On being responsible: ethical issues in appeals to personal responsibility in health campaigns.

Appeals to personal responsibility are highly prevalent in health communication campaigns, but their use entails both moral and strategic considerations. This article provides an overview of the notion of personal responsibility as a persuasive appeal in public health communication campaigns and an analysis of concomitant ethical implications. Whereas the issue of responsibility often is acknowledged by practitioners and scholars as a perennial challenge in health interventions, conceptual tools for the identification of its subtle manifestations are not readily available. This article outlines a framework that contextualizes potentially paradoxical consequences of campaign appeals to personal responsibility that can be explained by the medieval allegory of the "Tragedy of the Commons," psychological attribution theory, and public health concerns regarding "blaming the victim." Practice-oriented questions are introduced to help identify ethical issues in personal responsibility appeals that can be utilized in the design and implementation of health campaigns.

When the visit to the emergency department is medically nonurgent: provider ideologies and patient advice.

It is estimated that more than half of pediatric hospital emergency department (ED) visits are medically nonurgent. Anecdotal impressions suggest that ED providers castigate medically nonurgent visits, yet studies on such visits are scarce. This study explored the perspectives of 26 providers working in the EDs of two urban hospitals regarding medically nonurgent pediatric ED visits and advising parents or guardians on appropriate ED use. Three provider ideologies regarding the appropriateness of medically nonurgent ED use were identified and found to be linked to particular communication strategies that providers employed with ED users: restrictive, pragmatic, and all-inclusive. The analysis resulted in the development of a typology of provider ideological orientations toward ED use, distinguished according to different orientations toward professional dominance.

"Breast is best": knowledge among low-income mothers is not enough.

The beliefs of low-income mothers regarding breastfeeding compared to formula feeding, according to feeding method, were investigated. Interviews were conducted with 154 women who were assigned to one of two groups. Four health benefits of breastfeeding were rated significantly higher than for infant formula within both the breastfeeding (BF) and formula-feeding (FF) groups. Breastfeeding was seen as less convenient than formula feeding by the FF group (mean = 2.3 +/- 1.7 versus 3.8 +/- 1.5 for formula feeding and breastfeeding, respectively; P < .001). Both groups rated formula feeding as more likely to enable others to help in infant care, easier in terms of the mother's time control, and less likely to tie mother down than breastfeeding. The findings show that, despite formula-feeding mothers' beliefs in the health benefits of breastfeeding, they perceive that it limits their activities. Therefore, breastfeeding promotion must address not only benefits but also lifestyle issues.

Low-income mothers' views on breastfeeding.

Nourishing infants presents women today with choices, desires, obligations and constraints. Despite mounting evidence about the health, psychosocial and societal benefits of breastfeeding both for women and infants, current breastfeeding rates worldwide are far from optimal, particularly among low-income women. Many mothers choose to use infant formula. Drawing from structured interviews with 154 mothers from an urban low-income multiethnic population in the United States, a typology of mothers' feelings about their infant feeding method is developed. Findings indicate that regardless of their feeding method, mothers tended to attribute higher health benefits to breastfeeding and perceived community norms as probreastfeeding. They differed in their rating and perceptions of logistics and the extent to which benefits mattered in their infant-feeding decision. Contradictions associated with the practice of breastfeeding even among mothers who breastfed, were reflected in their perceptions of social disapproval of breastfeeding in public, reports of ridicule by friends, lack of support from some health providers, and difficulties associated with working. A typology of mothers' emotional states resulting from such contradictions summarizes the findings and underscores how some mothers who did not, but would have liked to breastfeed, may be subjected to feelings of guilt and deprivation. Implications for educational interventions are to amplify prenatal infant feeding consultations and address ways to overcome logistical and apprehension barriers.

Credibility of information from official sources on HIV/AIDS transmission.

OBJECTIVE: The authors analyzed data from the 1991 National Planning Survey to (a) assess respondents' awareness of three official sources of information about HIV/AIDS (CDC, the Surgeon General, and state health departments); (b) assess respondents' perceptions of the reliability of these sources; and (c) compare respondents' personal beliefs about HIV transmission with their beliefs regarding the experts' view. METHODS: The authors conducted a secondary analysis of the responses of the 1622 survey participants who gave complete information. RESULTS: People with more years of formal education were more likely to have heard of the CDC and the Surgeon General. The CDC was given the highest overall reliability rating, followed by the Surgeon General and then state health departments. Transmission of HIV/AIDS by various modes of casual contact was perceived more likely among those who gave the CDC lower reliability ratings. However, regardless of their perceptions of the reliability of the CDC as a source of HIV/AIDS information, many respondents believed the probability of transmission by casual contact more likely than they believed experts said it was. CONCLUSIONS: The discrepancy found between what people believe about health risks and what they think experts believe has important implications for the design of effective health information campaigns and for the design of questionnaire items that aim to assess people's "knowledge" and "attitudes" regarding sensitive health topics.

Values and justifications in health communication interventions: an analytic framework.

A conceptual framework for analyzing health communication interventions is presented as a systematic approach to identify values and justifications embedded in major facets of the communication intervention: the definition of the problem, the strategies adopted, the intervention stakeholders or its targeted populations, and the evaluation of the program. Although values and ethical concerns are embedded in all facets of health communication interventions, they are often left unexamined, or are taken for granted by practitioners and intervention populations (policy makers and the researchers who analyze, evaluate, or help design and implement them). The development, adaptation, and application of this framework can serve three inter-related purposes: (1) to provide constructs and a systematic approach to examine the design and implementation of interventions from a normative perspective, (2) to contribute to a theoretical perspective on health interventions as a social change phenomenon, and (3) to provide additional criteria for program evaluation and policy-making.

Morphogenesis of poliovirus. IV. existence of particles sedimenting at 150S and having the properties of provirion.

An apparent precursor to the poliovirion that cosediments with the virion at 150S was identified by its content of VP-0. It has properties previously associated with the provirion, a structure that sedimented at 125S, and it may be an alternate form of provirion. Like virions, the 150S precursor binds to and elutes from cells, after which it sediments at about 125S.

Complete translation of poliovirus RNA in a eukaryotic cell-free system.

Poliovirus RNA stimulates imcorporation of 35S from both [35S]methionine and formyl-[35S]methionyl-tRNAfMet in cell-free systems derived from HeLa cells or from poliovirus-infected HeLa cells. The largest product formed under the direction of the viral RNA is the same size as the polyprotein thought to represent translation of the entire RNA. Synthesis of this polyprotein and other large products was stimulated greatly by increasing the salt concentration during the reaction from the optimum for initiation (90 mM) to the optimum for elongation (155 mM). Only one initiation peptide could be identified, and a tryptic digest of the product contained mainly peptides that cochromatographed with peptides from authentic viral proteins. The RNA from a deletion mutant of poliovirus initiated protein synthesis at the same site used by standard RNA and programmed synthesis of an appropriately deleted set of polypeptides. The results strongly support the model of translation of poliovirus RNA from a single initiation site into a continuous polyprotein that is cleaved to form the functional proteins. It is suggested that uninfected HeLa cell extracts can carry out the cleavages of nascent polyprotein.

Morphogenesis of poliovirus 3. Formation of provirion in cell-free extracts.

Formation of an apparent virion precursor, the provirion, can be demonstrated in cytoplasmic extracts of poliovirus-infected HeLa cells.