Race and gender moderation of the relationship between cessation beliefs and intentions: is race or gender message segmentation necessary in anti-smoking campaigns?

Debate persists over whether different message strategies in anti-smoking campaigns are needed for audiences of different races or genders. This study considers the need for 'message segmentation', which is the process of differentiating the beliefs that might be the focus of messages for population subgroups. We have two aims: (i) lay out an approach that yields evidence about the necessity for message segmentation and (ii) demonstrate and assess findings from this approach using the formative evaluation for the Philadelphia Anti-Smoking Campaign. We examine whether associations between beliefs about quitting smoking and intention to quit are moderated by race (black/white) or gender. Data came from a representative sample of 501 adult smokers (46% black; 56% female) surveyed in July 2010 for the campaign's formative evaluation. Out of 26 beliefs about cessation, 8 were significantly related to cessation intention regardless of subgroup affiliation, suggesting that these would be promising beliefs for messages in a unified campaign. Four beliefs were significant for white smokers only, and three beliefs were significant for female smokers only. The evidence justified a unified message approach because subgroups shared enough beliefs that could become message strategies to increase cessation across smokers without the added costs associated with message segmentation.

The impact of risk information exposure on women's beliefs about direct-to-consumer genetic testing for BRCA mutations.

Despite an increase in direct-to-consumer (DTC) genetic testing, little is known about how variations in website content might alter consumer behavior. We evaluated the impact of risk information provision on women's attitudes about DTC BRCA testing. We conducted a randomized experiment; women viewed a 'mock' BRCA testing website without [control group (CG)] or with information on the potential risks of DTC testing [RG; framed two ways: unattributed risk (UR) information and risk information presented by experts (ER)]. Seven hundred and sixty-seven women participated; mean age was 37 years, mean education was 15 years, and 79% of subjects were white. Women in the RG had less positive beliefs about DTC testing (mean RG = 23.8, CG = 25.2; p = 0.001), lower intentions to get tested (RG = 2.8, CG = 3.1; p = 0.03), were more likely to prefer clinic-based testing (RG = 5.1, CG = 4.8; p = 0.03) and to report that they had seen enough risk information (RG = 5.3, CG = 4.7; p < 0.001). UR and ER exposure produced similar effects. Effects did not differ for women with or without a personal/family history of breast/ovarian cancer. Exposing women to the potential risks of DTC BRCA testing altered their beliefs, preferences, and intentions. Risk messages appear to be salient to women irrespective of their chance of having a BRCA mutation.

Symptoms and perceived severity of illness as predictive of treatment for diarrhea in six Asian and African sites.

This paper examines associations between symptoms, judgement of severity and treatments given for episodes of childhood diarrhea. Using data from ten large sample surveys conducted in six research sites in Asia and Africa, the paper addresses three main questions. One, to what extent are judgments of severity of diarrhea among young children a function of the symptoms observed during an episode of diarrhea? Two, what is the relative importance of symptoms observed vs judgments of severity in the treatments given for diarrhea? And three, what do the results imply for programs promoting the use of ORT for diarrhea? The study found that mothers, perception of severity of illness is linked most closely to three symptoms: vomiting, fever and lassitude. These symptoms are associated with (a) treating the child at all and (b) taking the child to a health facility. These conclusions take on particular significance since they are based on a comparison of ten data sets from six sites differing widely in population density, ecology, access to medical services, educational level and financial resources.

Social influences on the sexual behavior of youth at risk for HIV exposure.

OBJECTIVES: Adolescents are increasingly at risk for infection with human immunodeficiency virus (HIV) and other sexually transmitted diseases, especially in poor urban minority communities. To aid the design of interventions in these communities, this study investigated the role of knowledge, attitudes, perceived parental monitoring, and peer behavior in the onset and progression of sexual behavior in children at risk for exposure to HIV. METHODS: A computerized personal interview was administered to 300 African-American 9- to 15-year-old children living in six public housing developments in a large US city. RESULTS: Although children's knowledge about the hazards of sex increased with age, their sexual activity also increased (from 12% sexually experienced at 9 years of age to more than 80% experienced at 15 years of age). Parental monitoring appeared able to influence sexual activity. However, the perceived behavior of friends was associated with the rate at which sexual activity progressed with age and the degree to which condom use was maintained with age. CONCLUSIONS: The early onset and prevalence of sexual behavior and the importance of peer group influence call for early interventions that simultaneously influence the parents and peers in children's social networks.

Quality of home use of oral rehydration solutions: results from seven HEALTHCOM sites.

This study examined the volume of oral rehydration solutions given to children during diarrhea and the length of time the solutions are administered. It also attempted to test the importance of individual and contextual factors--especially mothers' knowledge--in explaining the administration of oral rehydration solutions. Data about the treatment of an episode of child diarrhea within the last three months were collected from large samples of mothers in seven sites in Africa, Asia, and Latin America. The results showed that oral rehydration solutions were given in smaller volumes and for shorter periods of time than recommended. The majority of children received at least a glass (200-250 ml) of solution on the first day, but few received more than that. Daily administration of packet-based solutions or of sugar-salt solutions (promoted in two of the countries) during diarrhea was generally quite low, ranging from 16 to 60% of cases given an oral rehydration solution. However, in four out of six sites, at least half of the children with diarrhea for more than one day were given an oral rehydration solution for more than one day. The majority of children were given some form of other fluids (e.g. more water, special teas, or continued breastfeeding), but their value in preventing dehydration was not clear because the volume of other fluids given could not be assessed. Few of the hypothesized predictors of administration explained the variation in volume or duration of ORS/SSS administration within any specific country or across sites. The research points to the need for more information on the decision process used by mothers when treating their children's diarrhea and on outside factors influencing this process.

Perceptions of severity of diarrhoea and treatment choice: a comparative study of HealthCom sites.

This paper examines the association of treatments given for childhood diarrhoea with the severity of the illness as perceived by mothers and caretakers. Drawing on 11 large sample surveys in seven research sites of the HealthCom project, the study shows that in all sites, the children judged as very sick were more likely to receive treatment than those not very sick, and that the more severe cases were more likely to be taken to a health facility. The results also show that in half of the surveys, the more severe cases were more likely to be given SSS or ORS. No overall pattern of relations was found between severity and giving herbal medicine or pharmaceutical drugs at home. The study found that most carers of children with diarrhoea give some form of treatment at home in all research sites and that treatment choice is influenced by the severity of the episode. The results suggest that the perception of mothers and carers of the severity of episodes of diarrhoea is an important factor in their choice of treatment, and thus could be used in messages promoting improved treatment of diarrhoeal disorders.

PIP: Staff of the Communication for Child Survival (HealthCom) project oversaw and reviewed 11 surveys from 7 HealthCom sites in 5 developing countries to determine the effect mother's perception of severity of illness has on diarrhea treatment choices. Mothers who perceived their children to be very sick were more likely to seek or give treatment than those who did not perceive their children to be very sick. They also were more likely to take the children perceived to be very ill to a health facility (e.g., in Zaire, 55% vs. 29% for somewhat sick and 24% for not sick; p .0001). In 5 surveys, mothers who perceived their children to be very sick were more likely to administer oral rehydration therapy (ORT) at home (e.g., in the Philippines, 52% vs. 30% for somewhat sick and 20% for not sick). On the other hand, severity was not associated with administering herbal treatment or pharmaceutical drugs at home, indicating that mothers applied cues other than severity for using herbal medicines and pharmaceuticals. At all sites, most mothers (range, 52% in 1 site in Lesotho to 76% in the Philippines) treated diarrhea at home. These findings showed that mothers were not only willing to treat their children with diarrhea at home, they were especially motivated to treat them when the children appeared seriously ill. In fact, at least 88% of children considered to be very sick were treated in 8 of 11 surveys. The results suggested that staff of health communication programs on diarrhea should consider perception of severity of diarrheal illness as well as knowledge of ORT when designing ORT promotion campaigns.

Improving vaccination coverage in urban areas through a health communication campaign: the 1990 Philippine experience.

From March to September 1990 the Philippine Department of Health, with the assistance of the HEALTHCOM Project, carried out a national mass-media communication campaign to support routine vaccination services. The essential elements of the campaign strategy were as follows: focusing on measles as a way to get mothers to bring their children to the health centre; emphasizing logistic knowledge in the mass-media messages, in particular popularizing a single day of the week as "vaccination day" and giving clear information about the age for measles vaccination; and focusing on urban areas, which had lower vaccination rates than rural areas. Evaluation of the effects of the campaign indicates an increase in vaccination coverage and a substantial increase in the timeliness of vaccination that can be attributed to improvement in carers' knowledge about vaccination. Furthermore, most of the observed increase in knowledge was related to exposure to the mass-media campaign. There was no evidence of any programmatic change that could account for the increase in vaccination or evidence that increased health education efforts at health centres could account for the change in knowledge. These results indicate that when countries meet certain conditions--a high level of access to the media, sufficient expertise and funds available to develop and produce high-quality radio and television advertisements, and a routine system that is able to serve the increased demand--a mass communication campaign can significantly improve vaccination coverage.

PIP: The Philippine Department of Health conducted a national mass media communication campaign during the period March-September 1990 to support routine vaccination services. The campaign focused upon measles as a way to get mothers to bring their children to the health center, emphasized logistic knowledge in the mass-media messages, and focused upon urban areas with lower vaccination rates than rural areas. Examples of logistic emphasis include designating one day per week as vaccination day and giving clear information about the age for measles vaccination. An increase in vaccination coverage and a substantial increase in the timeliness of vaccination were observed which may be attributed to the improvement in carers' knowledge about vaccination. Most observed increase in knowledge was related to campaign exposure. There was no evidence of any programmatic change which could account for the increase in vaccination or evidence that increased health education efforts at health centers could account for the change in knowledge. These results indicate that when countries meet certain conditions, a mass communication campaign can significantly improve vaccination coverage. Conditions include access to media, expertise, and funds to produce and air high quality television and radio spots, and a routine system capable of handling the increased demand.