Type 2 diabetes familial risk personalization process profiles: Implications for patient-provider communication.

People who have a single first-degree relative with type 2 diabetes (T2D) are at increased risk for developing T2D over their lifetime. A positive family history of T2D is also associated with developing risk awareness and engaging in risk-reducing behaviors among the unaffected relatives. Yet, little is known about how people with a positive family history for disease personalize and process their familial risk to form perceptions about their own risk. In this mixed method study, we explored risk personalization among a diverse group of people between the ages of 18 and 60, with a positive family history of T2D, who were themselves unaffected (n = 109). We collected interview and survey data with respect to the familial risk perception personalization model. Using cluster analysis, qualitative and quantitative data were combined to inductively derive three distinct clusters representing three different familial risk perception personalization processes. These results can serve as a basis for tailored interventions aimed at reducing risk for T2D among people with increased risk due to familial history.

From initiation to cessation: Turning points and coping resources in the breastfeeding experience of first-time mothers.

While most mothers initiate breastfeeding, many do not continue for recommended durations. This study aimed to understand the gap between breastfeeding initiation and duration through an in-depth exploration of first-time mothers' breastfeeding experiences. Contextual factors that may facilitate or deter breastfeeding maintenance were explored by identifying common turning points (significant events or periods promoting a change in thoughts/behaviors or facilitating maintenance) described by mothers with varied breastfeeding durations. In semistructured interviews conducted from March to June 2015, twenty-eight first-time mothers in Iowa were asked to describe their breastfeeding experiences from initiation through cessation. Using thematic analysis, seven turning points, consistent across varied durations and experiences were identified: breastfeeding problems, the unknowns, recurring stressors, living new life with baby, reentering social roles, special occasions, and letting go. Turning points were usually associated with stressful situations, and mothers described intrapersonal (e.g., determination) and interpersonal (e.g., social support) coping resources as facilitators of breastfeeding maintenance. These findings highlight contextual factors that may trigger turning points, representing critical intervention periods, and the importance of enhancing support networks. Interventions to facilitate longer breastfeeding durations should consider key turning points and availability of coping resources to determine strategies that best fit the mother at each point.

First-time mothers' breast-feeding maintenance: role of experiences and changes in maternal perceptions.

OBJECTIVE: Breast-feeding initiation rates have increased in the USA; however, maintenance of breast-feeding for recommended durations is low. The objective of the present study was to identify factors that may facilitate breast-feeding for longer durations among first-time mothers, including physiological and social experiences and changes in maternal perceptions. DESIGN: Survival analysis and linear regression methods were used to explore the relationship between experiences and breast-feeding duration, and the possible mediating effect of changes in maternal perceptions. SETTING: Secondary data from the Infant Feeding Practices Study II, conducted in the USA between 2005 and 2007. SUBJECTS: Data from 762 first-time mothers who ever breast-fed were analysed. RESULTS: Experiencing trouble with baby's latch, problems with milk flow/supply and painful breast-feeding were significantly associated with breast-feeding duration (64, 26 and 36 % shorter duration, respectively). Meanwhile, positive changes in perception with respect to breast-feeding self-efficacy, opinion about infant feeding and belief about breast milk were associated with 16-27 % longer duration. Furthermore, changes in perception were observed to partially mediate the impact of physiological experiences on breast-feeding duration. CONCLUSIONS: Perceptions of breast-feeding self-efficacy, beliefs and opinions can change over time and are influenced by breast-feeding experiences. The combined effect of experience and perception plays a key role in influencing breast-feeding duration. Future research should explore interventions to maintain or improve these perceptions while accounting for physiological experiences to support breast-feeding for recommended durations among first-time mothers.

Influence of Experiences and Perceptions Related to Breastfeeding One's First Child on Breastfeeding Initiation of Second Child.

Introduction Multiparas tend to initiate breastfeeding less than primiparas. While mothers often repeat the feeding method used for their first child with their second child, the way in which experiences and maternal perceptions related to breastfeeding one's first child may influence breastfeeding initiation with a second child remain underexplored. The objective of this study was to investigate whether physiological or social experiences, and related psychological factors, reported at the end of breastfeeding one's first child influence breastfeeding initiation with a second child. Methods Data from 174 multiparas who participated in the Infant Feeding Practices Study II, breastfed their first child, and completed the Year 6 Follow Up were analyzed using exact logistic regression. Results Mothers who reported experiencing trouble with the first baby's suck or latch had lower odds of initiating breastfeeding (OR 0.15, 95% CI 0.04-0.56) than those who did not report this experience, whereas mothers who agreed that breastfed children are less likely to become obese had greater odds of initiating breastfeeding with a second child (OR 11.49, 95% CI 1.56-513.18) than those who did not agree. Discussion Efforts to facilitate breastfeeding initiation among multiparas may consider mothers' previous experiences and beliefs associated with breastfeeding. Strategies to facilitate initiation may focus on addressing barriers mothers experienced while breastfeeding their first child and increasing awareness about how breastfeeding may prevent childhood obesity. Future research should explore how such approaches may impact breastfeeding outcomes with subsequent children.

What Motivates Young Adults to Talk About Physical Activity on Social Network Sites?

BACKGROUND: Electronic word-of-mouth on social network sites has been used successfully in marketing. In social marketing, electronic word-of-mouth about products as health behaviors has the potential to be more effective and reach more young adults than health education through traditional mass media. However, little is known about what motivates people to actively initiate electronic word-of-mouth about health behaviors on their personal pages or profiles on social network sites, thus potentially reaching all their contacts on those sites. OBJECTIVE: This study filled the gap by applying a marketing theoretical model to explore the factors associated with electronic word-of-mouth on social network sites about leisure-time physical activity. METHODS: A Web survey link was sent to undergraduate students at one of the Midwestern universities and 439 of them completed the survey. RESULTS: The average age of the 439 participants was 19 years (SD=1 year, range: 18-24). Results suggested that emotional engagement with leisure-time physical activity (ie, affective involvement in leisure-time physical activity) predicted providing relevant opinions or information on social network sites. Social network site users who perceived stronger ties with all their contacts were more likely to provide and seek leisure-time physical activity opinions and information. People who provided leisure-time physical activity opinions and information were more likely to seek opinions and information, and people who forwarded information about leisure-time physical activity were more likely to chat about it. CONCLUSIONS: This study shed light on the application of the electronic word-of-mouth theoretical framework in promoting health behaviors. The findings can also guide the development of future social marketing interventions using social network sites to promote leisure-time physical activity.

Body Image and Quality of Life and Brace Wear Adherence in Females With Adolescent Idiopathic Scoliosis.

BACKGROUND: Clinical evidence regarding the ability of braces to decrease the risk of curve progression to surgical threshold in patients with adolescent idiopathic scoliosis (AIS) continues to strengthen. Unfortunately, there is still a great deal of uncertainty regarding the impact of brace wear on psychosocial well-being or the impact of psychological well-being on brace wear adherence. The purpose of this study is to evaluate psychosocial well-being, in particular body image and quality of life (QOL), and brace wear adherence in female AIS patients undergoing brace treatment. METHODS: The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) was a multicenter, controlled trial using randomized and preference assignments into an observation or brace treatment group. BrAIST patients were skeletally immature adolescents diagnosed with AIS having moderate curve sizes (20 to 40 degrees). Patients in the bracing group were instructed to wear a thoracolumbosacral orthosis, at least 18 h/d. Scores on the Spinal Appearance Questionnaire and the PedsQL4.0 Generic Scales from 167 female BrAIST patients who were randomized to brace treatment (n=58) and patients who chose brace treatment (n=109) were analyzed. RESULTS: At baseline and at 12 months, no differences were found between the least-adherent brace wear group (<6 h/d) and most-adherent brace wear group (≥12 h/d) patients in terms of major curve, body image, and QOL. In the most-adherent group, poorer body image scores were significantly correlated with poorer QOL scores at baseline, at 6 months, and at 12 months but not at 18 months. In general, body image scores and QOL scores were not significantly correlated in the least-adherent group. When comparing patients that had a ≥6 degree increase of their major curve between baseline and 12 months to patients that did not, there were no significant differences in body image or QOL scores. CONCLUSIONS: For females adolescents with AIS, body image and QOL do not have a significant impact on brace wear adherence and are subsequently not significantly impacted by brace wear. LEVEL OF EVIDENCE: Level II-therapeutic (prospective comparative study).

Effects of Social Support About Physical Activity on Social Networking Sites: Applying the Theory of Planned Behavior.

Despite the physical and mental health benefits of leisure-time physical activity (LTPA), only about half of college students participate in the recommended amount of LTPA. While college students are avid users of social network sites (SNSs), whether SNSs would be an effective channel for promoting LTPA through peer social support is unclear. The aim of this study was to explore the effects of social support from students' contacts on SNSs on their intention to participate in LTPA, applying the Theory of Planned Behavior. Participants were recruited through a mass e-mail sent to undergraduate students at a large Midwestern university in fall 2011. In total, 439 surveys were analyzed. Descriptive analyses and analysis for mediating effects were conducted. Social support about LTPA from contacts on SNSs has indirect effect on intention through affective attitude, instrumental attitude, and perceived behavioral control (PBC). The results indicate that social support about LTPA from contacts on SNSs might not be effective to change students' intention unless attitudes and PBC are changed. Future interventions aiming to promote students' intention to participate in LTPA by increasing support from contacts on SNSs should increase affective attitude, instrumental attitude, and PBC at the same time.

Online information exchanges for parents of children with a rare health condition: key findings from an online support community.

BACKGROUND: The Internet provides new opportunities for parents of children with difficult illnesses and disabilities to find information and support. The Internet is particularly important for caregivers of children with special needs due to numerous health-related decisions they face. For at-risk populations, online support communities can become key settings and channels for health promotion and communication. OBJECTIVE: This study is an initial exploration of the information-seeking and information-provision processes present in an online support community, which is an area of opportunity and interest for Internet-based medical research and practice. The aim of this study was to explore and describe information-related processes of uncertainty management in relationship to clubfoot. Specifically, the study explored interpersonal communication (information seeking and provision) in an online support community serving the needs of parents of children with clubfoot. METHODS: The study population consisted of messages posted to an online community by caregivers (parents) of children with clubfoot. The theoretical framework informing the study was the Uncertainty Management Theory (UMT). The study used content analysis to explore and categorize the content of 775 messages. RESULTS: Women authored 664 of 775 messages (86%) and men authored 47 messages (6%). Caregivers managed uncertainty through information seeking and provision behaviors that were dynamic and multilayered. The ratio of information-seeking messages to information-provision responses was 1 to 4. All five types of information-seeking behaviors proposed by Brashers' schema were identified, most of them being correlated. Information seeking using direct questions was found to be positively correlated to self-disclosure (r=.538), offering of a candidate answer (r=.318), and passive information seeking (r=.253). Self-disclosure was found to be positively correlated to provision of a candidate answer (r=.324), second-guessing (r=.149), and passive information seeking (r=.366). Provision of a candidate answer was found to be positively correlated with second-guessing (r=.193) and passive information seeking (r=.223). Second-guessing was found to be positively correlated to passive information seeking (r=.311). All correlations reported above were statistically significant (P<0.01). Of the 775 messages analyzed, 255 (33%) identified a medical professional or institution by name. Detailed medical information was provided in 101 (13%) messages, with the main source of information identified being personal experience rather than medical sources. CONCLUSION: Online communities can be an effective channel for caregivers, especially women, to seek and offer information required for managing clubfoot-related uncertainty. To enhance communication with parents, health care institutions may need to invest additional resources in user-friendly online information sources and online interactions with caregivers of children with special illnesses such as clubfoot. Furthermore, explorations of information-seeking and information-provision behaviors in online communities can provide valuable data for interdisciplinary health research and practice.

Electronic word of mouth on twitter about physical activity in the United States: exploratory infodemiology study.

BACKGROUND: Twitter is a widely used social medium. However, its application in promoting health behaviors is understudied. OBJECTIVE: In order to provide insights into designing health marketing interventions to promote physical activity on Twitter, this exploratory infodemiology study applied both social cognitive theory and the path model of online word of mouth to examine the distribution of different electronic word of mouth (eWOM) characteristics among personal tweets about physical activity in the United States. METHODS: This study used 113 keywords to retrieve 1 million public tweets about physical activity in the United States posted between January 1 and March 31, 2011. A total of 30,000 tweets were randomly selected and sorted based on numbers generated by a random number generator. Two coders scanned the first 16,100 tweets and yielded 4672 (29.02%) tweets that they both agreed to be about physical activity and were from personal accounts. Finally, 1500 tweets were randomly selected from the 4672 tweets (32.11%) for further coding. After intercoder reliability scores reached satisfactory levels in the pilot coding (100 tweets separate from the final 1500 tweets), 2 coders coded 750 tweets each. Descriptive analyses, Mann-Whitney U tests, and Fisher exact tests were performed. RESULTS: Tweets about physical activity were dominated by neutral sentiments (1270/1500, 84.67%). Providing opinions or information regarding physical activity (1464/1500, 97.60%) and chatting about physical activity (1354/1500, 90.27%) were found to be popular on Twitter. Approximately 60% (905/1500, 60.33%) of the tweets demonstrated users' past or current participation in physical activity or intentions to participate in physical activity. However, social support about physical activity was provided in less than 10% of the tweets (135/1500, 9.00%). Users with fewer people following their tweets (followers) (P=.02) and with fewer accounts that they followed (followings) (P=.04) were more likely to talk positively about physical activity on Twitter. People with more followers were more likely to post neutral tweets about physical activity (P=.04). People with more followings were more likely to forward tweets (P=.04). People with larger differences between number of followers and followings were more likely to mention companionship support for physical activity on Twitter (P=.04). CONCLUSIONS: Future health marketing interventions promoting physical activity should segment Twitter users based on their number of followers, followings, and gaps between the number of followers and followings. The innovative application of both marketing and public health theory to examine tweets about physical activity could be extended to other infodemiology or infoveillance studies on other health behaviors (eg, vaccinations).

Mother-daughter communication about sex: the influence of authoritative parenting style.

Parent-child communication about sex has been shown to delay sexual activity and increase contraceptive and condom use. The influence of authoritative parenting style and mothers' perception of daughters' risk on communication about sex was examined in this study. Mothers in a random sample (n=283) with daughters aged 9-15 years were mailed surveys asking about communication with their daughters regarding 11 sex-related topics. Multivariate linear regression was used to assess the influence of authoritative parenting style and mothers' perceptions of risk on the number of topics communicated about and age of the daughter at time of communication for a variety of sexual health communication topics. Authoritative parenting style was related to the number of topics communicated about and was a predictor of age of daughter at the time of communication about sexual intercourse, menstruation, dating/relationships, sexually transmitted diseases (STDs), HIV/AIDS, alcohol, contraceptives, and abstinence, while perceptions of risk were not significant influencers of age at the time of communication for any topics. This research points to the importance of parenting style in determining the timing of parent-child communication about sexual and other risk behaviors.

Ambivalence, communication and past use: understanding what influences women's intentions to use contraceptives.

Unintended pregnancy among women in the 18-30 age group is a public health concern. The Extended Parallel Process Model (EPPM) provides a framework for exploring how women's perceptions of threat, efficacy, and fear influence intentions to use contraceptives. Past use and communication with best friends and partners were also considered. A telephone survey of 18-30-year-old women (N = 599) was completed. After univariate and bivariate analyses were conducted, the variables were entered into a hierarchal, multi-variate linear regression with three steps consistent with the EPPM to predict behavioral intention. The first step included the demographic variables of relationship status and income. The constructs for the EPPM were entered into step 2. Step 3 contained the fear measure. The model for the third step was significant, F(10,471) = 36.40, p < 0.001 and the variance explained by this complete model was 0.42. Results suggest that perceived severity of the consequences of an unintended pregnancy (p < 0.01), communication with friends (p < 0.01) and last sexual partner (p < 0.05), relationship status (p < 0.01), and past use (p < 0.001) were associated with women's intentions to use contraceptives. A woman's perception of the severity was related to her intention to use contraceptives. Half of the women (50.3%) reported ambivalence about the severity of an unintended pregnancy. In our study, talking with their last sexual partner had a positive effect on intentions to use contraceptives, while talking with friends influenced intentions in a negative direction. These results reconfirm the need for public health practitioners and health care providers to consider level of ambivalence toward unintended pregnancy, communication with partner, and relationship status when trying to improve women's contraceptive behaviors. Implications for effective communication interventions are discussed.

Protecting Young Agricultural Workers: The Development of an Online Supervisor Training.

Adolescents and young adults working in agriculture are at greater risk of injury. We describe the development of an online safety and health training for people who hire, teach, or supervise young agricultural workers. The online training targeted specific skills supervisors can use to effectively supervise, train, and communicate with young workers about health and safety hazards that impact injury risk. Consistent with NIOSH's evidence-based Total Worker Health® approach, the training integrated safety and health promotion and was also informed by behavioral change theories. An iterative approach was used to develop and evaluate the training. A content review provided feedback on topics and organization of material. Safety and health experts assessed the revised training content and rated the training topics on clarity, accuracy, and completeness. Finally, a pilot study with employers and health and safety professionals was used to evaluate the training materials. The content review suggested ways to reorganize the material to improve flow and reduce redundancy. Ratings of clarity, accuracy, and completeness were high, ranging from 5 to 7 (mean ratings from 5.8 to 7.0) on a scale of 1 ("does not do this at all") to 7 ("does this very well"). The pilot study led to changes in wording and items used to assess knowledge. A theoretically-informed approach was used to develop an online supervisor training to increase awareness and build skills. An iterative process that included expert review, evaluation of learning competencies, and a pilot study with the end-users is described.

A Test of Social Cognitive Theory to Increase Hearing Protection Use in Swine Buildings.

Farming ranks among the top occupations for which workers are at risk for noise-induced hearing loss (NIHL), an irreversible yet preventable condition. Hearing Protection Devices (HPDs) (i.e., earmuffs and ear plugs) are effective at preventing expo- sure to noise; however, few farmers report consistent use. The purpose of this study was to test an intervention based on Social Cognitive Theory with interactive smartphone technology to increase the use of HPDs among swine facility workers. A pilot, quasi-experimental study was implemented among 72 younger adult swine workers. Participants were randomly assigned to one of three groups. Group 1 received HPDs (e.g., earmuffs and ear plugs). Group 2 received the same HPDs as Group 1 and was also instructed to use a smartphone application to track their use of hearing protection for 60 days. Group 3 received the HPDs and instructions on using a smartphone app for tracking the use of hearing protection and setting daily goals for hearing protection use. Use of hearing protection was assessed via an online survey prior to the intervention (i.e., "baseline"), immediately after the post-intervention, and at a 3-month follow-up. Compared to baseline use, all three groups reported increased use of hearing protection immediately post-intervention. However, this increase was not maintained at a 3-month follow-up for two of the study groups. Group 3 (HPD, tracking, and goal-setting app) showed the greatest increase in the use of HPDs from baseline to immediate post-intervention; however, Group 1 (HPD only) showed the greatest sustained increase from baseline to the 3-month follow-up. Modifying the environment by supplying HPDs was effective in increasing HPD use among swine facility workers. Improving access to hearing protection devices alone may lead to sustained changes in behavior.

Evaluation of an Online Training for Supervisors of Young Agricultural Workers.

Adolescents and young adults (<25 years) working in agriculture are at greater risk of injury than youth working in other industries. Supervisors play an important role in protecting these young workers who lack workplace experience and whose bodies and brains are still developing. A theoretically based approach was used to develop an online training for supervisors of young agricultural workers. The training addresses an expanded view of occupational safety that not only addresses injury prevention, but also focuses on health promotion and worker well-being using a Total Worker Health approach. A pre-post/post study design was used to evaluate the training. Questionnaires included demographics, workplace characteristics, knowledge, beliefs about protecting young workers, and supervisors' communication behaviors. One-hundred-eighty-two participants completed all parts of the efficacy trial. A post-test administered immediately after completing the training, indicated that supervisors had greater understanding of the risks to young workers and at 3-month follow-up were more likely to engage in communication behaviors to protect the safety and health of young workers. Positive changes in when, how, and under what circumstances supervisors talk about safety and health occurred. Establishing patterns of protective behaviors in the workplace can have lifelong impact, particularly among young workers.

Preventing unintended pregnancies and improving contraceptive use among young adult women in a rural, Midwestern state: health promotion implications.

Despite high rates of unintended pregnancy among women aged 18 to 30 years, little research has been conducted to understand the factors associated with their contraceptive use. Eighteen focus groups were conducted with young adult women (N = 106) who were mostly white, non-Hispanic. Results suggested that contraceptive use was negatively affected by low contraceptive knowledge; use of alcohol; a lack of planning for sex; a misperception of the likelihood of pregnancy; forgetting to use contraceptives; and concerns about side effects, cost, and confidentiality. Women liked the peace of mind that using contraceptives gave them and the benefits of regular periods from some hormonal methods. Implications for reducing unintended pregnancies through interventions are offered.

Factors related to physicians' willingness to vaccinate girls against HPV: the importance of subjective norms and perceived behavioral control.

This study assessed factors related to physicians' intentions to vaccinate patients against human papillomavirus. A random sample of physicians was surveyed. The survey questions focused on the constructs of the Theory of Planned Behavior. Structural equation modeling was used to estimate the relationship of theoretical constructs to intention to vaccinate. Of the 207 physicians who responded, intentions to vaccinate were very high (86.5%). On a scale of 1 to 7 (strongly disagree to strongly agree) physicians had positive attitudes toward the vaccine. Physicians reported the vaccine was a good idea (M = 6.65, SD = 0.79), beneficial (M = 6.64, SD = 0.76), and protected against cervical cancer (M = 6.63, SD = 0.77). Intention to vaccinate was driven by subjective norms (provided by guidelines or standards of practice by important professional and general referent groups) (beta = 1.00, p < 0.05) and perceived behavioral control (beta = 0.39, p < 0.05). These findings indicate that public health efforts to encourage physicians to adopt the human papillomavirus vaccine should focus on subjective norms, such as those provided by professional organizations.

Using the theory of planned behavior to predict mothers' intentions to vaccinate their daughters against HPV.

This study assessed mothers' intentions to vaccinate their daughters against human papillomavirus (HPV) using the theory of planned behavior (TPB). Experience with sexually transmitted infections (STIs), beliefs about the vaccine encouraging sexual activity, and perception of daughters' risk for HPV were also examined for a relationship with intention. A random sample of mothers in a rural, Midwestern state were mailed a survey with questions pertaining to the intention to vaccinate. Attitudes were the strongest predictor of mothers' intentions to vaccinate, but intentions were not high. Subjective norms also influence intention. Mothers' risk perceptions, experience with STIs, and beliefs about the vaccine encouraging sexual activity were not related to intention. Mothers' perceptions of the daughters' risks for HPV were surprisingly low. This research provides a foundation for designing interventions to increase HPV vaccination rates. Further research should explore ways to influence mothers' attitudes and to uncover the referent groups mothers refer to for vaccination behavior.

Education and Training to Build Capacity in Total Worker Health®: Proposed Competencies for an Emerging Field.

OBJECTIVE: Establishment of core competencies for education and training of professionals entering the emerging field of Total Worker Health®. METHODS: Compilation and distillation of information obtained over a 5-year period from Total Worker Health symposia, workshops, and academic offerings, plus contributions from key stakeholders regarding education and training needs. RESULTS: A proposed set of Total Worker Health competencies aligns under six broad domains: Subject Matter Expertize; Advocacy and Engagement; Program Planning, Implementation and Evaluation; Communications and Dissemination; Leadership and Management; and Partnership Building and Coordination. CONCLUSIONS: Proposed set of core competencies will help standardize education and training for professionals being trained in Total Worker Health. It serves as an invitation for further input from stakeholders in academia, business, labor, and government.

'My friends love to tan': examining sensation seeking and the mediating role of association with friends who use tanning beds on tanning bed use intentions.

This paper explored how sensation seeking contributes to the likelihood of tanning bed use intentions both directly and indirectly through the way it shapes interaction with peers who use tanning beds and attitudes toward tanning bed. Eight hundred and ninety six (n = 896) male and female college students were recruited for the study. Measured variables included sensation seeking, association with friends who use tanning beds, attitudes toward tanning and tanning bed use intentions. Structural equation modeling was performed to test the hypotheses. In general, results supported the proposed hypotheses and documented that sensation seeking is indirectly associated with tanning bed use intentions through the mediation of association with peers who use tanning beds and attitudes toward tanning. The article discusses theoretical and methodological implications of the findings demonstrating the pathways of influence of sensation seeking on tanning bed use intentions.

The green acres effect: the need for a new colorectal cancer screening campaign tailored to rural audiences.

National health communication campaign developers have ignored rural audiences in campaign development and testing, despite the health disparities that exist for this group. Researchers in a rural Midwestern state tested the appropriateness of CDC's national colorectal cancer screening campaign, Screen for Life. Based on focus groups and a quasiexperimental design evaluation, researchers determined that the national campaign did not adequately address the needs of the rural audience. A new print and radio campaign was developed based on previous findings, grounded in social marketing and the health belief model. New tailored campaign materials were refined in focus groups. Final versions were tested in two quasiexperimental designs. Results support the campaign's reach and efficacy. Those in the intervention county were significantly more likely than the unexposed to (a) report recent exposure to ads, (b) plan to seek out information regarding screening, and (c) plan to get screened in the near future.