Targeting and tailoring message-framing: the moderating effect of racial identity on receptivity to colorectal cancer screening among African-Americans.

This study demonstrates the potential of racial identity to moderate how gain and loss-framed messaging, as well as culturally-targeted messaging, can affect receptivity to preventive health screening. African-Americans (N = 132) who were noncompliant with recommended colorectal cancer (CRC) screening completed a measure of racial identity centrality-encompassing the extent to which racial identity is a core component of self-concept-and then participated in an online education module about CRC screening, during which either gain or loss-framed messaging was introduced. Half of African-Americans were also exposed to a culturally-targeted self-help message about preventing CRC. Theory of Planned Behavior measures of attitudes, normative beliefs, perceived behavioral control, and intentions to obtain a CRC screen served as outcomes. Results confirmed that effects of messaging on receptivity to CRC screening depended on racial identity. Among low racial identity African Americans, gain-framed messaging most effectively increased normative beliefs about obtaining CRC screening, whereas among high racial identity African Americans loss-framed messaging was most compelling. However, these effects most strongly emerged when culturally-targeted self-help messaging was included. We discuss implications for health disparities theory and research, including a potential to simultaneously deploy culturally-targeted and tailored messaging based on racial identity.

Cognitive appraisal vs. exposure-based stress measures: links to perceived mental and physical health in low-income black women.

Although stress is linked to mental and physical health, self-reports of stress may be operationalized using measures that emphasize cognitive appraisals of stressors or that simply record stressor exposure. Theory and research suggest that appraisal-based measures may be superior in measuring self-reports of stress. However, use of exposure-based measures persists, especially in ethnic disparities research. This study examined the utility of appraisal-based versus exposure-based stress measures in linking stress to mental and physical health in low-income black women. Measures emphasizing cognitive appraisals were superior in predicting mental and physical health because global stress rating best predicted physical health whereas mental health was best predicted by perceived stress. A checklist of exposure to stressful events was not substantially predictive of either mental or physical health, suggesting that cognitive appraisals of stressors are important in linking stress to health perceptions in blacks. The results also suggest that stress impacts mental health first, which then, in turn, influences physical health. Overall, these results illuminate the importance of cognitive appraisals in linking stress to perceptions of mental and physical health in black women.

Low-income women's conceptualizations of emotional- and stress-eating.

Emotional- and stress-eating have been proposed as risk factors for obesity. However, the way that individuals conceptualize these behaviors is not well understood and no studies have employed a qualitative approach. We sought to understand how women conceptualize emotional- and stress-eating. Sixty-one low-income women from South-central Michigan with young children (ages 2-5 years) participated in either a focus group or individual semi-structured interview during which they were asked about their conceptualizations of eating behaviors among adults and children. Responses were transcribed and the constant comparative method was used to identify themes. Identified themes included that emotional- and stress-eating are viewed as uncommon, severe, pitiable behaviors that reflect a lack of self-control and are highly stigmatized; that when these behaviors occurred among children, the behaviors resulted from neglect or even abuse; and that bored-eating is viewed as distinct from emotional- or stress-eating and is a common and humorous behavior with which participants readily self-identified. Future research and interventions should seek to develop more detailed conceptualizations of these behaviors to improve measurement, destigmatize emotional- and stress-eating and potentially capitalize on the strong identification with bored-eating by targeting this behavior for interventions.

The effects of acute alcohol consumption, cognitive reserve, partner risk, and gender on sexual decision making.

OBJECTIVE: In past alcohol administration studies, intoxicated college students have been more willing to have unprotected sex with a hypothetical new partner than sober or placebo students. The objective of the present research was to extend past work by examining the effects of gender, cognitive reserve, and partner risk on intoxicated sexual decision making. METHOD: Before assigning participants (60 women and 60 men) to a drink condition, cognitive reserve was assessed with the reading subtest of the Wide Range Achievement Test 3 (WRAT3). After drinking, participants watched a video of a male and female college student in a sexual situation. There were two versions of the video that were identical, except for information that suggested the opposite-gender character had many past sexual partners or only a few. RESULTS: There was a significant interaction between drink condition and cognitive reserve such that intoxicated participants with lower WRAT3 scores were more likely than other participants to indicate that they would have unprotected sex if they were in this situation. Partner risk did not influence participants' willingness to have unprotected sex; however, they were less interested in dating the high-risk partner. CONCLUSIONS: As expected, participants with less cognitive reserve made riskier decisions when intoxicated. Unexpectedly, although participants clearly perceived the high- and low-risk partners differently, this did not affect their willingness to have unprotected sex with this hypothetical partner. These findings demonstrate the need for sexually transmitted disease/ HIV prevention programs that go beyond factual presentations and provide students with the skills they need to assess risk realistically and the need for programs with messages tailored for individuals with low cognitive skills.

Gain versus loss-framed messaging and colorectal cancer screening among African Americans: A preliminary examination of perceived racism and culturally targeted dual messaging.

OBJECTIVE: This preliminary study examined the effect of gain versus loss-framed messaging as well as culturally targeted personal prevention messaging on African Americans' receptivity to colorectal cancer (CRC) screening. This research also examined mechanistic functions of perceived racism in response to message framing. DESIGN AND METHODS: Community samples of African Americans (N = 132) and White Americans (N = 50) who were non-compliant with recommended CRC screening completed an online education module about CRC, and were either exposed to a gain-framed or loss-framed message about CRC screening. Half of African Americans were exposed to an additional and culturally targeted self-control message about personal prevention of CRC. Theory of planned behavior measures of attitudes, normative beliefs, perceived behavioural control, and intentions to obtain a CRC screen served as primary outcomes. The effect of messaging on perceived racism was also measured as an outcome. RESULTS: Consistent with prior research, White Americans were more receptive to CRC screening when exposed to a loss-framed message. However, African Americans were more receptive when exposed to a gain-framed message. The contrary effect of loss-framed messaging on receptivity to screening among African Americans was mediated by an increase in perceived racism. However, including an additional and culturally targeted prevention message mitigated the adverse effect of a loss-framed message. CONCLUSION: This study identifies an important potential cultural difference in the effect of message framing on illness screening among African Americans, while also suggesting a culturally relevant linking mechanism. This study also suggests the potential for simultaneously presented and culturally targeted messaging to alter the effects of gain and loss-framed messaging on African Americans. STATEMENT OF CONTRIBUTION: What is already known on this subject? African Americans are at an increased risk of both developing and dying from colorectal cancer (CRC). These disparities can be attributed in large part to deficits in the use of CRC screening among African Americans. Guided by prospect theory, available literature suggests that selectively pairing gain and loss-framed messaging with illness prevention and detection can better promote adaptive health behaviour. Specifically, loss-framed messages that emphasize the potential costs of failing to act may promote better use of illness detection behaviours, such as CRC screening. Emerging literature highlights the potential for cultural differences in the effects of gain and loss messaging on health behaviour, especially among collectivist or interdependent cultures. What does this study add? This study is the first to identify a potential and important cultural difference in the effect of message framing on cancer screening among African Americans, whereby gain-framed messaging better compelled receptivity to CRC screening. This study is also the first to show that the use of loss-framed messaging may reduce receptivity to CRC screening among African Americans by increasing perceived racism. This study demonstrates that simultaneously including a culturally targeted personal prevention message may attenuate the negative effects of loss-framed messaging on CRC screening among African Americans.

The bad taste of social ostracism: the effects of exclusion on the eating behaviors of African-American women.

African-American women experience disproportionately higher rates of obesity than do Caucasian women. The stress African-American women encounter from experiences of discrimination may influence their eating behaviours, which could contribute to weight gain. Emotional eating theory suggests some people increase their intake of high-calorie foods to cope with stressful experiences. We investigated the effects of social exclusion by other African-American women or by Caucasian women for African-American women's distress and food consumption using a laboratory paradigm. As hypothesised, there were main effects of ostracism and interactions between ostracism and race, although not all of the interactions took the expected form. As hypothesised, African-American women ate more potato crisps after being excluded by Caucasians than by African-Americans. Unexpectedly, African-American women who were excluded by other African-American women self-reported more emotional distress than did African-American women excluded by Caucasian women. These findings suggest that ostracism by both in-group and out-group members are disturbing, although people may respond to in-group and out-group exclusion in different ways. Directions for future research are suggested that could elucidate the circumstances under which different emotional and behavioural coping responses are employed.

Low-income women's conceptualizations of food craving and food addiction.

Food craving and food addiction have been proposed as targets for obesity focused interventions. However, individuals' conceptualizations of these constructs are not well understood and no studies have employed a qualitative approach. Therefore, we sought to understand how women conceptualize food craving and food addiction. Low-income women with preschool-aged children (2-5years old) participated in either a semi-structured individual interview or focus group in which they were asked about their conceptualization of eating behaviors among adults and children. All responses were audio-recorded and transcribed. Themes were identified using the constant comparative method of qualitative analysis. Identified themes revealed that the women perceived food craving to be common, less severe and to a degree more humorous than food addiction. It was not felt that food cravings were something to be guarded against or resisted. Food addiction was described in a very "matter of fact" manner and was believed to be identifiable through its behavioral features including a compulsive need to have certain foods all the time. A more detailed understanding of how the general population perceives food craving and food addiction may enable more refined measurement of these constructs with questionnaire measures in the future. In addition, interventions may be designed to use the language most consistent with participants' conceptualizations of these constructs.

Understanding alcohol expectancy effects: revisiting the placebo condition.

This article summarizes a symposium organized and cochaired by Maria Testa and presented at the 2005 Annual Meeting of the Research Society on Alcoholism, in Santa Barbara, California. The symposium explored issues relevant to understanding the function of placebo conditions and to interpreting placebo effects. Cochair Mark Fillmore began with an overview of the use of placebo conditions in alcohol research, focusing on methodological issues. Jeanette Norris and her colleagues conducted a review of studies examining placebo conditions among women. They conclude that expectancy effects are limited to a few domains. Maria Testa and Antonia Abbey presented papers suggesting that placebo manipulations may result in unanticipated compensatory effects in actual or hypothetical social situations. That is, placebo participants may compensate for anticipated cognitive impairment through vigilant attention to situational cues. John Curtin's research suggests that the compensatory strategies of placebo participants appear to involve a sensitization of evaluative control, resulting in improved performance. Kenneth Leonard provided concluding remarks on the meaning of placebo effects and the value of placebo conditions in research.