Primary Care Physicians' Strategic Pursuit of Multiple Goals in Cost-of-Care Conversations with Patients.

Despite the importance of cost-of-care conversations between physicians and patients, such discussions are not well understood. We used multiple goals theory to examine the specific goals that are salient in these discussions and how physicians pursue these goals. We used qualitative descriptive coding to analyze the verbatim transcripts from in-depth interviews with 36 primary care physicians. Our analysis identified a number of goals that are commonly salient in cost conversations, including task goals (reducing the cost of care, making treatment decisions, and promoting patient adherence), identity goals (reinforcing their professional identity as a "good doctor," acting as a steward of medical resources, being an advocate for patients, and preventing patient embarrassment), and relational goals (strengthening the physician-patient relationship and mitigating damage to the physician-patient relationship). In addition, participants articulated a number of ways in which these goals compete with each other, making cost conversations challenging. We found that physicians use a common repertoire of rhetorical strategies to manage these goals, including directly addressing cost, avoiding discussion of cost, and falsely reassuring patients about cost concerns. Our analysis revealed that the meaning of the cost conversation explains the connection between physicians' goals and strategies. Specifically, we found that physicians invoke polysemic meanings of cost conversations to achieve their multiple goals using seemingly contradictory strategies. The results of our analysis have implications for building theory and improving practice.

Using the Theory of Planned Behavior to Guide Focus Group Development of Messages Aimed at Increasing Compliance With a Tobacco-Free Policy.

PURPOSE: This study details the persuasive message development for a theory-based campaign designed to increase compliance with a university's tobacco-free policy. APPROACH: The theory of planned behavior (TPB) guided message design and evaluation for focus group-tested messages that were adapted to the context of complying with a tobacco-free policy. SETTING: The study was conducted at a university located in the tobacco belt. PARTICIPANTS: Undergraduate focus group participants (n = 65) were mostly male (69%), white (82%), and freshman (62%) who smoked at least 1 cigarette in the last 30 days; on-campus smoking percentages were never/rare (60%), occasionally (23%), and often/frequently (16%). METHOD: Data analysis used a theoretical thematic approach to identify how the TPB constructs related to perceptions of message effectiveness. RESULTS: Participants responded favorably to attitudinal strategies about health, respect, and university figures; they rejected approaches they considered juvenile and offensive. They also discussed the impact of noncompliance and avoiding overgeneralized statements for addressing subjective norms, suggesting shortening text, adjusting picture location, and emphasizing the importance of compliance to increase perceptions of behavioral control. CONCLUSION: Applying theory to preexisting messages is challenging. The design approach in this study is an evidence-based strategy that can be used as a universal process for message adaptation. Results offer health promotion suggestions for designing messages aimed at improving undergraduate smokers' willingness to comply with tobacco-free campus policies.

The Willingness to Intervene Against Suicide Questionnaire.

Three studies resulted in the Willingness to Intervene Against Suicide Questionnaire. College students (ns = 172, 253, and 367) completed an online questionnaire based on theory of planned behavior constructs regarding suicide intervention. Exploratory factor analysis produced 10 factors: intervening will affect the suicidal person and the participant; important others recommend seeking help, suggesting the suicidal person see a counselor, and talking to the suicidal person; interpersonal and intervention self-efficacy; and intention to seek outside help, encourage to seek outside help, and recognize a need for action. The Willingness to Intervene Against Suicide Questionnaire assesses college students' willingness to intervene when someone is suicidal.

Narrative and framing: a test of an integrated message strategy in the exercise context.

Health communication interventions encouraging exercise may aid in mitigating the obesity crisis in the United States. Although much research has investigated behavioral predictors of exercise, little work has explored message characteristics most persuasive in the exercise context. The purpose of this study, therefore, was to test a message strategy drawing on previous work in health behavior theory combined with persuasion theories (exemplification theory and prospect theory) to encourage positive exercise attitudes, control beliefs, and intentions. The authors report the results of a controlled experiment testing messages using gain or loss frames and narrative or statistical evidence. Results indicate that gain-framed messages are significantly more successful in promoting positive exercise variables and are perceived as more effective than are loss-framed or control messages. The authors discuss the implications of the results for future research.

Performance and subjective effects of diazepam and d-amphetamine in high and low sensation seekers.

Although sensation-seeking status is associated with age of initiation and amount of drug use among adolescents, and sensitivity to the behavioral and reinforcing effects of drugs among young adults, it is unclear whether sensation-seeking status among adolescents is predictive of sensitivity to the pharmacological effects of drugs (i.e. abuse potential) as adults. This study examined the acute behavioral effects of oral diazepam and d-amphetamine in young adults, ages 18-21 years, who had consistently scored in the highest or lowest third of their grade-based cohort on a modified Sensation Seeking Scale that was completed annually between ages 10 and 14 years. Healthy participants completed 16 7.5-h test days, with test days separated by a minimum of 48 h. Each day, assessments consisting of computer task performance, verbal report of drug effects, and cardiovascular measures were completed 0, 50, 110, 170, 230, and 290 min after drug administration. Placebo and three active doses of diazepam and d-amphetamine (2.5, 5.0 and 10.0 mg/70 kg) were tested under double-blind conditions according to a randomized-block design. Typical stimulant and sedative effects were obtained with d-amphetamine and diazepam, respectively. Drug effects varied as a function of sensation-seeking status, with magnitude of effects on cardiovascular function, task performance, and report of positive drug effects being greater among high sensation seekers, and report of negative drug effects being greater among low sensation seekers. Adolescents who report high levels of sensation seeking on a consistent basis are more sensitive to pharmacological effects of stimulant and sedative drugs that are associated with abuse potential as young adults.

Individual differences in drug abuse vulnerability: d-amphetamine and sensation-seeking status.

RATIONALE: While the personality dimensions of novelty seeking and sensation seeking are associated with drug abuse vulnerability, the mechanisms associated with this vulnerability remain obscure. OBJECTIVE: This study examined the behavioral effects of d-amphetamine in healthy volunteers scoring in the upper and lower quartiles based on age- and gender-adjusted population norms on the impulsive Sensation-Seeking Scale (SSS) of the Zuckerman-Kuhlman personality questionnaire (ZKPQ). METHOD: Participants completed 7-day outpatient studies examining the subjective, performance, and cardiovascular effects of d-amphetamine (0, 7.5, and 15 mg/70 kg, p.o.) under double-blind conditions according to a randomized block design. Performance tasks included behavioral measures of impulsivity, including attention, inhibition, and risk-taking behavior. RESULTS: No differences in baseline performance or d-amphetamine effects on measures of attention, inhibition, and risk-taking behavior were observed. High impulsive sensation seekers reported greater increases on several subjective report measures associated with drug abuse potential, including visual analog scales feel drug, like drug, and high. CONCLUSIONS: Healthy adults scoring in the top quartile on the population of the impulsive SSS of the ZKPQ may be vulnerable to the abuse potential of d-amphetamine.

How all stars works: an examination of program effects on mediating variables.

Prevention research continues to focus on school-based substance use programs aimed at adolescents. These programs are designed to reduce substance use and risk behavior by targeting key mediators, such as normative beliefs, which in turn reduce substance use. All Stars is a newly developed program that was recently evaluated in a randomized field trial in 14 middle schools in Lexington and Louisville, Kentucky. The authors examined targeted and nontargeted variables as possible mediators of program effectiveness. Findings indicate that All Stars achieved reductions in substance use and postponed sexual activity when teachers were successful at altering targeted mediators: normative beliefs, lifestyle incongruence, and manifest commitment to not use drugs. The program was not successful when it was delivered by specialists. At least in part, this failure is attributable to specialists' inability to change mediators as intended by the program.