Pilot study of peer modeling with psychological inoculation to promote coronavirus vaccination.

Promoting coronavirus vaccination is deterred by misinformation, ranging from elaborate conspiracy theories about sinister purposes to exaggeration of side effects, largely promulgated by social media. In this pilot study, we tested the effects of different messages on actions leading to vaccination. Two theory-based advertisements were produced for Facebook, which provided video testimonials from peer role models recommending vaccination and its benefits while providing psychological inoculation through the models' acknowledging misinformation, rejecting it and receiving the vaccine. These ads were paid to appear on Facebook users' feeds in rural counties in South Texas, along with a generic vaccine promotion ad from the CDC without peer models or psychological inoculation. Ad viewers could click a link to 'find a vaccine near you'; these responses served as the outcome variable for assessing experimental effects. Ads featuring peer modeling with psychological inoculation yielded a significantly higher rate of positive responses than CDC ads (30.5 versus14.9/1000 people reached in English and 49.7 versus 31.5/1000 in Spanish; P < 0.001 for both English and Spanish rate comparisons). This provides useful pilot data supporting the hypothesis that theory-based communication, i.e. peer modeling with psychological inoculation, may be more effective than more traditional forms of advertising for promoting coronavirus vaccination.

Effects of frequency and duration in telephone counselling for smoking cessation.

OBJECTIVE: This study evaluates alternative protocols in telephone counselling for smoking cessation. DESIGN: The American Cancer Society enrolled 6322 clients in a randomised trial comparing three counselling formats of varying duration and frequency of contact, with or without booster sessions, and mailed self help booklets without telephone counselling. SETTING AND PARTICIPANTS: Participants were drawn from callers to the American Cancer Society's National Cancer Information Center seeking assistance with smoking cessation who provided informed consent and were adult daily smokers, ready to make a quit attempt within two weeks, and from states not served by an evidence based proactive telephone counselling programme. OUTCOMES: Six-month cessation rates (30-day point prevalence) were measured in telephone interviews. RESULTS: There was a significant counselling effect. The overall cessation rates that were yielded by a brief protocol including booster sessions were equivalent to those obtained with the American Cancer Society's standard protocol with boosters. CONCLUSIONS: Based on these findings, the abbreviated protocol with five sessions and two boosters is considered to be an option for improving cost efficiency in the delivery of this service.

Texas Tobacco Prevention Pilot Initiative: processes and effects.

The study was designed to examine how intensity of anti-smoking media campaigns and differing types of anti-smoking community-based programs influence young adolescents' tobacco use and related psychosocial variables. Sixth grade students attending 11 middle schools in eight study communities assigned to varying intervention conditions were assessed by a pre-intervention survey conducted in spring 2000. The assessment was followed by summer and fall 2000 media and community interventions that were evaluated by post-intervention data collection taking place with a new cohort of sixth graders in the same 11 schools in late fall 2000. In analyses conducted at the school level, the enhanced school and comprehensive community program conditions outperformed the no intervention program condition to reduce tobacco use and intentions to use tobacco. Combining the intensive or low media campaign with the comprehensive community program was most effective in suppressing positive attitudes toward smoking, while the enhanced school program alone was less effective in influencing attitudes. The most consistent changes, at least short-term, to reduce teen tobacco use, susceptibility to smoking and pro-smoking attitudes were achieved by combining the intensive media campaign with the comprehensive community program condition.

Telephone assistance for smoking cessation: one year cost effectiveness estimations.

A randomised trial evaluated the American Cancer Society's telephone counselling service to assist smoking cessation. Counselling nearly doubles a smokers' odds of quitting and maintaining cessation for one year. The estimated cost for each case of maintained smoking cessation attributable to counselling availability is approximately 1300 dollars.

Repeated Pap smear screening among Mexican-American women.

The factors that influence repeated cervical cancer screening among Latina women are not well understood. Studies of compliance in this population over-emphasize initial or recent screening and under-emphasize how this practice is repeated over time. The purpose of this study was to identify the demographic and psychosocial factors associated with repeated Pap smear screening among low-income Mexican-American women living in two urban communities in Texas. A total of 1804 Mexican-American women were interviewed as part of a community survey. Multiple regression results indicate that demographic characteristics such as age, marital status, level of acculturation and health insurance were associated with the total number of Pap smears reported for the 5 years prior to the interview. Pap smear beliefs were the strongest predictor of repeated screening, while global beliefs about cancer did not significantly explain the results. Health promotion interventions should take into consideration the cultural and psychosocial needs of Mexican-American women, placing emphasis on their specific screening-related beliefs, if they are to succeed in promoting repeated compliance with Pap smear screening guidelines.

Do health behaviour and psychosocial risk factors explain the European east-west gap in health status?

BACKGROUND: Mortality rates are much more favourable in Western European countries than in those of Eastern Europe. Health behaviour and psychosocial factors have been suggested to be important contributors to East-West differences in mortality and health status. METHODS: To compare reported health status as well as health behaviours and psychosocial factors which may be related to unequal health status in different parts of Europe, standardised postal surveys of representative populations samples were conducted in six Eastern and Western European areas. RESULTS: Higher mortality in the eastern populations was associated with more reported morbidity and generally more negative health ratings. Health behaviours and psychosocial factors were also more negative in the East. Multivariate analyses suggested that the East-West difference in health status may be partly explained by differences in health behaviours and psychosocial factors. CONCLUSION: Efforts to promote health in Eastern Europe should concentrate both on the promotion of healthier lifestyles and on improvement of social and economic conditions.

Promoting tolerance and moral engagement through peer modeling.

Behavioral journalism influences audiences by presenting peer modeling for cognitive processes that lead to behavior change. This technique was used in student newsletters promoting intergroup tolerance and moral engagement in a Houston high school with a diverse ethnic composition. Pretest (N = 393) and posttest (N = 363) cross-sectional comparisons of the student population in that school provided evidence of short-term (6 month) communication effects on attitudes and behavior. Tolerance and moral engagement increased among students in the school where behavioral journalism newsletters were distributed, and there was a corresponding reduction in hostile behavioral intentions and in reports of verbal aggression.

Prevention campaigns for hard-to-reach populations at risk for HIV infection: theory and implementation.

Using applied behavioral science techniques that have been successful in other areas of health promotion, community-level campaigns were implemented in 5 cities to prevent HIV infection among hard-to-reach, at-risk populations: men who have sex with men but do not self-identify as gay; women who engage in sex for money or drugs; injecting drug users (IDUs), female sex partners of IDUs; and youth in high-risk situations. Communication materials presented positive role models for risk-reducing behaviors, and peer networks prompted and reinforced the behavior change process. This article describes the first year of intervention experience and documents the practical application of theoretical concepts of persuasion and learning. The use of theory and data to develop 188 educational messages is illustrated and training methods and experiences are reported for 150 peer leaders, 104 other community networkers, and 22 outreach workers. These activities are feasible and appear to offer an effective, general approach for diverse, special populations.

Interim outcomes for a community-based program to prevent perinatal HIV transmission.

The AIDS Prevention for Pediatric Life Enrichment (APPLE) project is a community-based program to prevent perinatal HIV infection by preventing infection in women. One project component tested a primary prevention model developed from principles of cognitive social learning theory which used street outreach and community-targeted small media materials to increase the use of condoms. Formative research was used to explore community perceptions about HIV/AIDS and to design media materials. Program evaluation employed a two-community, time series, quasi-experimental design. Annual street surveys samples individuals in areas where they were likely to encounter outreach workers. Baseline surveys found substantial pre-programmatic behavior change. After two years considerable APPLE name recognition (40%), contact with media materials (63%), and contact with outreach workers (36%) were found and norms reflecting social acceptability of condoms were more positive among women in the intervention community. Condom use at last sexual encounter rose in both communities but was significantly higher in the intervention community. Condom use also was higher among women who reported exposure to either small media or small media plus street outreach. Other self-reported HIV-prevention behaviors did not show change in the initial period.

Community level cancer control in a Texas barrio: Part II--Base-line and preliminary outcome findings.

In a quasiexperimental demonstration study, screening rates for breast and cervical cancers were measured among Mexican-American women in selected areas of San Antonio and Houston, Tex. This research was primarily designed to evaluate a cancer-screening promotion program in San Antonio by comparing changes in screening rates in panels from the two barrio communities. In a base-line population survey, we found a small, but significant, proportion of women (10%-15%) lacking Pap smears and a larger proportion (30%-40%) lacking mammography. In a panel study following women who lacked screening at base line, there was a trend toward greater Pap smear use among younger women and a significant increase in mammography for all age groups in San Antonio compared with groups in Houston. Although there was a difference in language use between the communities, rates of newly initiated screening within the communities were similar among monolingual Spanish speakers and among those who used English, supporting the hypothesis that the program increased both groups' participation in breast-cancer screening.

Smoking cessation in Texas-Mexico border communities: a quasi-experimental panel study.

UNLABELLED: BACKGROUDd. Smoking-related disease and injury is prominent among the numerous health problems on the U.S.-Mexico border, but little is known about the methods that might help promote smoking cessation among the low-income populations in this region. METHOD: Media campaigns were combined with different forms of intensive and community-wide interpersonal communication to encourage smoking cessation in a border U.S. city and in a Mexican city. Panels of moderate to heavy smokers were followed in four groups to allow quasi-experimental comparison of smoking cessation rates. RESULTS: Over a five-year study period smoking cessation rates of 17% (self-reported) and 8% (verified) were observed in panels in the program community (N = 160). In the comparison community (N = 135) corresponding rates of smoking cessation were 7% (self-reported) and 1.5% (verified). Within the program community, no differences were observed in smoking cessation among smokers exposed to a community-wide program and those assigned to receive personal counseling. DISCUSSION: Although the observed changes in smoking were unexpectedly small in the treatment and comparison groups, the approximately 8% effect size for the community-wide program was close to what was predicted. Results indicate that such programs may yield effects similar to those of more intensive approaches, but further research with greater statistical power will be necessary to confirm that point.

A Health Belief Model-Social Learning Theory approach to adolescents' fertility control: findings from a controlled field trial.

We evaluated an 8- to 12-hour Health Belief Model-Social Learning Theory (HBM-SLT)-based sex education program against several community- and school-based interventions in a controlled field experiment. Data on sexual and contraceptive behavior were collected from 1,444 adolescents unselected for gender, race/ethnicity, or virginity status in a pretest-posttest design. Over 60% completed the one-year follow-up. Multivariate analyses were conducted separately for each preintervention virginity status by gender grouping. The results revealed differential program impacts. First, for preintervention virgins, there were no gender or intervention differences in abstinence maintenance over the follow-up year. Second, female preintervention Comparison program virgins used effective contraceptive methods more consistently than those who attended the HBM-SLT program (p less than 0.01); among males, the intervention programs were equally effective. Third, both interventions significantly increased contraceptive efficiency for teenagers who were sexually active before attending the programs. For males, the HBM-SLT program led to significantly greater follow-up contraceptive efficiency than the Comparison program with preintervention contraceptive efficiency controlled (p less than 0.05); for females, the programs produced equivalent improvement. Implications for program planning and evaluation are discussed.

PIP: Between June 1986-August 19867, social scientists conducted 1 year controlled field trial of a pilot community or school based sexuality and contraceptive education program based on a Health Belief Model-Social Learning Theory (HBM-SLT) among 1444 adolescents from Texas and California. This program aimed to increase their knowledge of probability of conception, negative personal consequences of pregnancy, personal and interpersonal benefits of delayed and/or protected sexual intercourse, and to decrease misperceptions about abstinence and consistent contraceptive use. 60% of the youth were not lost to follow up. For preintervention virgins, no gender or intervention differences in maintaining virginity over the year existed between the HBM-SLT and programs other than the HBM-SLT program (comparison programs). Female preintervention virgins attending comparison programs tended to use an effective contraceptive at most recent intercourse and be more capable of using contraceptive than those who went to the HBM-SLT program (p.01). Yet they depended highly on condoms. For males, both programs proved to be equally effective at contraceptive use. Both programs significantly improved contraceptive efficiency for preintervention nonvirgins. For males, the HBM-SLT program resulted in a more significant improvement in contraceptive efficiency than the comparison programs (p.05). For females, both programs equally improved efficiency. The proportion of variance explained by the intervention programs and time 2 HBM-SLT programs was not as great for males and females as the researchers expected. Contributing factors to this included sexual activity was relatively low (52% of follow up participants remained virgins), HBM-SLT was assessed against other programs rather than a no treatment group, and the length of the HBM-SLT was shorter than the comparison programs.

Population behavior change: a theory-based approach.

Behavioral science provides useful ideas about how programs of mass communication and community participation can produce synergistic influences on the lifestyles and policy decisions of populations and their representatives. Media campaigns featuring real-life behavior models and community networks mobilized to promote behavior change provide a theoretically sound paradigm for community-level activities to accelerate the diffusion of innovation in health. Illustrative case studies demonstrate how behavioral science concepts can be applied to preventing HIV infections and to promoting citizen lobbying against selected nuclear weapons systems.

Evaluating the impact of a theory-based sexuality and contraceptive education program.

A controlled field study involving 1,444 adolescent males and females 13-19 years of age was performed to compare a sexuality education program based on the health belief model and social learning theory with several publicly funded community-based and school-based interventions. Among males who had never had intercourse prior to participating in the study, those in the experimental program were more likely than those in the comparison programs to maintain abstinence over the next year; there was no program effect, however, among females. Among female adolescents who initiated intercourse after the start of the study, attendees of the comparison programs were more likely to have used an effective contraceptive at most recent intercourse and to have used an effective method more consistently than were those who attended the experimental program; no such association was seen among comparable young men. Both experimental and comparison programs significantly increased the consistent use of effective methods among teenagers who had been coitally active before attending the programs. Among males, however, when preintervention contraceptive efficiency was held constant, the experimental program led to significantly greater contraceptive efficiency during the follow-up year than did the comparison programs; among females, the two approaches produced an equivalent degree of improvement. Finally, prior exposure to sexuality education was associated with greater contraceptive efficiency at the one-year follow-up among almost all sexual-experience and gender groups, regardless of the type of intervention program attended.

PIP: A controlled field study involving 1444 adolescent males and females ages 13-19 was performed to compare a sexuality education program based on the health belief model and social learning theory with several publicly funded community and school-based intervention. Among males who has never has intercourse prior to their participation in the study, those in the experimental program were more likely than those in the comparison programs to maintain abstinence over the next year. There was no program effect, however, among females. Among female adolescents who initiated intercourse after the start of the study, attendees of the comparison programs were more likely to have used an effective contraceptive at most recent intercourse and to have used an effective method more consistently than were those who attended the experimental program. No such association was seen among comparable young men. Both experimental and comparison programs significantly increased the consistent use of effective methods among teenagers who has been coitally active before attending the programs. Among males, however, when preintervention contraceptive efficiency was held constant, the experimental program led to significantly greater contraceptive efficiency over the follow-up year than did the comparison programs. Among females, however, the 2 approaches produced an equivalent degree of improvement. Finally, prior exposure to sex education was associated with greater contraceptive efficiency at the 1-year follow-up among almost all sexual experience and gender groups, regardless of the type of intervention program attended.

Preventing drug use in adolescents through media interventions.

The communications media, and the broadcast media in particular, have been disseminating an increasing volume of antidrug messages over the past several years. Many American business leaders believe that the media can help to reduce drug use, and they have supported a nationwide effort to highlight the dangers of illicit drug use on the airwaves and in newspapers and magazines. This article considers the efficacy of media-based efforts to prevent adolescent drug use. Selected theories and research are reviewed, and suggestions are made for integrating social and behavioral theory and research into media prevention strategies. The authors conclude that scientists and interventionists could do much to improve on current research and development in this prevention arena, within the limits of what is possible to achieve through mass communications as presently constituted in the United States.

Eight-year follow-up results of an adolescent smoking prevention program: the North Karelia Youth Project.

In the North Karelia Youth Program five to 10 classroom sessions over two years taught skills to resist pressures to start smoking to 13 to 15 year old students. Compared to students from comparison schools, the treatment groups reported less smoking immediately after the intervention and in a four-year follow-up survey. At the eight-year follow-up, there was consistent evidence of possible preventive effects only among those who had been non-smokers when the program began.

Mass media campaign--A Su Salud.

A mass media health promotion program directed toward reducing future cancer trends among Mexican Americans, the largest subgroup of Hispanics in the United States, by decreasing smoking and encouraging smoking prevention and other health practices is described. Included is an outline of the program design and its significant features and a discussion of social modeling, the theoretical approach which provides a framework for the program. The development of the program, including the role focus groups played in the identification of areas to be targeted by the program, and the production and implementation of the mass media campaign based upon the targeted program areas are also discussed.