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OBJECTIVE: To identify the perceptions that two communities of urban Hispanics have of various sources and channels of information regarding cigarette smoking and to compare them with those of non-Hispanic whites. DESIGN: Random samples of subjects of both ethnic groups and of both genders were surveyed by telephone to determine the perceived credibility and motivating power of 13 different channels of information and of 14 different sources of cigarette smoking information. SUBJECTS: 544 Hispanics and 542 non-Hispanic whites from San Francisco, California and Houston, Texas, 18-65 years in age, of both genders. RESULTS: Differences in the proportion of respondents assigning various perceived qualities to sources and channels of information regarding cigarette smoking were found to exist across ethnic groups (Hispanics and non-Hispanic whites); the respondents' gender (particularly among Hispanics); and the acculturation level of the Hispanic respondents. Nevertheless, there was a cluster of channels (printed media and television news) and of sources (physicians, people with cancer, friends, and peers) that were positively evaluated by large proportions of the respondents in both ethnic groups. CONCLUSIONS: Hispanics differ from non-Hispanic whites in their evaluation of various possible sources and channels of information about tobacco control. Culturally appropriate interventions for Hispanics need to be designed so as to use those channels and sources of information that are more positively perceived by Hispanics. 




BACKGROUND: New health warnings and contents labelling on tobacco products were introduced in Australia in 1995. OBJECTIVE: To assess awareness of the new warnings at a time when a mix of packs with old and new warnings were being sold and on changes in relevant knowledge and attitudes from shortly before the implementation of the new warnings. DESIGN AND SUBJECTS: Approximately 500 smokers and 500 non- smokers were surveyed in December 1994, before implementation of the new warnings. Similar numbers were also surveyed in May 1995, part-way through implementation. Respondents were selected by random-digit dialling of telephone numbers in Australia. Smokers were oversampled. In addition, 243 smokers from the initial survey were re-surveyed in May 1995. MAIN OUTCOME MEASURES: Awareness of change to health warnings, knowledge of health warnings and tobacco smoke constituents, beliefs about the health effects of smoking, and perceived impact of the warnings. RESULTS: There was high awareness of the new warnings, particularly among smokers, with the increased size of the new warnings being the most salient feature. More than a third of smokers reported being affected by the warnings, with reductions in consumption and talking about warnings being the most common effects. Among smokers, there was an increase in knowledge about the main constituents of tobacco smoke. The number of types of health effects mentioned also increased as did the number of warnings correctly recalled. Overall beliefs about the six warning statements became stronger. Few changes were found for non-smokers. The knowledge and recall effects were replicated in the re-contact subsample, but the belief changes were not. CONCLUSIONS: These results suggest the new health warnings are resulting in better informed smokers and thus suggest that informative health warnings can play an important role in better informing consumers. 




Background

Health warnings on cigarette packages provide smokers with universal access to information on the risks of smoking. However, warnings vary considerably among countries, ranging from graphic depictions of disease on Canadian packages to obscure text warnings in the U.S. The current study examined the effectiveness of health warnings on cigarette packages in four countries.

Methods

Quasi-experimental design. Telephone surveys were conducted with representative cohorts of adult smokers (N= 14,975): Canada (n =3687); the U.S. (n =4273); the UK (n= 3634); and Australia (n =3381). Surveys were conducted between 2002 and 2005, before and at three time points following new warnings on UK packages.

Results

. At Wave 1, Canadian smokers reported the highest levels of awareness and impact for health warnings among the four countries, followed by Australian smokers. Following the implementation of new UK warnings at Wave 2, UK smokers reported greater levels of awareness and impact, although Canadian smokers continued to report higher levels of impact after adjusting for the implementation date. U.S. smokers reported the lowest levels of effectiveness for almost every measure recorded at each survey wave.

Conclusions

Large, comprehensive warnings on cigarette packages are more likely to be noticed and rated as effective by smokers. Changes in health warnings are also associated with increased effectiveness. Health warnings on U.S. packages, which were last updated in 1984, were associated with the least effectiveness.

The validity of self-reported data on the presence of guns in the home obtained in a telephone survey was assessed in samples of households where a hunting license had been purchased or a handgun registered. The survey was conducted among a random sample of Ingham County, MI, residents who had purchased a hunting license between April 1990 and March 1991 and among those registering a handgun during 1990. A third study sample was selected from the county's general adult population using a random digit dialing method. The interviews were conducted between November 1991 and January 1992. The proportion of respondents who reported that at least one gun was kept in their household was 87.3 percent among handgun registration households and 89.7 percent among hunting license households. In the survey of the general population of the county, approximately one-third of the respondents reported keeping a gun in the household, 67 percent of them for hunting and 23 percent for safety. Despite some limitations, the data indicate that a question on gun presence in a household can be used in a in a telephone survey.

OBJECTIVE

To determine if hypothesized differences in attitudes and beliefs about cigarette smoking between Latino and non-Latino white smokers are independent of years of formal education and number of cigarettes smoked per day.

DESIGN

Cross-sectional survey using a random digit dial telephone method.

SETTING

San Francisco census tracts with at least 10% Latinos in the 1990 Census.

PARTICIPANTS

Three hundred twelve Latinos (198 men and 114 women) and 354 non-Latino whites (186 men and 168 women), 18 to 65 years of age, who were current cigarette smokers participated.

MEASUREMENTS AND MAIN RESULTS

Self-reports of cigarette smoking behavior, antecedents to smoking, reasons to quit smoking, and reasons to continue smoking were the measures. Latino smokers were younger (36.6 vs 39.6 years, p < .01), had fewer years of education (11.0 vs 14.3 years, p < .001), and smoked on average fewer cigarettes per day (9.7 vs 20.1, p < .001). Compared with whites, Latino smokers were less likely to report smoking “almost always or often” after 13 of 17 antecedents (each p < .001), and more likely to consider it important to quit for 12 of 15 reasons (each p < .001). In multivariate analyses after adjusting for gender, age, education, income, and number of cigarettes smoked per day, Latino ethnicity was a significant predictor of being less likely to smoke while talking on the telephone (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.26, 0.64), drinking alcoholic beverages (OR 0.66; 95% CI 0.44, 0.99), after eating (OR 0.55, 95% CI 0.37, 0.81), or at a bar (OR 0.62, 95% CI 0.41, 0.94), and a significant predictor of being more likely to smoke at a party (OR 1.72; 95% CI 1.14, 2.60). Latino ethnicity was a significant predictor of considering quitting important because of being criticized by family (OR 1.93; 95% CI 1.26, 2.98), burning clothes (OR 1.57; 95% CI 1.02, 2.42), damaging children's health (OR 1.67; 95% CI 1.08, 2.57), bad breath (OR 2.07; 95% CI 1.40, 3.06), family pressure (OR 1.67; 95% CI 1.10, 2.60), and being a good example to children (OR 1.83; 95% CI 1.21, 2.76).

CONCLUSIONS

Differences in attitudes and beliefs about cigarette smoking between Latinos and whites are independent of education and number of cigarettes smoked. We recommend that these ethnic differences be incorporated into smoking cessation interventions for Latino smokers.

Background

With declining cigarette sales, tobacco manufacturers have been developing and marketing new smokeless products, such as R. J. Reynolds' dissolvable tobacco, Camel Sticks, Strips and Orbs. This study assessed the availability, price and point-of-purchase promotional strategies for Camel Dissolvables, and investigated consumer awareness, interest and perception of these products in the Indiana test market.

Methods

An exploratory retail audit of point-of-purchase promotions was conducted in a random sample of retailers from 6 store categories (n = 81) in the test market area. Data included: store type, location, product placement, forms/flavors carried, price, types and locations of advertisements and promotions, and ad messages. An Awareness-Attitude-Usage (AAU) survey was used to gauge consumer awareness and knowledge of tobacco products including Camel Dissolvables. Respondents were shown promotional materials from a package onsert and perceptions and interest in the Camel Dissolvables were assessed. An Intended Target Survey (ITS) compared subjects' perceptions of ad targets for several non-tobacco products, as well as Camel Snus, Camel No. 9 and Camel Dissolvables. Respondents were asked to identify each ad's intended target category, perceived targetedness, and purchase intent.

Results

The products were carried by 46% of stores, most frequently gas stations (100%) and convenience stores (75%). They were shelved near smokeless tobacco (70%), cigarettes (25%) or candy (5%). Prices ranged from $3.59 -$4.19 per package; most stores carried at least 1 promotional item. Ad messages included: "Dissolvable Tobacco" (60%). "Free Trial" (24%), "Special Price" (24%), "What's Your Style?" (22%). At 14% of stores, free trial packs of Camel Dissolvables were offered with another Camel purchase. Awareness was reported by 42% of respondents (n = 243), and trial by 3%. Consumer interest was very low, but younger respondents (< 40 years) were more familiar with Camel Dissolvables (60% vs. 45% for those > 40 years, p < .01). Males, as well as current and former smokers had higher rates of interest and trial; only 1% of never smokers reported trial. In the ITS, only for the 3 tobacco product ads, was perceived targetedness for smokers significantly higher than for non-smokers. Smokers and nonsmokers perceived that the ads targeted smokers.

Conclusions

Current retail promotional strategies for Camel Sticks, Strips & Orbs appear to be targeting a select audience, primarily current smokers. Overall, consumer awareness, interest and trial were low.

Research on the federally mandated alcohol warning label has found mixed results, but some findings are consistent with a modest influence on precautionary behaviors to reduce drinkers’ self-reported drunk driving. We hypothesized that warnings would also influence the likelihood of intervening to deter other’s driving after drinking. Using data from 1376 adult drinkers in a US national survey, a conceptual model reflecting effects of exposure to the label’s drunk driving message on taking actions to avert another's driving under the influence was tested in a structural equation modeling framework. For males and females, in structural models with drinking and handling of alcoholic beverages potentially affecting both message recall and intervening, the predicted relationships were found between message recall and actions to deter another’s drinking driving. This finding suggests that an important preventive effect of the alcohol warning label may be to legitimate collateral’s attempts to avert another’s drunk driving.

A total of 190 secondary four male school students from three schools in Kota Bharu were surveyed on their smoking habits and their attitudes towards the health warning messages on cigarette packs. There were 57 (30.0%) students who were current smokers, 45 (23.7%) students who were ex-smokers and 88 (46.3%) students who have never smoked cigarettes. Nearly all current and ex-smokers (95.1%) as well as non-smokers (94.3%) knew the wording of the health warning message currently displayed on cigarette packs. Almost all the students (95.3%) also knew where the warning message was placed. There were more ex-smokers and non-smokers (70.5%) compared to current smokers (50.0%) who felt that there should be different health warning messages and each should be displayed concurrently on different cigarette packs. The students felt that the current health message was not effective to motivate smokers to quit (score=2.25). Alternative messages which the students felt may be more effective were ‘Smoking is dangerous for pregnancy’ (score = 3.3), ‘Cigarette smoke is dangerous for your child’ (score=3.11) and ‘Smoking can kill you’ (score=3.08). The current health message “Smoking is dangerous for your health’ is eighth with a score of only 2.64. The students felt that the least effective message was ‘Cigarettes are drugs’ (score=2.22). Most of the students (80.0%) felt that the health warning message should be placed at the front instead of on the side of the cigarette pack to be more effective.

The objective of this research was to compare the response of adult smokers in Malaysia to newly proposed pictorial cigarette warnings against the current text-only warnings. The study population included 140 adult male smokers who were enrolled in a randomized trial to view either the new pictorial warnings (intervention) or the old text-only warnings (control). Participants completed pre-exposure and post-exposure questionnaires that assessed their awareness of the health risks of smoking, response to the package warnings, and interest in quitting smoking. Exposure to the pictorial warnings resulted in increased awareness of the risks of smoking, stronger behavioral response to the warnings and increased interest in quitting smoking. The new warnings in Malaysia will increase smokers’ knowledge of the adverse health effects of smoking and have a positive effect on interest in quitting.

Background:

In 2007, because of a potential interaction between ceftriaxone and calcium-containing IV solutions, Roche Laboratories (manufacturer of Rocephin [ceftriaxone] in the United States) issued letters to health care professionals advising them of changes to the product monograph. Subsequently, warning letters were also issued by the US Food and Drug Administration (FDA) and Health Canada. The Health Canada recommendations and their implications for clinical practice generated debate in the Canadian hospital pharmacy community.

Objective:

To evaluate the response to the warnings among hospital pharmacists and their respective institutions.

Methods:

An anonymous, voluntary 10-question survey was distributed to members of the Pharmacy Specialty Networks of the Canadian Society of Hospital Pharmacists. Requests to participate were solicited via 2 e-mail messages. Responses were analyzed descriptively.

Results:

A total of 152 pharmacists participated in the survey. Forty-three respondents (28.3%) reported being very concerned and 86 (56.6%) reported being somewhat concerned about the Health Canada Notice to Hospitals. About half (77/152 [50.7%]) of the respondents felt that the Health Canada notice did not need to be strictly heeded. Two-thirds (98/145 [67.6%]) reported that their institutions had addressed the risk of an interaction through a change in policy regarding the administration of ceftriaxone. Eighty-eight (61.5%) of 143 participants indicated that their institution’s official position on the notice was that it represented a “relative contraindication” (i.e., the benefit may outweigh the risk).

Conclusions:

Warning letters issued by the manufacturer, the FDA, and Health Canada generated concern within the Canadian hospital pharmacy community. However, a large proportion of hospital pharmacy practitioners did not agree with strict adherence to the Health Canada notice.

Objectives. To determine the awareness of the warning signs, risk factors, and treatment of tuberculosis among urban Nigerians. Methods. This was a cross-sectional survey among 574 adults in Ilorin, Nigeria. Semistructured questionnaire was administered by trained interviewers to obtain information about awareness of tuberculosis warning signs, risk factors, and treatment. Results. Majority of the subjects (71.4%) were aware of at least one warning sign of tuberculosis. Cough (66.2%), weight loss (38.0%), and haemoptysis (30.7%) were the most identified warning signs. The predictors of awareness of warning sign were increasing age (r + 0.12), higher family income (r + 0.10), higher level of education (r + 0.10), and belonging to Christian faith (r + 0.11). Awareness of risk factors for tuberculosis was higher for tobacco smokers (77.0%) and history of contact with a case of TB (76.0%). Less than half were aware of HIV infection (49.8%), alcohol consumption (42.5%), chronic kidney disease (40.4%), extremes of ages (39.4%), cancers (36.9%), and diabetes mellitus (27.5%) as risk factors for TB. Tuberculosis was reported to be curable by 74.6% of the subjects and 67.9% knew that there are medications for treatment of tuberculosis, while 11.5% knew the duration of treatment. Conclusion. This study has revealed that the awareness of HIV and noncommunicable diseases as risk factors for TB is poor. This study has therefore demonstrated the need for health education programs that will emphasize recognition, identification, and modification of risk factor for TB.

Introduction

Rapid identification and treatment of ischemic stroke can lead to improved patient outcomes. Public education campaigns in selected communities have helped to increase knowledge about stroke, but most data represent large metropolitan centers working with academic institutions. Much less is known about knowledge of stroke among residents in rural communities.

Methods

In 2004, 800 adults aged 45 years and older from two Montana counties participated in a telephone survey using unaided questions to assess awareness of stroke warning signs and risk factors. The survey also asked respondents if they had a history of atrial fibrillation, diabetes, high blood pressure, high cholesterol, smoking, heart disease, or stroke.

Results

More than 70% of survey participants were able to correctly report two or more warning signs for stroke: numbness on any side of the face/body (45%) and speech difficulties (38%) were reported most frequently. More than 45% were able to correctly report two or more stroke risk factors: smoking (50%) and high blood pressure (44%) were reported most frequently. Respondents aged 45 to 64 years (odds ratio [OR] 2.44; 95% confidence interval [CI], 1.78–3.46), women (OR 2.02; 95% CI, 1.46–2.80), those with 12 or more years of education (OR 1.96; 95% CI, 1.08–3.56), and those with high cholesterol (OR 1.68; 95% CI, 1.17–2.42) were more likely to correctly identify two or more warning signs compared with respondents without these characteristics. Women (OR 1.48; 95% CI, 1.07–2.05) and respondents aged 45 to 64 years (OR 1.35; 95% CI, 1.01–1.81) were also more likely to correctly identify two or more stroke risk factors compared with men and older respondents.

Conclusion

Residents of two rural counties were generally aware of stroke warning signs, but their knowledge of stroke risk factors was limited.

Introduction

Many people are not aware of stroke symptoms, the need for emergency care for those symptoms, and that calling 9-1-1 is recommended. The New York State Department of Health developed and implemented a multimedia campaign to increase stroke symptom awareness and awareness of the need to call 9-1-1.

Methods

The evaluation of the campaign's impact was a pre/post intervention matched comparison design. A random-digit–dialed list-assisted telephone survey was administered to measure reach of the campaign and change in intention to seek emergency care for stroke by calling 9-1-1 in response to 4 signs or symptoms.

Results

A larger proportion of respondents in the intervention region than in the comparison region reported seeing a stroke advertisement and reported the advertisement's message was to call 9-1-1. There was a significant increase between baseline and follow-up in intention to call 9-1-1 for the 4 stroke symptoms. These increases were greater in the intervention region than the comparison region. The differences between intervention and comparison groups in the increases in intention to call 9-1-1 ranged from 9% to 12% for specific stroke symptoms identified in oneself and from 4% to 12% for symptoms identified in another person.

Conclusion

This multimedia campaign effectively increased intention to call 9-1-1 for stroke symptoms in the intervention region compared with a region matched for demographics and stroke rates. Multimedia campaigns are effective in increasing awareness of stroke symptoms and intention to immediately call 9-1-1.

Background

Although stroke is a leading cause of morbidity and mortality in Nigeria, there is no information on awareness of its warning signs. This study was designed to assess awareness of stroke warning signs in Nigerians at increased risk.

Methods

A hospital-based cross-sectional study conducted at Irrua Specialist Teaching Hospital, in southern Nigeria. Patients with a diagnosis of hypertension, diabetes or both were interviewed for the warning signs of stroke in the outpatient clinic by trained interviewers. The main outcome measure was ability to identify at least one stroke warning sign.

Results

There were 225 respondents with a mean age of 58.0 ± 11.7 years. Only 39.6% could identify at least one stroke warning sign while the commonest sign identified was sudden unilateral limb weakness (24.4%). On multivariate logistic regression analysis, male sex (β = 0.26, 95% CI = 0.14–0.39, p < 0.001) and 11 or more years of education (β = 0.16, 95% CI = 0.03–0.29, p = 0.02) emerged the independent predictors of ability to identify at least one warning sign.

Conclusion

Awareness of stroke warning signs is poor among Nigerians at increased risk for the disease. Efforts should be made to improve on the level of awareness through aggressive health education.

Design: Subjects examined two distracter ads and one of nine randomly assigned smokeless tobacco ads varying in health warning presence, size (8 to 18 point font), and contrast (low versus high)—including no health warning. They were then interviewed about ad content using recall and recognition questions.

Subjects: A convenience sample of 895 English speaking males aged 16–24 years old who were intercepted at seven shopping malls throughout Massachusetts during May 2000.

Main outcome measures: Proven aided recall, or recall of a health warning and correct recognition of the warning message among distracters, and false recall.

Results: Controlling for covariates such as education, employment/student status, and Hispanic background, proven aided recall increased significantly with font size; doubling size from 10 to 20 point font would increase recall from 63% to 76%. Although not statistically significant, recall was somewhat better for high contrast warnings. Ten per cent of the sample mistakenly recalled the warning where none existed.

Conclusions: As demonstrated by substantially greater recall among ads that included health warnings over ads that had none, health warnings retained their value to consumers despite years of exposure (that can produce false recall). Larger health warnings would enhance recall, and the proposed model can be used to estimate potential recall that affects communication, perceived health risk, and behaviour modification.

Objectives

The public has long been encouraged to engage in sun-safe practices to minimize exposure to sunlight, the major cause of nonmelanoma skin cancer. More recently, some have advocated unprotected sun exposure to increase cutaneous synthesis of vitamin D as a way to promote health. We assessed the net result of these conflicting messages.

Methods

In a cross-sectional survey in 2007, questionnaires were mailed to participants of an ongoing cohort study in Washington County, Maryland. The study population consisted of 8,027 adults (55% response rate).

Results

Thirty percent of respondents were aware that unprotected sun exposure increased endogenous vitamin D levels. Among those who were aware of this benefit, 42% reported going out into the sun to increase vitamin D levels. Sun-seeking to increase vitamin D production did not significantly differ according to self-reported personal history of skin cancer, but was significantly higher among women, older age groups, those with less education, and vitamin D supplement users.

Conclusion

A substantial proportion of respondents reported sun-seeking behavior expressly to increase endogenous vitamin D levels. The message about sun exposure and vitamin D is reaching the general public; however, this finding poses challenges to skin cancer prevention efforts.

Background

Surveys have provided evidence that tobacco use is widely prevalent amongst the youth in Pakistan. Several reviews have evaluated the effectiveness of various tobacco control programs, however, few have taken into account the perceptions of students themselves regarding these measures. The aim of this study was to determine the most effective anti-smoking messages that can be delivered to high-school students in Pakistan, based on their self-rated perceptions. It also aimed to assess the impact of pictorial/multi-media messages compared with written health warnings and to discover differences in perceptions of smokers to those of non-smokers to health warning messages.

Methods

This study was carried out in five major cities of Pakistan in private English-medium schools. A presentation was delivered at each school that highlighted the well-established health consequences of smoking using both written health warnings and pictorial/multi-media health messages. Following the presentation, the participants filled out a graded questionnaire form, using which they rated the risk-factors and messages that they thought were most effective in stopping or preventing them from smoking. The Friedman test was used to rank responses to each of the questions in the form. The Wilcoxon Signed Rank test used to analyze the impact of pictorial/multi-media messages over written statements. The Mann Whitney U test was used to compare responses of smokers with those of non-smokers.

Results

Picture of an oral cavity cancer, videos of a cancer patient using an electronic voice box and a patient on a ventilator, were perceived to be the most effective anti-smoking messages by students. Addiction, harming others through passive smoking and impact of smoking on disposable incomes were perceived to be less effective messages. Pictorial/multi-media messages were perceived to be more effective than written health warnings. Health warnings were perceived as less effective amongst smokers compared to non-smokers.

Conclusion

Graphic pictorial/multi-media health warnings that depict cosmetic and functional distortions were perceived as effective anti-smoking messages by English-medium high school students in Pakistan. Smokers demonstrated greater resistance to health promotion messages compared with non-smokers. Targeted interventions for high school students may be beneficial.

The present study was aimed at investigating the awareness level about warning signs of cancer and its determinants in an Iranian general population. This cross-sectional interview-based survey investigated 2,500 people aged 18 years and over, as a representative sample of Tehran population. Latent class regression was applied for analyzing data. A small (18.8%) proportion of the respondents had high level of knowledge, and 54.5% had moderate awareness, and 26.7% had low level of awareness. Most effective predictors for awareness were educational attainment, sex, and marital status. The findings suggest that the overall level of knowledge about warning signs of cancer among the public is low, particularly about some specific signs. Accordingly, educational and intervention programmes, with special attention placed on particular at-risk populations, to increase awareness about the disease leading to its early diagnosis are needed.

Background

In 2006, Australia introduced graphic cigarette packet warnings. The new warnings include one of 14 pictures, many depicting tobacco-related pathology. The warnings were introduced in two sets; Set A in March and Set B from November. This study explores their impact on smokers' beliefs about smoking related illnesses. This study also examines the varying impact of different warnings, to see whether warnings with visceral images have greater impact on smokers' beliefs than other images.

Methods

Representative samples of South Australian smokers were interviewed in four independent cross-sectional omnibus surveys; in 2005 (n = 504), 2006 (n = 525), 2007 (n = 414) and 2008 (n = 464).

Results

Unprompted recall of new graphic cigarette warnings was high in the months following their introduction, demonstrating that smokers' had been exposed to them. Smokers also demonstrated an increase in awareness about smoking-related diseases specific to the warning messages. Warnings that conveyed new information and had emotive images demonstrated greater impact on recall and smokers' beliefs than more familiar information and less emotive images.

Conclusions

Overall graphic pack warnings have had the intended impact on smokers. Some have greater impact than others. The implications for policy makers in countries introducing similar warnings are that fresh messaging and visceral images have the greatest impact.

Introduction:

This paper is concerned with the effects of cigarette pack warning labels on quitting intentions. We examined whether different responses among smokers toward cigarette pack warning labels could predict quit intentions and self-efficacy in quitting. Variables studied were “noticing warning labels during last month,” “reading or looking closely at warning labels,” “avoiding looking at labels during last month,” “thinking about health risks of smoking because of the warning labels, “more likely to quit because of the warning labels,” and “stopping from having a cigarette when about to smoke one because of the labels.”

Methods:

A total of 2,006 adult smokers in Malaysia were surveyed in face-to-face interviews using a standardized questionnaire. Of those, 1,919 male smokers were included in the analyses.

Results:

The responses “more likely to quit because of the warning labels” and “stopped from having a cigarette when about to smoke one” significantly predicted all stages of change and self-efficacy, independent of the other measures. In addition, thinking about the health risks and reading the warnings more often added extra predictive capacity but only in the early stages of contemplating change.

Discussion:

Less intense processing of the information may be important in initiating thoughts, but cognitions about quitting and foregoing cigarettes are the key mechanisms by which warnings stimulate quitting intentions and help smokers feel capable of succeeding. Malaysian smokers appear to respond to warnings in ways comparable with those from developed countries.

In this review, we have summarized the findings of fifteen studies of knowledge of stroke warning signs and risk factors in both high- and low-risk populations. In general, there appears to be low levels of knowledge of both risk factors and stroke warning signs among the communities studied. Using free recall, between 20% and 30% of respondents could not name a single risk factor, and between 10% and 60% could not name a single warning sign of stroke. Providing survey respondents with a list of potential warning signs substantially improved the identification of warning signs. Respondents in older age groups and having lower levels of educational attainment tended to have less knowledge of risk factors and warning signs of stroke than those in younger age groups and those with more education. Public campaigns to improve stroke knowledge are needed, particularly in the older age groups where the risk of stroke is greater.

A telephone survey of a random sample of Rhode Island women ages 40 and older residing in minority low-income census tracts--census tracts in the lowest quartile of a variety of socioeconomic indicators in which at least 5 percent of the population was classified as Hispanic or non-Hispanic black--was conducted in 1991, focusing on breast cancer screening. Hispanic women were found to have about half the breast cancer screening rate (20 percent, according to current screening guidelines) of other respondents (37 percent). Determinants of screening were explored to suggest reasons for this difference. The Health Belief Model was used to identify and compare determinants of breast cancer screening (sociodemographics, health care utilization, perceived susceptibility to breast cancer, perceived seriousness of breast cancer, cues to screening such as a provider's recommendation, and the perceived benefits and costs of screening) among Hispanics, non-Hispanic whites, and non-Hispanic blacks. Hispanics were younger, less educated, and had lower family incomes than other women residing in minority low-income census tracts, were less likely to receive medical care, to perceive themselves as susceptible to breast cancer, and to perceive breast cancer as curable. Logistic regression analyses revealed the importance of use of health care, cues for screening, and perceptions of mammography to explain the screening behavior of Hispanics and non-Hispanics alike. Access to medical care is a significant problem in the Rhode Island Hispanic community, related to recent immigration, undocumented immigration, and low income characteristics of its members.(ABSTRACT TRUNCATED AT 250 WORDS)

Cigarette smoking is the primary preventable cause of mortality and morbidity in the US. But in the mid-1990s, more than one-third of US teenagers were smokers, despite their awareness of the health risks and negative consequences of tobacco use. In 1996, as part of a three-year qualitative study to explore differences in adolescent smoking by gender and ethnicity, members of the Tobacco Control Network examined messages that teens receive about cigarette smoking. Consisting of 178 focus groups with 1,175 teenagers covering all levels of smoking experience, the study included teens from five ethnic groups, stratified by gender and ethnicity, from urban and rural areas across the US. The authors reviewed the sources and content of messages that teens reported were most influential in their decisions to smoke or not smoke cigarettes. Family and peers, school, television, and movies were the primary sources for both pro- and anti-smoking messages. The authors conclude that a lack of clear, consistent antismoking messages leaves teens vulnerable to the influences of pro-smoking messages from a variety of sources. Interventions need to be culture- and gender-specific. Family-based interventions appear to be needed and efficacious, but resource intensive. Building self-esteem may prove to be a promising intervention.

Communication theories and research data were used to design cross-cultural health education messages. A University of California Los Angeles-Universidad Autonoma in Tijuana, Mexico, research team used the methods of ethnographic and survey research to study behaviors, attitudes, and knowledge concerning prenatal care of a sample of pregnant low-income women living in Tijuana. This audience provided information that served as a framework for a series of messages to increase awareness and change prenatal care behaviors. The message design process was guided by persuasion theories that included Petty and Caccioppo's elaboration likelihood model, McGuire's persuasion matrix, and Bandura's social learning theory. The results from the research showed that poor women in Tijuana tend to delay or not seek prenatal care. They were not aware of symptoms that could warn of pregnancy complications. Their responses also revealed pregnant women's culturally specific beliefs and behaviors regarding pregnancy. After examination of these and other results from the study, prenatal care messages about four topics were identified as the most relevant to communicate to this audience: health services use, the mother's weight gain, nutrition and anemia, and symptoms of high-risk complications during pregnancy. A poster, a calendar, a brochure, and two radio songs were produced and pretested in focus groups with low-income women in Tijuana. Each medium included one or more messages addressing informational, attitudinal, or behavioral needs, or all three, of the target population.

The purpose of this study was to determine black adults' knowledge and perceptions of cancer by utilizing the Health Belief Model. The subjects were obtained by randomly selecting 11 churches from a list of 33. There were 769 black adults who responded to the survey (64 percent response rate). Mean age of respondents was 44.3 years, SD = 14.7. Only 29 percent were able to correctly identify all seven of the American Cancer Society warning signs; 13 percent were unable to identify any warning signs. One in four believed it was likely they would develop cancer sometime in their life, and 42 percent believed blacks were more susceptible to cancer than whites. Forty-one percent believed most people who get cancer will die from it. Perceived barriers to treatment included cost and pain. A large number of significant differences (P < .01) were found when responses were examined in relation to the sex, educational level, and age of the subjects.