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1.  Cancer Information Scanning and Seeking in the General Population 
Journal of health communication  2010;15(7):734-753.
The amount of cancer-related information available in the media and other sources continues to increase each year. We wondered how people make use of such content in making specific health decisions. We studied both the information they actively seek (“seeking”) and that which they encounter in a less purposive way (“scanning”) through a nationally representative survey of adults aged 40–70 years (n=2,489) focused on information use around three prevention behaviors (dieting, fruit and vegetable consumption and exercising) and three screening test behaviors (prostate-specific antigen, colonoscopy, mammogram). Overall, respondents reported a great deal of scanning and somewhat less seeking (on average 62% versus 28% for each behavior), and used a range of sources including mass media, interpersonal conversations and the Internet, alongside physicians. Seeking was predicted by female gender; age of 55–64 vs. 40–44; higher education; Black race and Hispanic ethnicity and being married. Scanning was predicted by older age, female gender and education. Respondents were fairly consistent in their place on a typology of scanning and seeking across behaviors. Seeking was associated with all six behaviors and scanning was associated with three of six behaviors.
doi:10.1080/10810730.2010.514029
PMCID: PMC3661288  PMID: 21104503
Cancer; information seeking; scanning
2.  Measurement Models for Reasoned Action Theory 
Quantitative researchers distinguish between causal and effect indicators. What are the analytic problems when both types of measures are present in a quantitative reasoned action analysis? To answer this question, we use data from a longitudinal study to estimate the association between two constructs central to reasoned action theory: behavioral beliefs and attitudes toward the behavior. The belief items are causal indicators that define a latent variable index while the attitude items are effect indicators that reflect the operation of a latent variable scale. We identify the issues when effect and causal indicators are present in a single analysis and conclude that both types of indicators can be incorporated in the analysis of data based on the reasoned action approach.
doi:10.1177/0002716211424709
PMCID: PMC3520136  PMID: 23243315
effect indicators; causal indicators; measurement models; Integrative Model
3.  Psychosocial Determinants of Cancer-Related Information Seeking among Cancer Patients 
Journal of health communication  2011;16(2):212-225.
This study explores the utility of using the Integrative Model of Behavioral Prediction as a framework for predicting cancer patients’ intentions to seek information about their cancer from sources other than a physician, and to examine the relation between patient’s baseline intentions to seek information and their actual seeking behavior at follow-up. Within one year of their diagnosis with colon, breast, or prostate cancer, 1641 patients responded to a mailed questionnaire assessing intentions to seek cancer-related information from a source other than their doctor, as well as their attitudes, perceived normative pressure, and perceived behavioral control with respect to this behavior. In addition, the survey assessed their cancer-related information seeking. One year later, 1049 of these patients responded to a follow-up survey assessing cancer-related information seeking during the previous year. Attitudes, perceived normative pressure, and perceived behavioral control were predictive of information seeking intentions, though attitudes emerged as the primary predictor. Intentions to seek information, perceived normative pressure regarding information seeking, baseline information seeking behavior, and being diagnosed with stage 4 cancer were predictive of actual information seeking behavior at follow-up. Practical implications are discussed.
doi:10.1080/10810730.2010.522227
PMCID: PMC3069660  PMID: 21207310
4.  Understanding tailoring in communicating about health 
Health education research  2008;23(3):454-466.
‘Tailoring’ refers to any of a number of methods for creating communications individualized for their receivers, with the expectation that this individualization will lead to larger intended effects of these communications. Results so far have been generally positive but not consistently so, and this paper seeks to explicate tailoring to help focus future research. Tailoring involves either or both of two classes of goals (enhancing cognitive preconditions for message processing and enhancing message impact through modifying behavioral determinants of goal outcomes) and employs strategies of personalization, feedback and content matching. These goals and strategies intersect in a 2 × 3 matrix in which some strategies and their component tactics match better to some goals than to others. The paper illustrates how this framework can be systematically applied in generating research questions and identifying appropriate study designs for tailoring research.
doi:10.1093/her/cyn004
PMCID: PMC3171505  PMID: 18349033
5.  A Model of Adolescents’ Seeking of Sexual Content in their Media Choices 
Journal of sex research  2011;48(4):309-315.
This paper reports on the extent to which adolescents report actively seeking sexual content in media, identifies from which media they report seeking, estimates the association between seeking sexual information and romantic and sexual behavior, and shows that active seeking of sexual content in media sources is explained by an intention to seek such content using the Integrative Model of Behavioral Prediction, a reasoned action approach. The data are a national sample of 810 adolescents aged 13-18 years. Results show that fifty percent of adolescents reported actively seeking sexual content in their media choices, which included movies, television, music, internet pornography sites, and magazines. Males sought sex content more than females and gender differences were greatest for seeking from internet pornography sites, movies, and television. Path analysis demonstrate that seeking sexual content is well predicted by intentions to seek and intentions are primarily driven by perceived normative pressure to seek sexual content.
doi:10.1080/00224499.2010.497985
PMCID: PMC2970688  PMID: 20672214
6.  Differentiating Between Precursor and Control Variables When Analyzing Reasoned Action Theories 
AIDS and behavior  2009;14(1):225.
This paper highlights the distinction between precursor and control variables in the context of reasoned action theory. Here the theory is combined with structural equation modeling to demonstrate how age and past sexual behavior should be situated in a reasoned action analysis. A two wave longitudinal survey sample of African-American adolescents is analyzed where the target behavior is having vaginal sex. Results differ when age and past behavior are used as control variables and when they are correctly used as precursors. Because control variables do not appear in any form of reasoned action theory, this approach to including background variables is not correct when analyzing data sets based on the theoretical axioms of the Theory of Reasoned Action, the Theory of Planned Behavior, or the Integrative Model
doi:10.1007/s10461-009-9560-z
PMCID: PMC2819107  PMID: 19370408
Integrative Model; adolescent sexual behavior; African-Americans; structural equation modeling
7.  Estimating the Longitudinal Association Between Adolescent Sexual Behavior and Exposure to Sexual Media Content 
Journal of sex research  2009;46(6):586-596.
Purpose
To estimate the association between adolescent sexual behavior and exposure to sexual media content.
Methods
A three wave longitudinal survey sample (N = 506) of 14-16 year olds at baseline is analyzed using growth curves.
Results
Growth trajectories are linear for sexual behavior but not for exposure to sexual media content. The signs of the exposure slopes are not uniformly positive: Hispanic and African-American respondents show declines of exposure to sexual media content over the age range investigated here.
Conclusions
While changes in exposure to sex content are highly associated with changes in sexual behavior among Whites, there is little or no association between changes in these variables among Blacks.
doi:10.1080/00224490902898736
PMCID: PMC2783973  PMID: 19382030
adolescent sexual behavior; sexual media content; media effects; growth curves
8.  The Role of Communication with Friends in Sexual Initiation 
Communication research  2010;37(2):239-255.
This study identifies a theoretical mechanism through which communication with friends about sex influences sexual initiation in a sample of adolescents. The Integrative Model was used to assess the effect of attitudes, normative pressure and self efficacy on intentions to have sex in a sample of virgin adolescents. Results show that the constructs of the theory partially mediated the effect of communication with friends on subsequent sexual initiation. The effect of communication with friends on sexual initiation was not different for males and females. Overall, the results suggest how conversations with friends about sex influence adolescents’ intentions to initiate sexual intercourse, which in turn influence subsequent sexual initiation.
doi:10.1177/0093650209356393
PMCID: PMC2897170  PMID: 20613973
Communication with friends; sexual initiation; adolescents; Integrative Model
9.  Evaluating the Risk and Attractiveness of Romantic Partners When Confronted with Contradictory Cues 
AIDS and behavior  2007;11(3):479-490.
Research shows that people engage in “risky” sex with “safe” partners and in “safer” sex with “riskier” partners. How is the determination of “risky” or “safe” status made? Factorial survey methodology was used to randomly construct descriptions of romantic partners based on attractive and/or risky characteristics. Respondents evaluated 20 descriptions for attractiveness, health risk, likelihood of going on a date, likelihood of unprotected sex, and likelihood of STD/HIV infection. Respondents were most attracted to and perceived the least risk from attractive descriptions and were least attracted to and perceived the most risk from the risky descriptions. The differences between the “conflicting information” descriptions are attributable to a primacy effect: descriptions that began with attractiveness information but end with risk information were evaluated more positively than those that began with risk and ended with attractive information.
doi:10.1007/s10461-006-9156-9
PMCID: PMC2879144  PMID: 17028997
sex partner selection; factorial surveys; sexual decision making
10.  How Sources of Sexual Information Relate to Adolescents’ Beliefs about Sex 
Objectives
To examine how sources of sexual information are associated with adolescents’ behavioral, normative, and control beliefs about having sexual intercourse using the Integrative Model of Behavior Change.
Methods
Survey data from a quota sample of 459 youth.
Results
The most frequently reported sources were friends, teachers, mothers, and media. Regression analyses indicated that learning about sex from parents, grandparents, and religious leaders was associated with beliefs likely to delay sex; friends, cousins, and media were associated with beliefs that increase the likelihood of having sexual intercourse.
Conclusions
Different sexual information sources were associated with different underlying beliefs.
PMCID: PMC2860278  PMID: 18844519
adolescents; sexual information; media; Integrative Model
11.  Developing Respondent Based Multi-Media Measures of Exposure to Sexual Content 
Despite the interest in the effects of the media on sexual behavior, there is no single method for assessing exposure to a particular type of media content (e.g., sex). This paper discusses the development of six sexual content exposure measures based on adolescents’ own subjective ratings of the sexual content in titles in 4 media (i.e., television, music, magazines, videogames). We assessed the construct and criterion validity of these measures by examining the associations among each of these measures of exposure to sexual content as well as their associations with adolescents’ sexual activity. Data were collected in summer 2005 through a web-based survey using a quota sample of 547 youth aged 14–16 from the Philadelphia area. Adolescents rated how often they were exposed to specific television shows, magazine titles, etc. on 4-point never to often scales. They also rated the sexual content of those titles on 4-point no sexual content to a lot of sexual content scales. Sexual behavior was measured using an ordered index of lifetime pre-coital and coital sexual activity. The strength of association between exposure to sexual content and sexual activity varied by medium and measure. Based on our findings, we recommend the use of a multiple media weighted sum measure. This measure produces findings that are consistent with those of similar studies.
doi:10.1080/19312450802063040
PMCID: PMC2857347  PMID: 20411048
12.  It Works Both Ways: The Relationship between Exposure to Sexual Content in the Media and Adolescent Sexual Behavior 
Media psychology  2008;11(4):443-461.
Using a longitudinal web-based survey of adolescents 14-16 years of age, we estimate regression models where self-reported sexual behavior and content analytic-based exposure to sex in the media are related cross-sectionally and longitudinally. We find evidence for both cross-sectional non-recursive and prospective longitudinal relationships even after adjusting for both established predictors of sexual behavior (e.g., physical development, having a romantic partner, parental monitoring, peer and parental norms, respondent's age) and of exposure to sexual media content (e.g., time the respondent goes to bed, extracurricular activities, television in the bedroom, total time spent with television, music, videogames, and magazines). Sexually active adolescents are more likely to expose themselves to sex in the media and those exposed to sex in the media are more likely to progress in their sexual activity. These findings are consistent with others in the literature that demonstrate a causal effect of exposure to sexual content on sexual behavior but extend established results by also looking at the causal effect of sexual behavior on exposure both cross-sectionally and over time.
doi:10.1080/15213260802491986
PMCID: PMC2850066  PMID: 20376301
13.  An assessment of the relationship between condom labels and HIV-related beliefs and intentions 
AIDS and behavior  2008;12(3):452-458.
The aim of this paper is to examine the impact of the FDA's proposed condom package labeling on HIV-related beliefs about condom effectiveness, on intentions to recommend condoms for friends to use, and intentions to use condoms. Using a nationally representative survey we randomized 1,194 adults ages 18-65 years into one of three condom label conditions: the current label on condom packaging; a label with the proposed FDA language; and a label with CDC language on condom effectiveness. In short, there are no significant differences between the proposed FDA label and the current label on HIV-related beliefs and intentions. In contrast, from an HIV prevention perspective, the CDC condom language appears to offer a better alternative to the current condom label for unmarried populations.
doi:10.1007/s10461-007-9353-1
PMCID: PMC2849306  PMID: 18228124
condom labels; FDA warning labels; HIV prevention
14.  Reducing firearm violence: a research agenda 
Injury Prevention  2007;13(2):80-84.
In the United States, firearms are involved in tens of thousands of deaths and injuries each year. The magnitude of this problem prompted the National Academy of Sciences (NAS) to issue a report in 2004 detailing the strengths and limitations of existing research on the relationship between firearms and violence. In response, a multidisciplinary group of experts in the field of firearms and violence formed the National Research Collaborative on Firearm Violence. The Collaborative met for 2 days in June 2005 to (1) critically review the main findings of the NAS report and (2) define a research agenda that could fill research and data gaps and inform policy that reduces gun‐related crime, deaths and injuries. This article summarizes the Collaborative's conclusions and identifies priorities for research and funding.
doi:10.1136/ip.2006.013359
PMCID: PMC2610593  PMID: 17446246
15.  Experimental evaluation of antitobacco PSAs: Effects of message content and format on physiological and behavioral outcomes 
Nicotine & Tobacco Research  2009;11(3):293-302.
Introduction:
Antitobacco media campaigns using public service announcements (PSAs) have shown promise in reducing smoking initiation and increasing intentions to quit. Research on what makes an effective PSA has had mixed outcomes. The present study tested the effects of specific message features in antitobacco PSAs, using theory-based physiological and self-report outcomes.
Methods:
PSAs were categorized as high or low in message sensation value (MSV) and strength of argument and presented to 200 current smokers in a 2 × 2 factorial design. Physiological responses—specifically, heart rate, skin conductance, zygomaticus major, and corrugator supercilii—were assessed while participants viewed the PSAs. Beliefs, attitudes, efficacy, norms, and intentions to quit were assessed immediately following viewing.
Results:
Corrugator activity was significantly greater in the high MSV condition. Among those low in sensation seeking, low MSV PSAs elicited higher self-efficacy, whereas the reverse was true for high sensation seekers. High MSV PSAs elicited higher negative beliefs in low sensation seekers. Adding physiological measures to a model predicting intention to quit did not improve the explained variance.
Discussion:
The present study represents the first comprehensive theory-based experimental investigation of the effects of different features of antitobacco PSAs and provides a framework for future research in identifying effective features of such PSAs. Results illustrate the importance of considering individual differences, characterizing both PSA content and format, and outcome and response measures when evaluating antitobacco PSAs.
doi:10.1093/ntr/ntn026
PMCID: PMC2666374  PMID: 19246628
16.  Confirming Preferences or Collecting Data? Information Search Strategies and Romantic Partner Selection 
This article investigates two kinds of information search strategies in the context of selecting romantic partners. Confirmatory searching occurs when people ask for more information about a romantic partner in order to validate or confirm their assessment. Balanced searches are characterized by a search for risk information for partners rated as attractive and for attractiveness information about partners rated as risky in order to attain a more complete evaluation. A factorial survey computer program randomly constructed 5 types of partner descriptions and college-age respondents evaluated nine descriptions in terms of both health risk and romantic attractiveness outcomes. The results show little evidence of balanced search strategies: for all vignette types the respondents searched for attractiveness information. Regression analysis of the search outcomes showed no difference between males and females in the desire for attractiveness or risk information, the amount of additional information desired, or the proportion of descriptions for which more information was desired. However, an attractive physical appearance did increase the amount of additional information desired and the proportion of vignettes for which more information was desired. The results were generally inconsistent with a balanced search hypothesis; a better characterization of the respondents' strategy might be “confirmatory bias.”
doi:10.1080/13548500701246010
PMCID: PMC2819121  PMID: 18350465
confirmation bias; sexual partner selection; risk assessments
17.  Validating an Index of Adolescent Sexual Behavior Using Psychosocial Theory and Social Trait Correlates 
AIDS and behavior  2007;12(2):321.
Using a web-based survey of adolescents 14–16 years of age, a hierarchical index of heterosexual behavior was developed with excellent psychometric properties. The easiest sexual behavior to perform was “deep kissing” and the most difficult was “receiving anal sex” for females and “giving anal sex” for males. The index was validated with data that show increased sexual activity with being older and of minority status, with social traits such as physical development, having a romantic partner, and sensation seeking, and with psychosocial variables known to be associated with sexual behavior such as attitudes, norms, self-efficacy and intentions.
doi:10.1007/s10461-007-9272-1
PMCID: PMC2819112  PMID: 17636374
adolescent sexual behavior; Mokken scaling; media effects; sensation seeking
18.  Adjuncts or adversaries to shared decision-making? Applying the Integrative Model of behavior to the role and design of decision support interventions in healthcare interactions 
Background
A growing body of literature documents the efficacy of decision support interventions (DESI) in helping patients make informed clinical decisions. DESIs are frequently described as an adjunct to shared decision-making between a patient and healthcare provider, however little is known about the effects of DESIs on patients' interactional behaviors-whether or not they promote the involvement of patients in decisions.
Discussion
Shared decision-making requires not only a cognitive understanding of the medical problem and deliberation about the potential options to address it, but also a number of communicative behaviors that the patient and physician need to engage in to reach the goal of making a shared decision. Theoretical models of behavior can guide both the identification of constructs that will predict the performance or non-performance of specific behaviors relevant to shared decision-making, as well as inform the development of interventions to promote these specific behaviors. We describe how Fishbein's Integrative Model (IM) of behavior can be applied to the development and evaluation of DESIs. There are several ways in which the IM could be used in research on the behavioral effects of DESIs. An investigator could measure the effects of an intervention on the central constructs of the IM - attitudes, normative pressure, self-efficacy, and intentions related to communication behaviors relevant to shared decision-making. However, if one were interested in the determinants of these domains, formative qualitative research would be necessary to elicit the salient beliefs underlying each of the central constructs. Formative research can help identify potential targets for a theory-based intervention to maximize the likelihood that it will influence the behavior of interest or to develop a more fine-grained understanding of intervention effects.
Summary
Behavioral theory can guide the development and evaluation of DESIs to increase the likelihood that these will prepare patients to play a more active role in the decision-making process. Self-reported behavioral measures can reduce the measurement burden for investigators and create a standardized method for examining and reporting the determinants of communication behaviors necessary for shared decision-making.
doi:10.1186/1748-5908-4-73
PMCID: PMC2781788  PMID: 19909547
19.  A Reasoned Action Approach to Health Promotion 
This article describes the integrative model of behavioral prediction (IM), the latest formulation of a reasoned action approach. The IM attempts to identify a limited set of variables that can account for a considerable proportion of the variance in any given behavior. More specifically, consistent with the original theory of reasoned action, the IM assumes that intentions are the immediate antecedents of behavior, but in addition, the IM recognizes that environmental factors and skills and abilities can moderate the intention-behavior relationship. Similar to the theory of planned behavior, the IM also assumes that intentions are a function of attitudes, perceived normative pressure and self-efficacy, but it views perceived normative pressure as a function of descriptive as well as of injunctive (i.e., subjective) norms. After describing the theory and addressing some of the criticisms directed at a reasoned action approach, the paper illustrates how the theory can be applied to understanding and changing health related behaviors.
doi:10.1177/0272989X08326092
PMCID: PMC2603050  PMID: 19015289
medical decision making; attitude; behavioral prediction; reasoned action; integrative model
20.  Translating shared decision-making into health care clinical practices: Proof of concepts 
Background
There is considerable interest today in shared decision-making (SDM), defined as a decision-making process jointly shared by patients and their health care provider. However, the data show that SDM has not been broadly adopted yet. Consequently, the main goal of this proposal is to bring together the resources and the expertise needed to develop an interdisciplinary and international research team on the implementation of SDM in clinical practice using a theory-based dyadic perspective.
Methods
Participants include researchers from Canada, US, UK, and Netherlands, representing medicine, nursing, psychology, community health and epidemiology. In order to develop a collaborative research network that takes advantage of the expertise of the team members, the following research activities are planned: 1) establish networking and on-going communication through internet-based forum, conference calls, and a bi-weekly e-bulletin; 2) hold a two-day workshop with two key experts (one in theoretical underpinnings of behavioral change, and a second in dyadic data analysis), and invite all investigators to present their views on the challenges related to the implementation of SDM in clinical practices; 3) conduct a secondary analyses of existing dyadic datasets to ensure that discussion among team members is grounded in empirical data; 4) build capacity with involvement of graduate students in the workshop and online forum; and 5) elaborate a position paper and an international multi-site study protocol.
Discussion
This study protocol aims to inform researchers, educators, and clinicians interested in improving their understanding of effective strategies to implement shared decision-making in clinical practice using a theory-based dyadic perspective.
doi:10.1186/1748-5908-3-2
PMCID: PMC2265300  PMID: 18194521

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