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.

MADD victim impact panels and stages-of-change in drunk-driving prevention.

OBJECTIVE: To assess the additional effects of Mothers Against Drunk Driving (MADD) Victim Impact Panels (VIPs) over the effects of a DWI (driving while intoxicated) school, on (1) moving individuals through the stages-of-change toward not drinking while driving and (2) drunk-driving recidivism. METHOD: A randomized experiment with 813 (75% male) DWI offenders in New Mexico measured progress through the stages-of-change at pretest, posttest, 1-year follow-up and 2-year follow-up. In addition, drunk-driving recidivism over 2 years was measured from state driving records. Individuals were randomly assigned to a DWI school or a DWI school plus a MADD VIP. RESULTS: No significant difference in movement through the stages-of-change, or in recidivism, occurred between respondents in the DWI-school-only treatment, and those in the DWI school plus VIP treatment. CONCLUSIONS: There was no additional effect of the MADD VIP, a relatively emotional intervention, over that of the DWI school, a relatively informational approach, on DWI behavior (whether measured by stages-of-change or by DWI rearrest data) over the 2-year period following the two interventions.

Entertainment-education and HIV/AIDS prevention: a field experiment in Tanzania.

Entertainment-education is the process of designing and implementing an entertainment program to increase audience members' knowledge about a social issue, create more favorable attitudes, and change their overt behaviors regarding the social issue. The results of a field experiment in Tanzania to measure the effects of a long-running entertainment-education radio soap opera, Twende na Wakati (Let's Go with the Times), on knowledge, attitudes, and adoption of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) prevention behaviors are presented. Multiple independent measures of effects and the experimental design of this study confer strong internal and external validity regarding the results of this investigation. The effects of the radio program in Tanzania include (1) a reduction in the number of sexual partners by both men and women, and (2) increased condom adoption. The radio soap opera influenced these behavioral variables through certain intervening variables, including (1) self-perception of risk of contracting HIV/AIDS, (2) self-efficacy with respect to preventing HIV/AIDS, (3) interpersonal communication about HIV/AIDS, and (4) identification with, and role modeling of, the primary characters in the radio soap opera.

A staged model of communication effects: evidence from an entertainment-education radio soap opera in Tanzania.

The authors draw on (1) the hierarchy-of-effects (HOE) model, (2) the stages-of-change (SOC) model, (3) social learning theory (SLT), and (4) the diffusion of innovations (DOI) to synthesize a staged model through which communication messages have effects on individual behavior change by stimulating (1) involvement with media characters and role modeling of their actions, and (2) interpersonal communication. Data from a field experiment in Tanzania on the effects of an entertainment-education radio soap opera, Twende na Wakati (Let's Go With the Times), on the adoption of family planning, are analyzed in light of a six-staged model of communication effects. It is found that (1) the model provides a useful framework for understanding the effects of an entertainment-education program, and (2) the radio soap opera promoted progress through the stages for family planning adoption in the treatment area in three of the four years of broadcast, and in the comparison area after broadcasts of the radio program began there.

Effects of an entertainment-education radio soap opera on family planning behavior in Tanzania.

An entertainment-education radio soap opera introduced in Tanzania in 1993 was evaluated by means of a field experimental design in which the radio program was broadcast by seven mainland stations of Radio Tanzania. An eighth station broadcast alternative programming from 1993 to 1995, its listenership serving as a comparison area in which contemporaneous changes in family planning adoption were measured. The soap opera was subsequently broadcast nationwide from 1995 to 1997. Data about the effects of the radio soap opera were gathered in five annual surveys of about 2,750 households in the comparison and the treatment areas and from a sample of new family planning adopters in 79 health clinics. The soap opera had strong behavioral effects on family planning adoption; it increased listeners' self-efficacy regarding family planning adoption and influenced listeners to talk with their spouses and peers about contraception.

PIP: This article evaluates the effects of an entertainment-education radio soap opera, "Twende na Wakati" (Let's Go with the Time), introduced in Tanzania in 1993 on the adoption of family planning methods. The soap opera was evaluated by means of a large-scale field experimental design in which the radio program was broadcast in seven mainland stations. An eight-station broadcast was added from 1993 to 1995 and its listenership served as the basis in which contemporaneous changes in planning adoption were measured. Subsequently, the soap opera was broadcast nationwide from 1995 to 1997. In determining the effect of the soap opera, five annual surveys were conducted. Included in the survey were about 2750 households in the comparison and the treatment areas and from a sample of family planning adopter in 79 health clinics. Results of the survey indicate that the soap opera had strong behavioral effects on family planning adoption. Additionally, the incidence increases listeners' self-efficacy regarding family planning adoption and influences listeners to talk with their spouses and peers about contraception.

Nuclear factor-kappa B p65 mediates the assembly and activation of the TNF-responsive element of the murine monocyte chemoattractant-1 gene.

TNF-alpha transcriptionally regulates murine monocyte chemoattractant protein-1 (MCP-1) expression. Three approaches were used to determine the mechanism by which TNF regulates MCP-1. Mutation analysis showed that two distal kappa B sites, a novel dimethylsulfate-hypersensitive sequence, and a promoter proximal SP-1 site were required for TNF induction. Although the kappa B sites and the hypersensitive sequence function as a NF-kappa B-mediated enhancer, regulating induction by TNF, stereospecific alignment of the kappa B sites was not critical. Trans-activation studies conducted by cotransfection of p50 and/or p65 expression vectors with MCP-1 constructions showed that TNF regulates MCP-1 through NF-kappa B. Examination of MCP-1 induction in NF-kappa B-disrupted embryonic fibroblasts showed that p65 was necessary for both the induction and the TNF-induced protein occupancy of the enhancer in vivo. The action of the antioxidant inhibitor of NF-kappa B activation, pyrrolidine dithiocarbamate, in wild-type and NF-kappa B mutant cells was examined. The results suggested that TNF activates NF-kappa B through both pyrrolidine dithiocarbamate-sensitive and -insensitive mechanisms. This study illustrates the crucial role for NF-kappa B p65 in the induction of the MCP-1 gene by TNF and in the assembly of a NF-kappa B dependent enhancer in vivo.

The MHC class II transactivator (CIITA) requires conserved leucine charged domains for interactions with the conserved W box promoter element.

The class II transactivator CIITA is required for transcriptional activation of the major histocompatibility complex (MHC) class II genes. Aside from an N-terminal acidic transcriptional activation domain, little is known about how this factor functions. Extensive mutagenesis of CIITA was undertaken to identify structural motifs required for function. The ability of mutants to activate a reporter gene under the control of MHC class II conserved W-X-Y or X-Y regulatory elements was determined. Two mutants displayed differential activity between the two promoters, activating transcription with the W-X-Y but not the X-Y elements. All mutants were tested for their ability to interfere with wild-type CIITA activity. Five CIITA mutant constructions were able to down-regulate wild-type CIITA activity. Three of these mutants contained targeted disruptions of potential functional motifs: the acidic activation domain, a putative GTP-binding motif and two leucine charged domains (LCD motifs). The other two contained mutations in regions that do not have homology to described proteins. The characterization of CIITA mutants that are able to discriminate between promoters with or without the W box strongly suggests that CIITA requires such interactions for function. The identification of LCD motifs required for CIITA function brings to light a previously undefined role of these motifs in CIITA function.

Diffusion of innovations theory and work-site AIDS programs.

Four case studies of the adoption of work-site AIDS programs are investigated, two of which were modifications of the Centers for Disease Control and Prevention's Business Responds to AIDS (BRTA) program. AIDS work-site programs were mainly initiated by the four study companies as a result of the efforts of a champion (defined as an individual who gains attention and resources for an issue in a system) or the occurrence of a tragic event, such as a company employee contracting AIDS. The BRTA program is an innovation that has not yet reached critical mass, which is the point after which further rates of adoption occur rapidly in a self-sustaining process.

Regulatory factor X, a bare lymphocyte syndrome transcription factor, is a multimeric phosphoprotein complex.

Regulatory factor X (RFX) is a transcription factor that binds the conserved X1 box of MHC class II promoters and is essential for transcription of class II genes. The subunit structure of the native RFX complex was examined by coimmunoprecipitation using polyclonal antisera to the 75-kDa subunit of RFX, RFX5. Two polypeptides with apparent masses of 41 and 36 kDa coimmunoprecipitated with RFX5 and appear to be subunits of the native RFX complex. Metabolic labeling of wild-type and mutant B cells with [32P]orthophosphate demonstrated that each of the RFX subunits was phosphorylated in vivo and that the phosphorylation of the RFX subunits was independent of the essential MHC class II regulatory factor, CIITA. The trimeric RFX complex was also present in fibroblast cells with or without IFN-gamma treatment. Both the p41 and p36 subunits were absent in immunoprecipitations of RFX5 from lysates of independently established B cell lines from bare lymphocyte syndrome complementation groups B and D. Together, these results suggest that RFX complex assembly is required for class II expression and that the mutations in bare lymphocyte syndrome complementation groups B and D result in an inability to assemble the RFX complex.

Social marketing and diffusion-based strategies for communicating with unique populations: HIV prevention in San Francisco.

We conducted a 2-year investigation of the extent to which strategies based on social marketing and diffusion of innovations concepts are used in preventive health communication with unique (highly ostracized) populations. Of the 49 organizations in San Francisco that operate HIV prevention programs (N = 100), programs that most highly targeted unique populations were surveyed. Personal interviews were then conducted with 38 staff leaders who operated the most and least effective programs. Audiotapes and transcripts were content analyzed to identify the strategies used by program staff. Strategies based on social marketing concepts were more prevalent than strategies based on the diffusion of innovations: More effective programs were characterized by emphasis on homophily, audience segmentation, compatibility-based strategies, and interorganizational collaboration.

The field of health communication today: an up-to-date report.

One important starting point for the field of health communication was the Stanford Heart Disease Prevention Program, a multiyear community intervention that began 25 years ago. Health communication is a specialty field of communication study that includes the media agenda-setting process for health issues; media advocacy for health; scientific communication among biomedical scientists; doctor-patient communication; and, particularly, the design and evaluation of preventive health communication campaigns, the focus of this article. Health communication study today is a well-established, expanding specialty in the United States and abroad.

The origins and development of the diffusion of innovations paradigm as an example of scientific growth.

PIP: Diffusion is the process by which an innovation is communicated through certain channels over time among members of a social system. The diffusion of innovations is a communication theory which has laid the groundwork for behavior change models across the social sciences, representing a widely applicable perspective. The diffusion of innovations paradigm began with the 1943 publication of the results of an hybrid seed corn study conducted by Bryce Ryan and Neal C. Gross, rural sociologists at Iowa State University. The diffusion paradigm spread among midwestern rural sociological researchers in the 1950s and 1960s, and then to a larger, interdisciplinary field of diffusion scholars. By the late 1960s, rural sociologists lost interest in diffusion studies, not because it was ineffective scientifically, but because of lack of support for such study as a consequence of farm overproduction and because most of the interesting research questions were thought to be answered. Since 1943, more than 4000 research publications have appeared and diffusion research became a widely practiced variety of scholarly study in sociology and other social sciences. This paper describes some of the history of rural sociological research on the diffusion of agricultural innovations with the goal of understanding how the research tradition emerged and to determine how it influenced the larger body of diffusion research conducted later by scholars in other disciplinary specialties. The authors describe how diffusion of innovations research followed and deviated from the Kuhnian concept of paradigm development.^ieng

Communication campaigns to change health-related lifestyles.

PIP: The North Karelia Project in Finland and the Stanford Heart Disease Prevention Program in California are 2 communication campaign examples for achieving health-related life styles. In 1972, health workers began a heart disease risk reduction program in North Karelia which had the highest levels of cardiovascular disease in Finland which in turn had the highest rate in the world as a pilot project to test the feasibility of involving the local community. In 1971, the Stanford Heart Disease Program began in 3 communities and had spread to 5 more around 1978. Communication strategies aim to diffuse preventive health innovations to a relatively large group of people within a specific time period using an organized set of communication activities. Prevention campaigns incorporate strategies from social learning, social marketing, and entertainment-education for mass communication. Social marketing strategies involve at least audience segmentation and use of symbols or logos, e.g., the Stanford Program used red hearts as its logo. Social learning revolves around the theory that people learn from both positive and negative roll models. In 1978, the North Karelia Project had a TV smoking cessation campaign with 10 people representing various target groups including a middle-aged man and a young woman. Evaluation research is also used to provide feedback to the project which allows the project to move on effectively. The main goal of diffusion prevention health innovations is to reach critical mass: the point where the innovation diffuses in a self-sustaining manner. The diffusion begins rather slowly then about the time 15-25% of the target audience adopts the innovation, the adoption rate grows quickly. In North Karelia, after 20 years, people eat a low fat and low cholesterol diet. In both California and Finland, there has been considerable reduction in cardiovascular disease risk.^ieng

Lowering the cost of lowering the cholesterol: a formulary policy for lovastatin.

OBJECTIVES: To describe a medical center policy designed to contain the cost of using the lipid-lowering drug lovastatin in a primary care setting, to examine the effect of the policy on cost containment, and to examine physician acceptance of the policy. SETTING: A Veterans Affairs medical center. INTERVENTIONS: The policy made lovastatin available to physicians when failure of therapy with diet and two first-line drugs was documented on an order form. The form also contained educational information including prices and recommended niacin as the drug treatment of first choice for most patients. DESIGN: To evaluate the effect of the policy, lipid-lowering drug use at the medical center was compared with that at a similar center that did not restrict lovastatin use, and with lipid-lowering drug use in the United States as a whole. A written questionnaire was used to survey physician reaction to the policy. RESULTS: The use of lovastatin as a percentage of total lipid-lowering drug use at the center with the lovastatin policy was one-fourth that at the other center or nationwide, and the use of niacin was four times greater (p less than 0.0001). The estimated savings in drug costs to the center with the lovastatin policy due to these differences was more than $30,000 per year. In the survey of physicians affected by the policy (n = 78, response rate = 100%), less than one-fourth viewed it unfavorably, and 90% favored this policy over restricting the drug to a subspecialty clinic. CONCLUSION: The authors' experience indicates that a formulary policy that permits limited use of an expensive drug in a primary care setting can contain costs in a way that is acceptable to physicians. A policy of this type could be useful to the increasing number of health care provider organizations that cover the cost of outpatient medications.

Outpatient pharmacy redesign to improve work flow, waiting time, and patient satisfaction.

An outpatient pharmacy redesign in which a pharmacist located outside the dispensing area speaks with each patient before the prescription is processed is described, and the effect of patients' waiting time and satisfaction is reported. Adoption of an open pharmacy plan at a Veterans Administration outpatient pharmacy allows patients to present their prescriptions to pharmacists in consultation booths equipped with computer terminals. The pharmacist promptly identifies and resolves any problem associated with a prescription or medication profile. The prescription then enters the dispensing work area, which was also redesigned to improve efficiency; patients now pick up their medications at a window on the opposite end of the dispensing area from where the pharmacist initially receives the prescription. Workload data and waiting times before and after implementation of the open pharmacy showed that prescriptions could be processed more quickly under the new system; average waiting times decreased from more than one hour to 30 minutes. Interviews of randomly selected patients indicated that the reduced waiting times led to increased patient satisfaction. The open pharmacy design appeared to improve work flow and to improve patient satisfaction by decreasing waiting times.

Pro-development soap operas: a novel approach to development communication.

PIP: Soap operas have their roots in 18th century English romance novels. These evolved into serialized radio dramas. In their current form, they were developed primarily to attract large audiences in order to sell consumer products. Hence the name soap which refers to the soap manufacturers who commonly advertise on such programs. In the world of soap operas there are 2 kinds. Those that function primarily to entertain and sell consumer products, and those that primarily entertain, but infuse positive social messages. The former are found everywhere, but are the only kind in America. The latter are found exclusively in developing countries. American soap operas have conveyed pro-social messages in the past, but they differ fundamentally from pro-development soap operas in their theoretical foundations. American soap operas are created by people who want to sell consumer goods. Development soap operas are created by people who want to convey pro-social messages that will aid their country's development. Both must be popular in order to be successful, but the former lack moral coherency, are unrealistic, erode values, and are created through a process of a theoretical development; while the latter have moral coherency, are realistic, promote values, and are created through a process of theoretical development. The 1st pro-development soap opera was Ven Conmigo (Come With Me) and was produced in Mexico between 1975-76. Its primary purpose was to increase adult literacy. During the year it ran, applicants at adult literacy centers rose by 600,000 or 63% compared to 7% the year before, and 2% the year after. The 2nd pro-development soap opera was Acompaname (Accompany Me) and it primary purpose was to promote family planning. It ran from 1977-78 and during that time the number of family planning adopters rose by 560,000 and contraceptive sale sin Mexico rose sharply. The question of what are pro-social messages and who should control them must be answered by each country in its effort to increase development.^ieng