Programmatic research to increase the effectiveness of health communication campaigns.

This article reviews a long program of research designed to investigate ways to increase the effectiveness of televised antidrug public service announcements. The review highlights the importance of audience targeting (adolescent and young adult high sensation seekers) and message design (message sensation value) in campaign research. It also emphasizes the role of theory and evaluation in programmatic research.

Development and implementation of mass media campaigns to delay sexual initiation among African American and White youth.

Reducing new HIV/STD infections among at-risk adolescents requires developing and evaluating evidence-based health communication approaches. Research overwhelmingly supports the conclusion that early sexual initiation is associated with STDs and other negative outcomes in later years (e.g., unintended pregnancy). The authors' research group secured funding from the National Institute of Mental Health to develop, implement, and rigorously evaluate televised mass media campaigns to delay initiation of sexual intercourse among African American and White adolescents in two cities in the Southeastern United States. The focus of the present study is on the development and implementation of the campaigns, including (a) rationale and theoretical underpinnings; (b) collection, screening, and assessment of existing public service announcements; (c) development of new public service announcements; (d) study design and campaign airing plan; and (e) message exposure achieved in the campaigns. Health communication campaigns hold much promise in reaching at-risk adolescent populations with targeted, timely, and relevant risk-reduction messages.

Sensation seeking and impulsivity: combined associations with risky sexual behavior in a large sample of young adults.

Although prior studies have shown that sensation seeking and impulsive decision-making are related to sexual risk-taking, it is still unclear whether these personality traits operate independently or synergistically. The purpose of this study was to elucidate the joint contribution of these personality traits to HIV and sexually transmitted disease (STD) risk behaviors using data from a large sample of sexually active young adults (N = 2,386). Regression modeling indicated that both sensation seeking and impulsive decision-making were consistently associated with sexual risk behaviors across 11 risk-related outcomes. Results further indicated that sensation seeking and impulsive decision-making operated synergistically with respect to the outcome variables of sex acts using drugs, acts with a partner using alcohol, and acts with a partner using drugs. In contrast to this, sensation seeking and impulsive decision-making operated independently with respect to the other sexual risk outcomes. Theoretical implications, as well as implications for HIV/STD prevention among high sensation seekers and impulsive decision-makers, are discussed.

Reactions to safer-sex public service announcement message features: attention, perceptions of realism, and cognitive responses.

For this article, we conducted a qualitative investigation of participants' reactions to five televised public service announcements (PSAs) that were aired as part of a large safer-sex mass media campaign to increase condom use among young adults. We conducted qualitative interviews (N = 139) to determine which features of PSAs participants thought were most effective in terms of attention and recall, perceived realism of characters and situations, and cognitive responses. Our analysis of the results highlights the importance of high-sensation-value messages for gaining attention as well as the critical role of personal relevance for enhancing perceptions of realism. Cognitive responses to PSAs were mostly positive, but there was evidence of third-person effects. That is, many participants indicated that the safer-sex messages were important for other people but not for themselves. We discuss the implications of our results for designing PSAs that are attention-catching, realistic, and persuasive.

In-depth investigation of interpersonal discussions in response to a safer sex mass media campaign.

We know from theory and limited research that people talk about campaign messages-and that these conversations may play an important role in campaign reach and possibly even efficacy. We know very little, however, about what individuals talk about and with whom they talk. The current study seeks to fill this gap by reporting qualitative and descriptive quantitative data from interviews conducted with 139 young adults about conversations that took place in the context of a large, televised safer sex mass media campaign. Results indicated that public service announcements (PSAs) were often viewed in the company of friends and significant others, and that it was not uncommon for conversations about the PSAs to take place. Three broad categories of conversations that took place involved discussions about PSA realism, the seriousness of the message, and humor. While in some cases conversations seemed to advance the goal of the campaign (e.g., participants discussed sexually transmitted disease [STD] risk and condom use), in other cases they did not (e.g., participants discussed the lack of realism in a particular PSA). Implications for campaign theory, design, and implementation are discussed.

Adapting and applying a multiple domain model of condom use to Chinese college students.

This study adapts a multiple domain model (MDM) to explain condom use among a sample of sexually active Chinese college students. A cross-sectional survey was conducted and structural equation modeling was used to test the proposed model. Preparatory behaviors, theory of reasoned action (TRA)/theory of planned behavior variables, impulsivity, length of relationship, and alcohol use were significant direct predictors of condom use. The results suggest that MDM can provide a better understanding of heterosexual condom use among Chinese youth, and help in the design of HIV-preventive and safer sex interventions in China.

Assessing the Relationship Between Perceived Message Sensation Value and Perceived Message Effectiveness: Analysis of PSAs From an Effective Campaign.

The current study is an analysis of public service announcements (PSAs) from an effective safer sex campaign that utilized a sensation-seeking targeting (SENTAR) approach. Two random samples of heterosexually active young adults (sample one N = 1,463, sample two N = 895) viewed different sets of safer sex PSAs on a laptop computer and answered questions about their perceived sensation value and perceived effectiveness. Multiple regression analyses examined the impact of (a) demographic, (b) individual difference, (c) sexual context, and (d) message variables including perceived message sensation value (PMSV) on the perceived message effectiveness (PME) of the PSAs. Results indicated that females, African Americans, condom users, and those with less education viewed the PSAs as slightly more effective than males, Caucasians, non-condom users, and those with more education. PMSV and personal utility emerged as the strongest predictors of PME, even after controlling for all of the aforementioned variables. Implications for further research on PMSV and perceived and actual effectiveness of PSAs are offered.

Demographic and personality factors as predictors of HIV/STD partner-specific risk perceptions: implications for interventions.

Although risk perception as a motivator of precautionary behavior is a key component of several health behavior theories, this motivational hypothesis has found mixed support in the HIV/AIDS area. This may be, in part, because risk perceptions are more complex than they are treated in many studies of the motivational hypothesis. The current study examines demographic, personality, and sexual risk factors as predictors of partner-specific (main vs. casual) HIV/STD risk perceptions in a sample of 1,489 young adults. As expected, perceptions of HIV/STD risk were higher in the context of "casual" as compared with "main" partnerships. Although univariate analyses demonstrated that gender, race/ethnicity, sensation seeking, impulsivity, number of partners, and condom use all influenced HIV/STD risk perceptions, only gender, condom use, and race/ethnicity remained significant in multivariate analyses. Implications of these results for the design of efficacious HIV prevention interventions are discussed.

A 10-year systematic review of HIV/AIDS mass communication campaigns: Have we made progress?

The purpose of the current study was to conduct a 10-year systematic review of HIV/AIDS mass communication campaigns focused on sexual behavior, HIV testing, or both (1998-2007) and to compare the results with the last comprehensive review of such campaigns, conducted by Myhre and Flora (2000). A comprehensive search strategy yielded 38 HIV/AIDS campaign evaluation articles published in peer-reviewed journals, representing 34 distinct campaign efforts conducted in 23 countries. The articles were coded on a variety of campaign design and evaluation dimensions by two independent coders. Results indicated that compared with the previous systematic review (1986-1998 period), campaigns increasingly have employed the following strategies: (1) targeted defined audiences developed through audience segmentation procedures; (2) designed campaign themes around behavior change (rather than knowledge change); (3) used behavioral theories; (4) achieved high message exposure; (5) used stronger research designs for outcome evaluation; and (6) included measures of behavior (or behavioral intentions) in outcome assessments. In addition, an examination of 10 campaign efforts that used more rigorous quasi-experimental designs revealed that the majority (8 of 10) demonstrated effects on behavior change or behavioral intentions. Despite these positive developments, most HIV/AIDS campaigns continue to use weak (i.e., preexperimental) outcome evaluation designs. Implications of these results for improved design, implementation, and evaluation of HIV/AIDS campaign efforts are discussed.

Effects of a televised two-city safer sex mass media campaign targeting high-sensation-seeking and impulsive-decision-making young adults.

This study evaluates the ability of a safer sex televised public service announcement (PSA) campaign to increase safer sexual behavior among at-risk young adults. Independent, monthly random samples of 100 individuals were surveyed in each city for 21 months as part of an interrupted-time-series design with a control community. The 3-month high-audience-saturation campaign took place in Lexington, KY, with Knoxville, TN, as a comparison city. Messages were especially designed and selected for the target audience (those above the median on a composite sensation-seeking/impulsive-decision-making scale). Data indicate high campaign exposure among the target audience, with 85%-96% reporting viewing one or more PSAs. Analyses indicate significant 5-month increases in condom use, condom-use self-efficacy, and behavioral intentions among the target group in the campaign city with no changes in the comparison city. The results suggest that a carefully targeted, intensive mass media campaign using televised PSAs can change safer sexual behaviors.

Individual differences and context: factors mediating recall of anti-drug public service announcements.

A sample of 597 participants was surveyed to examine factors that influence recall of antidrug public service announcements (PSAs). High sensation-seekers and polydrug users recalled somewhat more antidrug PSAs than low sensation-seekers and nonusers. Regression analyses indicated that total hours of television viewing did not predict recall of televised antidrug PSAs; instead, recall was predicted by preference for specific program genres, such as sports, news shows, action programs, sitcoms, and stand-up/comedy channel programs, and individual-difference variables such as sensation-seeking, drug use, and gender. The findings provide more evidence for the sensation-seeking targeting (SENTAR) approach and demonstrate the relevance of selective exposure and program contexts in reaching potential drug users.

Effects of the Office of National Drug Control Policy's Marijuana Initiative Campaign on high-sensation-seeking adolescents.

OBJECTIVES: We evaluated the effects of the Marijuana Initiative portion of the Office of National Drug Control Policy's National Youth Anti-Drug Media Campaign on high-sensation-seeking and low-sensation-seeking adolescents. METHODS: Personal interviews were conducted via laptop computers with independent monthly random samples of 100 youths from the same age cohort in each of 2 moderate-sized communities over 48 months (April 1999-March 2003) of the campaign, including the critical first 6 months of the 9-month initiative. The start of the initiative was treated as an "interruption" in time-series analyses of the combined community sample. RESULTS: The Marijuana Initiative reversed upward developmental trends in 30-day marijuana use among high-sensation-seeking adolescents (P<.001) and significantly reduced positive marijuana attitudes and beliefs in this at-risk population. Use of control substances was not affected. As expected, low-sensation-seeking adolescents had low marijuana-use levels, and the campaign had no detectable effects on them. Other analyses indicated that the initiative's dramatic depiction of negative consequences of marijuana use was principally responsible for its effects on high-sensation-seeking youths. CONCLUSIONS: Substance use prevention campaigns can be effective within an approach using dramatic negative-consequence messages targeted to high-sensation seekers.

Personality traits as predictors of intentions to seek online information about STDs and HIV/AIDS among junior and senior college students in Taiwan.

The purpose of this cross-sectional study is to examine how personality traits such as sensation- seeking and impulsive decision-making affect Taiwanese college students' intentions to seek online information about sexually transmitted diseases (STDs) and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Five hundred thirty-five (n = 535) junior and senior college students in Taiwan were recruited and completed self-report questionnaires. This study found high sensation-seekers were more likely to seek information about STDs and HIV/AIDS on the Internet than low sensation-seekers. Impulsive decision-makers were less likely than rational decision-makers to seek information about STDs and HIV/AIDS on the Internet. These findings suggest that personality needs to be considered as an exploratory factor which potentially influences intentions to seek STD and HIV/AIDS information on the Internet among Taiwanese college students.

Integrating personality and psychosocial theoretical approaches to understanding safer sexual behavior: implications for message design.

The purpose of this study was to propose and conduct tests of a multivariate model of condom use utilizing data from 2 independent samples of young adults (City 1, N=746; City 2, N=743). The model examined the relations between personality characteristics, including sexual sensation seeking and sexual impulsive decision making; psychosocial variables, including condom attitudes, norms, and self-efficacy; and condom use behaviors, including carrying, communicating about, and using condoms. Structural equation modeling analyses indicated a good fit for both models (Confirmatory Fit Index=.93; Average Absolute Standardized Residuals=.05 for both), with each explaining 25% of the variance ( R (2)=.25) in condom use behaviors. Results support the fusion of personality and psychosocial approaches to gain a broader theoretical understanding of condom use in young adults. In addition, those developing and implementing health communication campaigns may find sexual sensation seeking and sexual impulsive decision making to be fruitful variables on which to target messages aimed at increasing safer sexual behavior.

Brief measures of sensation seeking for screening and large-scale surveys.

Sensation seeking is central to research on the prevention of risky health behaviors, but current measures of sensation seeking are fairly long, thereby reducing their chances of inclusion in some research projects. Hence, we developed and evaluated two brief indices of sensation seeking, a four-item measure that retains the framework of the Sensation Seeking Scale-Form V (SSS-V) and a shorter two-item measure focusing on the risk-taking elements of sensation seeking. We compared the performance of the new indices with that of two well documented but longer measures of sensation seeking. The evaluation was based on data provided by more than 5000 teens and pre-teens in grades 7 through 11. Psychometric analyses revealed that the internal consistency of the two new measures was very good overall and across grade and sex categories. Additionally, the new indices correlated as expected with a series of risk and protective factors as well as tobacco, alcohol, and marijuana use. Both indices performed in ways remarkably similar to the established measures of sensation seeking and should prove useful for future research involving risky health behaviors.

Perceived message sensation value (PMSV) and the dimensions and validation of a PMSV scale.

Sensation seeking has been linked to drug abuse and risky behaviors, and is positively associated with preferences for messages high in sensation value (i.e., perceived to be highly novel, arousing, dramatic, or intense). This suggests the utility of valid and reliable measures of perceived message sensation value (PMSV) in research on information processing, persuasion, and reducing risk-related behaviors. Dimensions and construct validity of a 17-item PMSV scale were examined via 2 studies: 1 of 368 high school students' reactions to televised antimarijuana public service announcements (PSAs) and one of 444 college students' responses to televised anticocaine PSAs. Exploratory and confirmatory factor analyses indicated 3-dimensional solutions for the PMSV scale were nearly identical for high sensation seeking (HSS) and low sensation seeking (LSS) respondents in Study 1 and HSS respondents in Study 2. Total scale alphas were .87 for Study 1 and .93 for Study 2. The PMSV scale and its dimensions (Emotional Arousal, Dramatic Impact, Novelty) were positively correlated with affective response measures in both studies for HSS and LSS. Study 1 also examined cognitive, narrative, and sensory PSA processing, which were found to be positively associated with total PMSV and the Arousal and Dramatic Impact dimensions of PSMV for both HSS and LSS.

Predictors of exposure from an antimarijuana media campaign: outcome research assessing sensation seeking targeting.

Using data from a large-scale antimarijuana media campaign, this investigation examined the demographic and psychographic variables associated with exposure to public service announcements designed to target high sensation-seeking adolescents. The literature on sensation seeking indicates that adolescents high in this trait are at greater risk for substance abuse. Analyses assessed the predictive utility of various risk and protective factors, normative influences, demographic variables, and marijuana-related attitudes, intentions, and behaviors on campaign message exposure. Results confirm that level of sensation seeking was positively associated with greater message exposure. In addition, viewers reporting greater exposure were younger adolescents who indicated that they had poor family relations, promarijuana attitudes, and friends and family who used marijuana. Implications for designing future antimarijuana messages based on these findings are discussed.