Improving health communication with photographic images that increase identification in three minority populations.

The homophily principle, that perceived similarities among people produce positive reactions, is a cross-cultural, global phenomenon. This study aimed to test the prediction that photographs that depict models similar to the target population improve health communication by increasing perceived identification in three racial/ethnic populations. Three separate nationally representative stratified samples (n = 1638) of African American, Hispanic and Native American adults were drawn from GfK's Knowledge Panel�. Participants read a message advocating increased physical activity and improved diets and completed measures on behavioral intentions, outcome and self-efficacy expectations and identification. The message contained photographs from a stock photograph service or photographs created for the research project to match the three minority populations, Real Health Photos (RHP). Structural equation modeling confirmed the theoretical hypothesis that RHP which matched the minority population increased behavioral intentions and was mediated by identification (P < 0.05) in all three racial/ethnic minority samples. Messages with only half of the matched RHP images had these same positive indirect effects among African Americans and Hispanics (P < 0.05). The impact of matching visual images in health messages to recipients derived from identification with the characters in images. Homophily and identification are hardwired, evolutionary, biological phenomena that should be capitalized on health educators with minority populations.

Prevalence and diffusion of helmet use at ski areas in Western North America in 2001-02.

OBJECTIVE: The purpose of this study was to examine diffusion of and predictors of helmet use among skiers and snowboarders in the Western United States and Canada. DESIGN: 6400 skiers and snowboarders at 29 ski resorts in the Western United States and Canada were interviewed on chair lifts and observed for helmet use during two consecutive ski seasons (winters 2001 and 2002). SETTING: Skiers and snowboarders were observed and interviewed at 29 ski resorts in Alaska, California, Colorado, Idaho, Montana, New Mexico, Nevada, Oregon, Utah, and British Columbia as part of a sun protection project. SUBJECTS: Participants completing the survey consisted of 3525 adult skiers and snowboarders in the 2002 season and 2978 adult skiers and snowboarders in the 2001 season. MAIN OUTCOME MEASURE: The outcome measure for all analyses was prevalence of helmet use by skiers and snowboarders. RESULTS: Helmet use by skiers and snowboarders is increasing and is most prevalent among snowboarders, experts, and more frequent skiers/snowboarders. No evidence was found for the hypothesis that helmet use is diffusing more rapidly among earlier adopters of helmets than later adopters. CONCLUSIONS: Although controversy remains, helmets are rapidly diffusing as a safety device at western North American ski resorts. Expert and more frequent skiers and snowboarders are more likely to wear helmets, which may indicate that helmets are recognized as a safety device.

Understanding factors that influence smoking uptake.

OBJECTIVE: To explore relationships between patterns of smoking uptake and social context and attitudinal variables. DESIGN: Cross sectional survey. SETTING: Public schools in Tucson, Arizona and Albuquerque, New Mexico. PARTICIPANTS: 982 children in grades 6-9 (ages 11-15 years). MAIN OUTCOME MEASURES: Items measuring smoking history, nicotine dependence and quit attempts, susceptibility to smoking in the future, smoking norms, use of other tobacco products, attitudes toward smoking, and demographic characteristics. RESULTS: Overall, 43% of children had smoked a cigarette and 57% had never used them. Ever smokers lived in social contexts with more smoking and where smoking was normative. Among never users, 25% are susceptible to smoking; these children have positive attitudes toward smoking, do not feel social pressure to stay off cigarettes, and had more friends who smoked. Among ever users, 36% were currently smoking in the past 30 days. Current users also lived in social context with more smoking and had positive attitudes toward smoking. Most users had tried to stop smoking. Only 9% of current users smoked daily; 29% had not smoked a whole cigarette. Greater cigarette consumption was associated with more favourable attitudes toward smoking. Most of past users were in early uptake: 95% had smoked less than 100 cigarettes but 49% were susceptible to smoking again. CONCLUSIONS: There is promise in differentiating subgroups among the never, past and current use of cigarettes. Susceptibility within each of these groups was associated with similar patterns of attitudes and social context. These patterns in smoking uptake need to be confirmed prospectively.

Formative research activities to provide Web-based nutrition education to adults in the Upper Rio Grande Valley.

The Internet is a promising new tool for disseminating cancer prevention information. Barriers to full implementation include disparities in access and skill and availability of information relevant at the local level. A nutrition education Web site to promote fruit and vegetable intake is being produced for a tri-ethnic adult population in Colorado and New Mexico. Development is guided by findings from formative research including focus groups with local residents, a survey on computer and Internet use with 200 adults in 1998, an assessment of public access computer sites, and in-depth discussion with local community computer skills trainers.

Long-term effects of language intensity in preventive messages on planned family solar protection.

A series of sun safety messages containing highly intense language and deductive logical style achieved the most immediate compliance by parents, particularly when they intended to improve protection. Inductive messages were more successful when no intentions existed (D. B. Buller, Borland, & Burgoon, 1998; D. B. Buller et al., 2000). Interviewers recontacted 568 parents during the winter following message dissemination and assessed solar protection. A 2 (language intensity) x 2 (logical style) x 3 (behavioral intention) x 2 (person) mixed-model analysis of variance showed that parents receiving high-intensity, deductive messages reported the most improved solar protection and improvement was greatest when parents intended to improve protection. Over the long term, high language intensity may reinforce decisions to take preventive action and does not appear to provoke psychological reactance or resistance to these highly directive messages.

Using language intensity to increase the success of a family intervention to protect children from ultraviolet radiation: predictions from language expectancy theory.

BACKGROUND: Even though people are informed about skin cancer prevention, they do not always comply with prevention advice. From Language Expectancy Theory, it was predicted that messages with high language intensity would improve compliance with sun safety recommendations and that this effect would be enhanced with deductive argument style. METHODS: Parents (N = 841) from a pediatric clinic and elementary schools received sun safety messages (newsletters, brochures, tip cards) by mail that varied in language intensity and logical style. Effects on attitudes and behavior were tested in a pretest-posttest factorial design. RESULTS: As hypothesized, parents receiving messages with high- as opposed to low-intensity language complied more with sun safety advice. Messages with highly intense language were more persuasive when the arguments were formatted in a deductive style; low language intensity was more persuasive in inductively styled messages. CONCLUSIONS: By carefully adjusting messages features, health professionals can obtain further compliance beyond that produced by educating people about health risks and creating favorable attitudes and self-efficacy expectations. Highly intense language may be a good general strategy in prevention messages and works better when conclusions and recommendations are offered explicitly to recipients, especially when advice is aimed at reducing their personal risk.

Communication strategies for dietary change in a worksite peer educator intervention.

At the heart of peer health education programs is the assumption that tapping social networks increases adoption of behavior change, yet the communication strategies used by peer educators have not been previously documented to assess the use of social networks in promotion of health messages. Our program in public worksites trained peer health educators to utilize their social networks along with individual persuasive strategies to promote the 5 a Day for Better Health message (i.e. eat five or more servings of fruits and vegetables every day). Communication strategies utilized by the peer health educators were tracked via monthly focus groups over a 9 month intervention in 40 social networks of labor and trades employees. Audiotapes were transcribed and content analyzed to identify 10 communication strategies used by peer educators. Strategies were rated as enacted in an individual or a group (collective) context. Peer health educators were more likely to implement 'creating context' and 'role modeling' as group context change strategies, and 'encouragement' and 'responding to employee needs' as individual change strategies. Strategies used most frequently by males were 'mock competition', 'giving materials' and 'encouragement', while females used 'creating context' and 'keeping 5 a Day visible' most frequently. Hispanic peer health educators were more likely to use individual change strategies than their non-Hispanic counterparts. Documentation of the creative approaches utilized by lay educators among their peers can inform public health professionals on (1) how to better train outreach workers within various cultural, gender and social contexts, and (2) how to maximize social network effects.

Randomized trial testing the effect of peer education at increasing fruit and vegetable intake.

BACKGROUND: The National Cancer Institute recommends that Americans eat at least five daily servings of fruits and vegetables. National strategies to increase consumption may not reach minority and lower socioeconomic populations. In a randomized trial, peer education was tested for effectiveness at increasing fruit and vegetable intake among lower socioeconomic, multicultural labor and trades employees. METHODS: Employees (n = 2091) completed a baseline survey and received an 18-month intervention program through standard communication channels (e.g., workplace mail, cafeteria promotions, and speakers). Ninety-three social networks (cliques) of employees were identified, which were pair matched on intake. At an interim survey (during months 8 and 9), 11 cliques no longer existed and 41 matched pairs of cliques containing 905 employees remained, with one clique per pair being randomly assigned to the peer education intervention. Employees who were central in the communication flow of the peer intervention cliques served as peer educators during the last 9 months of the intervention program. Fruit and vegetable intake was measured with 24-hour intake recall and with food-frequency questions in baseline, outcome (i.e., at 18 months), and 6-month follow-up surveys. All P values are two-sided. RESULTS: By use of multiple regression, statistically significant overall effects of the peer education program were seen in the intake recall (increase of 0.77 total daily servings; P<.0001) and the food-frequency (increase of 0.46 total daily servings; P =.002) questions at the outcome survey. The effect on the total number of servings persisted at the 6-month follow-up survey when measured by the intake recall (increase of 0.41 total daily servings; P =.034) but not the food-frequency (decrease of 0.04 total daily servings; P =.743) questions. CONCLUSIONS: Peer education appears to be an effective means of achieving an increase in fruit and vegetable intake among lower socioeconomic, multicultural adult employees.

Evaluation of the "Sunny Days, Healthy Ways" sun safety CD-ROM program for children in grades 4 and 5.

Computer-based sun safety instruction has many advantages that may be attractive to health educators in schools. An educational multimedia computer program on sun safety was produced on CD-ROM for children in grades 4 and 5, which was based on the "Sunny Days, Healthy Ways" sun safety curriculum (SDHW). Its effects on children's sun safety knowledge, attitudes and behaviour were evaluated with 162 students in 8 fourth and fifth grade classes in a randomized pretest-posttest 2 x 2 factorial design. Children interacting with the CD-ROM program showed significant improvements in knowledge (p = 0.007). The effect on knowledge may have indirectly improved children's sun protection (r = 0.201, p = 0.013), even though the CD-ROM program did not directly increase sun protection (p > .05) or improve attitudes (p > .05). The CD-ROM program may be a cost-effective and administratively acceptable sun safety instructional strategy, however, like many short prevention strategies, it will be most successful at conveying information on sun safety to children.

Skin cancer prevention for children: a critical review.

Increasing sun protection for children may reduce their risk for skin cancer, so many health authorities recommend comprehensive sun safety for children. Sun protection of children in North America and Europe is generally lower than desired and lower than in Australia. This article provides a critical review of evaluations on the effects of 24 sun protection programs for children under age 14. Programs are classified based on the target population, setting, and features. Most programs improved sun safety knowledge, but changes in sun protection attitude and behaviors were smaller. Multiunit presentations were more effective than short-duration presentations. Peer education was effective but needs further evaluation. Some programs for parents have been shown to increase sun protection for children. Strategies to improve sun safety policies need further study. A few community-wide programs have effectively improved sun protection. Future research should address innovative strategies and issues of design and measurement. There is no gold standard for measuring sun protection behavior, but self-report, prospective diaries, and observational techniques show small positive correlations.

Sun safety behaviours of alpine skiers and snowboarders in the western United States.

Skin cancer is epidemic. Sun safety behaviours of skiers and snowboarders have not been investigated despite prolonged exposure at high altitudes. A sample of 156 adult alpine skiers and snowboarders at 14 high-altitude ski resorts in the western United States were interviewed during 1996-97 to ascertain their sun protective actions and exposure. Few of the adults said they received any messages over their entire lifespan regarding sun safety while skiing or snowboarding. Sun protective behaviour was variable: it was negatively associated with being male, younger, a snowboarder, exposed to prevention messages, and being in cold, windy and cloudy weather, and positively related to chair-lift elevation, skin sun sensitivity and prior sunburning while skiing or snowboarding. Prevention programs should target the young, males, novices and snowboarders, and advocate protection throughout the season and during inclement weather.

Sun Smart Day: a pilot program for photoprotection education.

Excessive exposure to the sun's ultraviolet radiation (UVR) contributes to the etiology of melanoma and nonmelanoma skin cancers. Many behaviors that increase lifetime risk of skin cancer--sun exposure, sunburn, and lack of sun protection--occur early in childhood. A 1-day school-based skin cancer prevention effort--Sun Smart Day--was implemented and evaluated in three elementary schools to improve fourth-graders' knowledge, attitudes, and behaviors related to skin cancer prevention. A classroom-based skin cancer prevention lesson was compared to an interactive sun safety fair was vehicles for promoting comprehensive photoprotection. Sun Smart Day interventions had their greatest impact on fourth-graders' awareness and knowledge of skin cancer and children's increased knowledge persisted through the summer break. While both the classroom curriculum and the health fair boosted awareness and knowledge of sun safety among fourth graders, the classroom curriculum demonstrated a slight immediate advantage over the health fair on these outcomes. Also the curriculum was less difficult to implement, but the health fair was more engaging. A Sun Smart Day program may be an important first step in increasing public awareness and understanding of skin cancer and its prevention.

Sunny days, healthy ways: evaluation of a skin cancer prevention curriculum for elementary school-aged children.

BACKGROUND: Primary prevention of skin cancer must start early in life to reduce total life-time sun exposure and severe overexposure in childhood. Childhood is an excellent time to form life-long prevention habits. A school-based curriculum can be an effective prevention strategy. OBJECTIVE: Our purpose was to determine the effectiveness of a skin cancer prevention curriculum at increasing knowledge and attitudes supporting prevention and decreasing sun exposure by children in grades four, five, and six. METHODS: Twenty-four classes (N = 447 students) from four public elementary schools in southern Arizona participated. Half received a pretest, half were tested at the conclusion of the 5-week curriculum in early spring, and half were tested 8 weeks later in late spring. Objective measures of suntanning were obtained. RESULTS: The curriculum increased knowledge about skin cancer prevention and attitudes supporting prevention and decreased suntanning. Self-reported preventive behavior was inconsistent and only weakly associated with measures of suntanning. CONCLUSION: The curriculum was effective at increasing skin cancer prevention. Resulting reduction in sun exposure was superior to that achieved with previous prevention curricula. Change in attitude needed time to emerge, appearing after 8 weeks. Self-reported preventive behavior by children in elementary school may lack validity. Pretesting did not alter effectiveness. Sixth-graders may be ready for more advanced content, but the curriculum is probably too advanced for kindergarten through third grade.

Attitudes and practices of primary care physicians for prostate cancer screening.

Prostate cancer screening with digital rectal examination (DRE) and prostate-specific antigen (PSA) is recommended by several professional organizations. Our objective was to assess the prostate cancer screening practices and attitudes reported by primary care physicians. We randomly surveyed 454 Arizona primary care physicians, subsequently excluding 124 ineligible subjects. Overall, 141 of 329 eligible physicians completed the survey (42.9%). Survey data included physician demographics, practice characteristics, screening and follow-up strategies, and attitudes toward screening. One hundred thirty-one physicians (93%) reported screening asymptomatic men with DRE or PSA. Respondents generally agreed that screening tests were accurate and that early detection was beneficial. Screening began at an average patient age of 45 years, though 7.8% of respondents began screening men younger than 40 years and 7.0% began screening men older than 50 years. PSA levels ranging from 3.9 to 40 ng/mL were considered abnormal, and 11.6% of respondents used a cutpoint higher than 10 ng/mL. Primary care physicians report a high rate of screening for prostate cancer and consider PSA and DRE accurate and useful tests. Screening practices, however, varied considerably between physicians. The screening of younger men reported by practitioners would tend to increase the rate of false-positive tests, while using a high cutpoint for PSA and delaying screening beyond age 50 years would decrease the chance for early detection. These screening practices may increase health care costs without necessarily leading to improved health outcomes. Medical Subject Headings (MeSH): prostatic neoplasms, prostate-specific antigen, primary health care, screening.

Skin cancer prevention by parents of young children: health information sources, skin cancer knowledge, and sun-protection practices.

PURPOSE/OBJECTIVES: To describe and evaluate parents' skin cancer prevention knowledge, sun-protection practices for themselves and their children, and use of health information sources. DESIGN: Cross-sectional survey. SETTING: A medium-sized (population 700,000) metropolitan area in the southwestern United States. SAMPLE: 205 adults, ages 19-56, with children under age 13. Fifty-three percent of the subjects were female, 72% were Caucasian, 22% were Hispanic, 69% were educated beyond high school, and 80% were married. METHODS: Adults were recruited from the county's randomly selected Superior Court jury pool. Jurors were approached by a researcher and asked to complete a self-administered questionnaire. MAIN RESEARCH VARIABLES: Parents' levels of sun-protection practices for themselves and their children, skin cancer knowledge, and skin sensitivity to sun; amount of health information parents received from healthcare providers, family and friends, schools, employers, and the media; and parents' perceptions of the information's accuracy, utility, and comprehensibility. FINDINGS: Parents are more likely to practice skin cancer prevention for their children than themselves. Parents' own protection is positively related to protection for children. Parents who were knowledgeable about skin cancer prevention received the most information from healthcare providers and family and friends. Parents who more frequently received information from healthcare providers practiced more prevention strategies. CONCLUSIONS: Parents need to improve their practices of protecting their children from the sun, particularly by limiting their sun exposure and having them wear protective clothing. IMPLICATIONS FOR NURSING PRACTICE: Nurses in schools, work sites, and healthcare organizations should be active in skin cancer prevention. Nurses can teach parents that children are at risk, encourage parents to teach children to protect themselves, and address barriers to prevention.

Public education projects in skin cancer. The evolution of skin cancer prevention education for children at a comprehensive cancer center.

BACKGROUND: Skin cancer affects more Americans than any other type of cancer. Children are prime targets for prevention education, because sun overexposure in early childhood may affect the development of skin cancer later in life. Preventive behaviors adopted early in life may be less resistant to change than those acquired in adulthood. Thus, there is a need to educate children at an early age about sun overexposure. METHODS: This article describes the evolution of skin cancer prevention research at the Arizona Cancer Center, a National Cancer Institute--designated comprehensive cancer center. Research focusing on children is high-lighted. RESULTS: From its roots in the Arizona Sun Awareness Project, an informal public skin cancer education program, skin cancer prevention research at the Arizona Cancer Center has produced two developmentally appropriate, age-based curricula aimed at teaching children about the benefits and dangers of the sun. The elementary school curriculum, Sunny Days, Healthy Ways, has undergone two tests of feasibility and is the intervention used in a large, randomized, experimental trial. The preschool curriculum, Be Sun Safe, has been tested in a randomized trial and was found to have a positive effect on preschoolers' knowledge and comprehension of sun safety. CONCLUSIONS: Educating children about skin cancer may be an important way of decreasing the incidence of skin cancer. Although informal skin cancer prevention education can be helpful, educational programs preferably should be research based and evaluated for effectiveness before public distribution. The Arizona Cancer Center experience can serve as a model for other programs.

The experience, expression, and perceived appropriateness of emotions across levels of relationship development.

Emotion experience and expression in romantic relationships were investigated. We predicted (a) a curvilinear relationship between level of relationship development and intensity of emotion experience, (b) a curvilinear relationship between level of relationship development and intensity of emotion expression, and (c) a linear relationship between level of relationship development and perceived appropriateness of emotion expression. Two hundred one student and community respondents completed an emotion survey assessing a positive and negative emotion incident they had experienced, the intensity of experience, expression, and degree of appropriateness. Level of relationship development was operationalized by length of relationship. Confirmation for the first two hypotheses was found for negative emotions only. Perceived appropriateness of emotion expression did not vary across levels of relationship development for either negative or positive emotions.

"Sunshine and skin health": a curriculum for skin cancer prevention education.

Skin cancer rates are increasing. Instilling preventive behavior in youngsters is essential to prevent overexposure during childhood. The effectiveness of a curriculum for increasing knowledge and skills, creating supportive attitudes, and engendering a supportive environment to enhance skin cancer prevention was tested on 139 fourth-, fifth-, and sixth-graders. One class in each grade was assigned to treatment (curriculum) and another to control. The curriculum increased knowledge of the effects of exposure to sunlight, skin cancer, and prevention immediately and eight weeks later, across all grades. It also cultivated less favorable attitudes toward tanning and, among fourth-graders, reduced unfavorable attitudes toward sunscreen. Behavioral changes were less consistently evident, with students reporting less suntanning, fourth-graders more frequently using sunscreen, and fifth- and sixth-graders more frequently wearing protective clothing compared with controls. The curriculum was more effective at influencing knowledge and attitudes than changing behavior, highlighting the need for student- and parent-oriented cues to action.