found in D.A.R.E. represent a very narrow breadth of prescription drug topics. Moreover, all prescription-drug related content and objectives were presented in an Abuse-Implicit context. Although some educational material in D.A.R.E. modules potentially is related to prescription drugs, none of the content or objectives explicitly identify drugs discussed as prescription drugs. If elementary and middle schools rely on D.A.R.E. modules to teach students about drug abuse, students are likely to be underinformed about prescription drug risks.

Parent communication and child pain and distress during painful pediatric cancer treatments.

Children with cancer often consider treatment procedures to be more traumatic and painful than cancer itself. Previous research indicates that parents' behavior before and during painful medical procedures influences children's distress level. Understanding parents' naturally occurring communication patterns is essential to identifying families in need of an intervention to enhance coping and emotional well-being. Using the concept of definition of the situation from a symbolic interactionism theoretical framework, this study developed a typology of parent communication patterns and tested relationships between those patterns and children's responses to potentially painful treatment procedures. Analyses are based on video-recorded observations of 31 children and their primary parents (individuals functioning in a parenting role and serving as the primary familial caregivers during the observed procedure) in the USA during clinic visits for potentially painful pediatric oncology treatments. Four communication patterns emerged: normalizing, invalidating, supportive, and distancing. The most common communication patterns differed by clinic visit phase: normalizing during pre-procedure, supportive during procedure, and both distancing and supportive during post-procedure. Parents' communication also varied by procedure type. Supportive communication was most common during lumbar punctures; normalizing and distancing communication were most common during port starts. Six children (19.4%) experienced invalidation during at least one clinic visit phase. Analyses indicated that invalidated children experienced significantly more pain and distress than children whose parents used other communication patterns. This typology provides a theoretical approach to understanding previous research and offers a framework for the continuing investigation of the influence of parents' communication during potentially painful pediatric oncology procedures.

Direct-to-consumer print ads for drugs: do they undermine the physician-patient relationship?

BACKGROUND: Critics of direct-to-consumer print advertising for drugs (DTCA) contend it alters physician-patient communication by promoting greater patient participation and control. We assessed the nature of messages in print DTCA to identify potential guidelines they may provide to consumers for communicating with physicians. METHODS: We analyzed all unique advertisements (ie, excluded ads repeated across issues or magazines) in 18 popular magazines (684 issues) from January 1998 to December 1999 (n=225). We identified every statement that referred to physicians, and within that set, statements that focused on physician-patient communication. Each communication-related statement was coded as a message to consumers about communication in terms of cues suggesting who should initiate communication, who should be in relational control, and appropriate interaction topic(s). RESULTS: More than three-quarters (83.8%) of the advertisements' statements referring to physicians focused on physician-patient communication (M=2.6 per ad; SD=1.8). Most (76.1%) of these messages explicitly or implicitly promoted consumers initiating communication, but cast the physician in relational control (54.5%). The most frequently suggested interaction topics were clinical judgments of the product's appropriateness (41.8%) and information about the product (32.1%). CONCLUSIONS: Typical direct-to-consumer print ads contain multiple messages about communicating with physicians. The patterned nature of these messages appears to promote social norms for consumers' communication behavior by repeatedly implying the appropriateness of consumers initiating interaction, physicians maintaining relational control, and avoiding negative consequences of advertised drugs as conversational topics.

Using social cognitive theory to explain consumers' behavioral intentions in response to direct-to-consumer prescription drug advertising.

BACKGROUND: Previous research describing consumers' communication behaviors in response to direct-to-consumer advertising (DTCA) suggests a social cognitive rationale to explain DTCA-related communication behavior. OBJECTIVE: Guided by social cognitive theory, the objective of this study was to explore outcome expectancy and self-efficacy beliefs as predictors of individuals' intentions to communicate with their physicians about an advertised drug. METHODS: One hundred and seven female college students completed a questionnaire, read an advertisement for an oral contraceptive drug, and completed a second questionnaire. The questionnaires assessed participants' self-efficacy and outcome expectancy beliefs, intended communication behavior, and demographic information. RESULTS: Pearson product-moment correlation analyses showed that outcome expectancy (r=0.75, P<.01) and self-efficacy (r=0.21, P<.05) beliefs were associated positively with intentions to communicate with physicians in response to DTCA. However, ordinary least squares regression analyses revealed that only outcome expectancy beliefs predicted intended communication behavior (B=1.56, P<.01). Results also showed that participants had a relatively greater likelihood of requesting information about, than requesting a prescription for, the advertised drug [t(106)=14.75, P<.01]. CONCLUSIONS: The results identify cognitive factors that guide consumers' plans for interacting with physicians in response to DTCA. Health care providers can use these results to guide communication with patients regarding DTCA and meet patients' drug-related informational expectations.

Marketing drugs, marketing health care relationships: a content analysis of visual cues in direct-to-consumer prescription drug advertising.

Proponents and opponents of direct-to-consumer advertising (DTCA) of prescription drugs argue that it promotes greater participation in health care by consumers with significant implications for public health and health care outcomes. This article (a). proposes a social cognitive theoretical framework to explain DTCA's effects, and (b). reports the first in a series of studies on DTCA's observational learning functions that may influence consumer behavior and the physician-patient relationship. This investigation addresses visual features of print DTCA. Results focus on the prevalence and nature of models featured in the ads and how visual cues may offer identity and relational motivators while reinforcing the value of prescription drug treatments. Further, DTCA may market disenfranchising images that increase disparity in health care information and access, despite their argued educational function.

At the intersection of micro and macro: opportunities and challenges for physician-patient communication research.

The health care relationship model is undergoing dramatic change. Micro-level communication patterns yield health care relationship models (e.g. paternalism, mutual participation, consumerism). At the same time, macro-level systems appear increasingly likely to influence the nature of micro-level interaction. The intersections of health care communication micro-level and macro-level phenomena provide important venues for research and interventions. This essay identifies theoretical premises regarding the relationships between communication and health-related behavior; explores three prominent and growing macro-level phenomena that observers argue likely influence the physical-patient relationship and communication therein: complementary and alternative medicine, the Internet, and direct-to-consumer advertising of prescription drugs; and offers a research agenda for exploring macro-level influences on micro-level physician-patient communication.