This study employs a meta-theoretical perspective for examining risk perceptions and behavior in the rural, Appalachian cultural context, an area that remains largely unexplored. In-depth interviews were conducted with 113 rural adolescents to describe how youth conceptualize risk and how risk is communicated in the rural environment. Analyses revealed adolescents viewed behavior as risky when they had personal or vicarious experiences resulting in a loss of control or physical harm. Elements of the rural Appalachian culture including activities, familism, and community ties can both prevent and promote adolescent risk-taking in various forms. This study demonstrates the conceptualization of risk and messages about risk are culturally-situated and communicatively devised and enacted. The implications of these findings for adolescent risk prevention programs are discussed.
adolescent risk; risk behavior; risk messages; Appalachian health
The purpose of this study was (1) to examine the association of race/ethnicity on clinical trial awareness, controlling for several sociodemographic, attitudinal, and knowledge variables, and (2) to inform future communication campaigns to increase clinical trial awareness and participation. Secondary analysis was conducted among 6,754 Hispanic, Black, and White adult respondents to the National Cancer Institute’s 2007 Health Information National Trends Survey (HINTS). The dependent variable was awareness of clinical trials. Logistic regression was used to examine possible correlates of clinical trial awareness including sociodemographics, trust of sources of health information, beliefs about safety of health information, family/personal history of cancer, health seeking information, and awareness of three health agencies. Compared with Whites, Blacks and Hispanics were significantly less likely to have heard of a clinical trial. Other significant correlates of clinical trial awareness included education, income, belief that health information is safely guarded, family history of cancer, awareness of the Centers for Disease control, trust of health information from the Internet and charitable organizations, and distrust of health information from religious institutions. Blacks and Hispanics are significantly less aware of clinical trials. Campaigns that exploit unique beliefs and delivery channels for racial/ethnic subgroups should be considered.
There is currently a lack of valid instruments to measure adolescent diabetes numeracy. The Diabetes Numeracy Test (DNT) was adapted for type 1 diabetes and administered to two samples of adolescents. Sample 1 was administered the 39-item version of the DNT (DNT-39) with measures of self-management, responsibility, reading, and glycemic control (A1C). Sample 2 was administered the 14-item version of the DNT (DNT-14) with measures of self-management, responsibility, problem solving, and A1C. Both versions of the DNT showed adequate internal reliability. In sample 1, the DNT-39 and DNT-14 were related (r=.87, p=.001), and both DNT versions were related to parent education (DNT-14 r=.31, p=.02; DNT-39 r=.29, p=.03) and reading (DNT-14 r=.36, p=.005; DNT-39 r=.40, p=.001). In sample 2, the DNT-14 was related to A1C (r=−.29, p=.001), reading skills (r=.36, p=.005), diabetes problem solving (r=.27, p=.02), adolescent age (r=.19, p=.03), and parent education (r=.31, p=.02). In combined analyses, 75% of items were answered correctly on the DNT-14 (Range 7-100), and performance was associated with age (r=.19, p=.03), pump use (r=.33 p=.001), and A1C (r=−.29, p=.001). The DNT-14 is a feasible, reliable, and valid numeracy assessment that indicated adolescents with T1D have numeracy deficits that may impact their glycemic control.
Tuberculosis (TB) disproportionately affects immigrants and refugees to the United States. Upon arrival to the US, many of these individuals attend adult education centers, but little is known about how to deliver TB health information at these venues. Therefore, a participatory approach was used to design and evaluate a tuberculosis education video in this setting. Focus groups data were used to inform the content of the video that was produced and delivered by adult learners and their teachers. The video was evaluated by learners for acceptability through 3 items with a 3-point Likert scale. Knowledge (4 items) and self-efficacy (2 items) about TB were evaluated before and after viewing the video. A total of 159 learners (94%) rated the video as highly acceptable. Knowledge about TB improved after viewing the video (56% correct vs. 82% correct; p=<0.001), as did TB-related self-efficacy (77% vs. 90%; p=<0.001). Adult education centers that serve large immigrant and refugee populations may be excellent venues for health education, and a video may be an effective tool to educate these populations. Furthermore, a participatory approach in designing health education materials may enhance the efficacy of these tools.
To examine the influence of race/ethnicity on seeking health information from the internet among women aged 16–24 years.
A self-administered survey was conducted on 3181women regarding their internet use and obtaining information on reproductive health (menstruation, contraception, pregnancy, sexually transmitted infections) and general health from the internet. Multivariate logistic regression was performed to examine the association between race/ethnicity and online health-related information seeking after adjusting for covariates.
Racial/ethnic disparities were noted in overall internet use and its use to locate health information. Overall, more white (92.7%) and black (92.9%) women used the internet than Hispanics (67.5%). More white women (79.2%) used it to find health information than blacks and Hispanics (70.3% and 74.3%, respectively). Compared to white women, blacks and Hispanics were less likely to seek information on contraception [(odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58–0.91) and (OR 0.75, 95% CI 0.61–0.92)], and more likely to seek information on pregnancy tests [(OR 1.67, 95% CI 1.28 −2.18) and (OR 1.40, 95% CI 1.09–1.81] and sexually transmitted infections [(OR 1.39, 95% CI 1.11–1.73) and (OR 1.25, 95% CI 1.01–1.54)] respectively. With regard to general health issues, such as how to quit smoking, how to lose weight, alcohol/drug use, mood disorders, and skin disorders, blacks, but not Hispanics, were significantly less likely to seek online information than whites.
Disparities in the way women from different backgrounds use the internet for health-related information could be associated with overall health awareness.
Race/ethnicity; disparity; reproductive-aged; internet use; health information
Patient-centered care includes involving patients and their families in self-management of chronic diseases. Identifying and addressing barriers to self-management, including those related to health literacy and vision limitations, may enhance one’s ability to self-manage. A set of brief verbal screening questions (BVSQ) that does not rely on sufficient vision to assess health literacy was developed by Chew and colleagues in the outpatient setting. We sought to evaluate the utility of this tool for hospitalized patients and to determine the prevalence of poor vision among inpatients. In a prospective study, the BVSQ and the Rapid Estimate of Adult Learning in Medicine–Revised (REALM-R; among participants with sufficient vision, ≥20/50 Snellen) were administered to general medicine inpatients. Of 893 participants, 79% were African-American, and 57% were female; the mean age was 53 years. Among 668 participants who completed both tools, the proportion with low health literacy was 38% with the BVSQ versus 47% with the REALM-R (p = .0001). Almost one fourth of participants had insufficient vision; participants with insufficient vision were more likely to be identified as having low health literacy by the BVSQ, compared to those with sufficient vision (59% vs. 38%, p < .001).
Limited health literacy is associated with worse executive function, but
the association between limited health literacy and decline in executive
function has not been established because of a lack of longitudinal studies. The
authors aimed to examine this association by studying a prospective cohort in
the setting of a randomized controlled trial to promote walking in older adults.
Participants were community dwelling, older adults (age ≥65) who scored
≥2 on the Mini-Cog, without depression (PHQ-9 <15), who completed
both baseline and 12-month evaluations (n = 226).
Health literacy was measured using the Short Test of Functional Health Literacy
in Adults (S-TOFHLA). Executive function measured at baseline and 12 months
using the Trail Making Test (TMT), Controlled Oral Word Association Test (FAS),
and Category Fluency. The associations between health literacy and 12-month
decline in each test of executive function were modeled using multivariate
linear regression. Health literacy was found to be limited in 37% of
participants. Limited health literacy was associated with reduced performance on
all three executive function tests. In fully adjusted models, limited health
literacy was associated with greater 12 month decline in performance on the TMT
than higher health literacy, (p = .01). In conclusion,
older adults with limited health literacy are at risk for more rapid decline in
scores on the TMT, a measure of executive function.
In the United States, Hispanic women contribute disproportionately to cervical cancer incidence and mortality. This disparity, which primarily reflects lack of access to, and underutilization of, routine Pap smear screening may improve with increased availability of vaccines to prevent Human Papillomavirus (HPV) infection, the principal cause of cervical cancer. However, limited research has explored known determinants of HPV vaccine acceptability among Hispanic women. The current study examines two such determinants, HPV awareness and knowledge, using data from the 2007 Health Interview National Trends Survey (HINTS) and a cross-section of callers to the National Cancer Institute’s (NCI) Cancer Information Service (CIS). Study data indicate that HPV awareness was high in both samples (69.5% and 63.8% had heard of the virus) but that knowledge of the virus and its association with cervical cancer varied between the two groups of women. The CIS sample, which was more impoverished and less acculturated than their HINTS counterparts, were less able to correctly identify that HPV causes cervical cancer (67.1% vs. 78.7%) and that it is a prevalent sexually transmitted infection (STI; 66.8% vs. 70.4%). Such findings imply that future research may benefit from disaggregating data collected with Hispanics to reflect important heterogeneity in this population subgroup’s ancestries, levels of income, educational attainment, and acculturation. Failing to do so may preclude opportunity to understand, as well as to attenuate, cancer disparity.
Acetaminophen is highly accessible yet potentially dangerous when used incorrectly. In attempts to address concerns about acetaminophen, The U.S. Food and Drug Administration (FDA) has identified gaps in evidence about unintentional misuse among adolescents. Therefore, our objectives were to assess: adolescents’: 1) health literacy; 2) knowledge about acetaminophen; 3) recent use of over-the-counter (OTC) medicines; 4) and use of medication dosing instructions to understand the medicine and how to use it (‘acetaminophen skills’).
Subjects and Setting: We conducted a cross-sectional survey of adolescents and young adults (ages 16–23 years) recruited from education settings and health care sites in Monroe County, New York, from 11/08–9/09. Measures: Using structured in-person interviews, we assessed acetaminophen knowledge and recent use of over-the-counter (OTC) medicines. We assessed participants’ ability to identify acetaminophen in OTC products and answer questions about instructions for acetaminophen use through role-plays of everyday health scenarios. We measured health literacy with the Rapid Estimate of Adult Literacy in Medicine (REALM) for participants >18, and the REALM-Teen for those <18.
Confusion about acetaminophen and its use was common. Limited health literacy was an independent risk factor for poor knowledge, misunderstanding, and potential unsafe use of acetaminophen-containing medicines, however, most participants at all health literacy levels erred dangerously in ‘unsafe’ understanding of acetaminophen use from label instructions.
Individuals with limited health literacy may face disproportionate risk of unsafe use of acetaminophen due to confusion and misunderstanding of label information. Better labeling, public health programs, and educational efforts could facilitate safer use of acetaminophen.
Health literacy; patient safety; adolescent medicine use; adolescents; young adults; acetaminophen knowledge; acetaminophen safety; OTC or over the counter medicines; safe use of medicines; acetaminophen risk; FDA Safe Use Initiative
Concerns have been raised about the quality of life and healthcare received by cancer patients at the end-of-life (EOL). Many patients die with pain and other distressing symptoms inadequately controlled, receiving burdensome, aggressive care that worsens quality of life and limits patient exposure to palliative care, such as hospice. Patient-physician communication is likely a very important determinate of EOL care. EOL discussions with physicians are associated with an increased likelihood of: 1. acknowledgement of terminal illness, 2. preferences for comfort care over life-extension, and 3. receipt of less intensive, life-prolonging and more palliative EOL care; while this appears to hold for white patients, it is less clear for black, advanced cancer patients. These results highlight the importance of communication in determining EOL cancer care and suggest that communication disparities may contribute to black-white differences in the EOL care. We review the pertinent literature and discuss areas for future research.
Audience segmentation is a useful tool for designing effective campaigns. Further, the efficiency promised in diffusion science rests to some degree on the existence of adopter categories that can be identified and used to strategically disseminate prevention innovations. This study investigates the potential to identify adopter categories in potential recipients (n = 127) of an innovation to prevent food shortages in Mozambique. A five-class model was found using latent class analysis, but it showed important differences from existing descriptions of adopter categories. Implications for theory and practice are discussed.
Audience segmentation; Adopter categories; Mozambique; Prevention
Scientists are taking advantage of web-based technology to work in new collaborative environments, a phenomenon known as Science 2.0. The National Cancer Institute (NCI) created a web-based tool called HINTS-GEM that allows a diverse group of stakeholders to collaborate in a virtual environment by providing input on content for the Health Information National Trends Survey (HINTS). This involved stakeholders providing new suggested content and commenting and rating on existing content. HINTS is a nationally-representative survey of the US non-institutionalized adult population (see Finney Rutten et al. [this journal] for more information about the HINTS program). This paper describes the conceptual development of HINTS-GEM and provides results of its use by stakeholders in creating an improved survey instrument.
Smoking quitlines, with their demonstrated efficacy and convenience, have become integral to tobacco control efforts in the United States. However, use of quitlines in smoking cessation remains low relative to their potential. To increase quitline use in the United States, a better understanding of current awareness of quitlines is needed. We analyzed data from the 2007 Health Information National Trends Survey (n =7,674) to identify factors associated with awareness and use of quitlines. Data were weighted to provide representative estimates of the adult U.S. population. Of those surveyed, approximately 50% were aware of quitlines (65% of current smokers) and 3.5% had called a quitline (9% of current smokers). Current and former smokers were significantly more likely to be aware of quitlines than never smokers (p < .01). Age, ethnicity, and education were significantly related to quitline awareness. Looking for health information (OR =1.40, CI =1.14–1.73) and having more trust in the government as a source of health information (OR =1.25, CI =1.05–1.48) were associated with awareness. Current smoking status was strongly associated with quitline use (OR =9.25, CI =3.18–26.85). Respondents who looked for health or medical information from any source, had a personal or family history of cancer, and reported psychological distress were more likely to have called a quitline. While awareness of quitlines appears to be high, quitline utilization is low. Implications and future research directions are discussed.
This article examines the relationship between literacy and colorectal cancer (CRC) screening knowledge, beliefs, and experiences, with a focus on fecal occult blood tests (FOBTs). Participants were 975 patients in 8 Louisiana federally qualified health centers. Participants were 50 years of age or older and not up to date with CRC screening; approximately half (52%) had low literacy (less than a 9th-grade level). Participants with low literacy were less likely than were those with adequate literacy to be aware of advertisements promoting CRC screening (58.7% vs. 76.3%, p < .0001) or to believe it was very helpful to find CRC early (74.5% vs. 91.9%, p < .0001). The majority of participants had positive beliefs about the benefits of CRC screening using FOBTs. Participants with low literacy had more perceived barriers to FOBT completion and were more likely to strongly agree or agree that FOBTs would be confusing, embarrassing, or a lot of trouble; however, none of these remained significant in multivariate analyses controlling for relevant covariates. Confidence in being able to obtain an FOBT kit was high among those with low and adequate literacy (89.8% vs. 93.1%, respectively, p = .20); yet multivariate analyses revealed a significant difference in regard to literacy (p = .04) with low-literacy participants indicating less confidence. There was no significant difference by literacy in ever receiving a physician recommendation for CRC screening (38.4% low vs. 39.0% adequate, p = .79); however, multivariate analyses revealed significant differences in FOBT completion by literacy (p = .036). Overall, findings suggest that literacy is a factor in patients’ CRC knowledge, beliefs, and confidence in obtaining a FOBT.
According to the Office of Minority Health, an estimated 4.9 million people living in the United States consider themselves American Indian or Alaska Native (AIAN), either alone or in combination with one or more races/ethnicities. AIAN are a racial/ethnic group experiencing serious health disparities, with very little if any improvement in health outcomes over the last several decades. This study was designed to explore use of the Internet as a health information source among American Indians in the Central Plains region of the United States. Nine hundred and ninety eight Natives in the region were recruited from May 2008 to December 2009 at pow wows, health fairs, through focus groups, career fairs and conferences, and other social and cultural events, and asked to complete a self-administered survey. Although compared with data from the general population, AIAN from our sample may seem heavier Internet users, their use of modern wireless devices is limited, and their usage of Internet to access health information is lower compared to the adult US population. Natives living in the Central Plains region face generational differences in both general and health-related use of the Internet. Inadequate availability of culturally appropriate health information websites may drive AIAN towards search engines and general information websites.
AIAN; health information; online; health disparities; generational divide
Theory-based research is needed to understand how maps of environmental health risk
information influence risk beliefs and protective behavior. Using theoretical concepts from multiple
fields of study including visual cognition, semiotics, health behavior, and learning and memory
supports a comprehensive assessment of this influence. We report results from thirteen cognitive
interviews that provide theory-based insights into how visual features influenced what participants
saw and the meaning of what they saw as they viewed three formats of water test results for private
wells (choropleth map, dot map, and a table). The unit of perception, color, proximity to hazards,
geographic distribution, and visual salience had substantial influences on what participants saw and
their resulting risk beliefs. These influences are explained by theoretical factors that shape what
is seen, properties of features that shape cognition (pre-attentive, symbolic, visual salience),
information processing (top-down and bottom-up), and the strength of concrete compared to abstract
information. Personal relevance guided top-down attention to proximal and larger hazards that shaped
stronger risk beliefs. Meaning was more local for small perceptual units and global for large units.
Three aspects of color were important: pre-attentive “incremental risk” meaning of
sequential shading, symbolic safety meaning of stoplight colors, and visual salience that drew
attention. The lack of imagery, geographic information, and color diminished interest in table
information. Numeracy and prior beliefs influenced comprehension for some participants. Results
guided the creation of an integrated conceptual framework for application to future studies. Ethics
should guide the selection of map features that support appropriate communication goals.
risk communication; visual communication; visual cognition; environmental health; health behavior; hazard proximity
Patients with rare illnesses may use medication information sources that are appreciably different from those used by patients with more common illnesses. This article's purpose is to describe vasculitis patients' most frequently used medication information sources, determine which sources patients perceive as credible, and explore gender differences in source use and perceived credibility. Using an online questionnaire, patients (n=232) indicated how often they obtained medication information from 12 sources during the previous year and rated the credibility of 6 sources. The authors used multivariate analysis of covariance and follow-up contrasts to test for gender differences in source use and conducted t tests to compare patients' perceived credibility ratings. Patients used physicians and the Internet most often to obtain medication information and rated them as the most credible sources. Male patients used their spouse/partner more often and rated them as more credible than did female patients. Female patients were more likely to use medication package inserts and the Internet and were less likely to use nurses than were male patients. There appear to be similarities and differences between the information-seeking behaviors of vasculitis patients and other patient populations. Because male patients view their spouse/partner as a credible information source, providers may want to involve the spouse/partner in prescription decision making.
Dating abuse is a prevalent adolescent health problem with substantial public health consequences. As many as 1 in 10 high school students in the US reports being “hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend” in the past year. We used the Rihanna-Chris Brown dating abuse incident of 2009 as a case study to conduct what is, to our knowledge, the first assessment of media framing of dating abuse. We reviewed the 20 leading U.S. single copy sales magazines published February–April, 2009 and identified 48 relevant articles which were all printed in seven “tabloid” magazines. We conducted a content analysis of the media frames of the articles using five frame categories: (1) Abuse is objectionable; (2) Victim-blaming; (3) Abuse is sexualized/romanticized; (4) Myths about abuse perpetration; and (5) Abuse is normalized. “Abuse is objectionable” was the dominant frame of 40% of articles, “victim-blaming” in 36%. Although the vast majority of articles reviewed (83%) made at least passing reference to the idea that abuse is wrong, a minority (40%) used a dominant frame that condemned abuse. Instead, the majority of articles communicated “mixed messages” about dating abuse, and many minimized the seriousness of partner abuse perpetration. Advocacy is needed to improve future tabloid media framing of dating abuse incidents.
The HEALTHY Study was a 3-year school-based intervention designed to change the behaviors of middle school students to reduce their risk for developing type 2 diabetes mellitus. This report examines the relation between exposure to communications campaign materials and behavior change among students in the HEALTHY intervention schools. Using data from campaign tracking logs and student interviews, the authors examined communications campaign implementation and exposure to the communications campaign as well as health behavior change. Campaign tracking documents revealed variability across schools in the quantity of communications materials disseminated. Student interviews confirmed that there was variability in the proportion of students who reported receiving information from the communication campaign elements. Correlations and regression analysis controlling for semester examined the association between campaign exposure and behavior change across schools. There was a significant association between the proportion of students exposed to the campaign and the proportion of students who made changes in health behavior commensurate with study goals. The results suggest that, in the context of a multifaceted school-based health promotion intervention, schools that achieve a higher rate of exposure to communication campaign materials among the students may stimulate greater health behavior change.
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.
Cancer; information seeking; scanning
Text messaging programs on mobile phones have shown some promise in helping people quit smoking. Text2Quit is an automated, personalized and interactive mobile health program that sends text messages and emails timed around a participant’s quit date over the course of 3 months. The text messages include pre- and post-quit educational messages, peer ex-smoker messages, medication reminders and relapse messages, as well as multiple opportunities for interaction. Study participants were university students (n=23) enrolled in the Text2Quit program. Participants were surveyed at baseline and at 2 and 4 weeks post-enrollment. The vast majority of participants agreed that they liked the program at 2 and 4 weeks post-enrollment (90.5% and 82.3%, respectively). Support for text messages was found to be moderate, and higher than that of the email and web components. Seventy-five percent of participants reported reading most or all of the texts. On average, users made 11.8 responses to the texts over a 4 week period, although responses declined following the quit date. The interactive feature for tracking cigarettes was the most used interactive feature, followed by the craving trivia game. This pilot test provides some support for the Text2Quit program. A future iteration of the program will include additional tracking features in both the pre-quit and post-quit protocol and an easier entry into the not-quit protocol. Future studies are recommended that identify the value of the interactive and personalized features that characterize this program.
Companies need to maintain a good reputation to do business; however, companies in the infant formula, tobacco, and processed food industries have been identified as promoting disease. Such companies use their websites as a means of promulgating a positive public image, thereby potentially reducing the effectiveness of public health campaigns against the problems they perpetuate. The author examined documents from the websites of Philip Morris, Kraft, and Nestlé for issue framing and analyzed them using Benoit’s typology of corporate image repair strategies. All three companies defined the problems they were addressing strategically, minimizing their own responsibility and the consequences of their actions. They proposed solutions that were actions to be taken by others. They also associated themselves with public health organizations. Health advocates should recognize industry attempts to use relationships with health organizations as strategic image repair and reject industry efforts to position themselves as stakeholders in public health problems. Denormalizing industries that are disease vectors, not just their products, may be critical in realizing positive change.
Little research has examined the antecedent characteristics of patients most likely to seek online cancer information. This study employs the Cognitive-Social Health Information Processing (C-SHIP) model as a framework to understand what psychosocial characteristics precede online cancer-related information seeking among rural breast cancer patients who often have fewer healthcare providers and limited local support services. Examining 144 patients who were provided free computer hardware, Internet access and training for how to use an Interactive Cancer Communication System, pre-test survey scores indicating patients’ psychosocial status were correlated with specific online cancer information seeking behaviors. Each of the factors specified by the C-SHIP model had significant relationships with online cancer information seeking behaviors with the strongest findings emerging for cancer-relevant encodings and self-construals, cancer-relevant beliefs and expectancies and cancer-relevant self-regulatory competencies and skills. Specifically, patients with more negative appraisals in these domains were more likely to seek out online cancer information. Additionally, antecedent variables associated with the C-SHIP model had more frequent relationships with experiential information as compared to didactic information. This study supports the applicability of the model to discern why people afflicted with cancer may seek online information to cope with their disease.