What About Promotores? Promotores' Psychosocial Determinants That Influenced the Delivery of a Cervical Cancer Education Intervention to Hispanics.

This study tested whether a cancer education intervention affected promotores' self-efficacy to deliver an intervention to Hispanics and which psychosocial determinants of promotores influenced the number of Hispanic residents reached by promotores in the subsequent education intervention. A quasi-experimental, pre/post-design with a treatment group (no control) assessed differences for promotores (n = 136) before and after exposure to the cancer education intervention. The design also included a cross-sectional evaluation of the number of residents promotores reached with the educational intervention. After being trained, the promotores delivered the intervention to Hispanic residents (n = 1,469). Paired t-tests demonstrated increases in promotores' self-efficacy from pre- to post-intervention. Regression models assessed associations between the numbers of residents reached and select psychosocial determinants of promotores. Age and promotores' years of experience influenced their delivery of a cervical cancer education intervention to Hispanics, but not their delivery of breast or colorectal cancer education interventions. This is the first study to examine which psychosocial determinants influence promotores delivery of cancer education interventions. The outcomes potentially have implications for CHW interventions and training by examining this potential connection between CHWs' psychosocial determinants and intervention outcomes.

Predictors of COVID-19 Preventive Perceptions and Behaviors Among Millennials: Two Cross-sectional Survey Studies.

BACKGROUND: COVID-19 preventive perceptions and behaviors, especially among US millennials, are an important means by which the pandemic can be slowed and negative health outcomes can be averted. OBJECTIVE: This manuscript aims to advance knowledge on COVID-19 preventive perceptions and behaviors and their main predictors, including digital health information-seeking behavior (HISB), political party identification, and COVID-19 testing status. METHODS: Two cross-sectional online surveys of US millennials were conducted from April 10 to 14, 2020 (N=274) (ie, Study 1), and from April 27 to May 7, 2020 (N=1037) (ie, Study 2). In the regression models, dependent variables included preventive behaviors (eg, wearing a face mask and social distancing) as well as four preventive perceptions: severity (ie, a person's conception of the seriousness of COVID-19), susceptibility (ie, a person's conception of the likelihood of being infected with COVID-19), self-efficacy (ie, a person's perception that he or she can wear a face mask and perform social distancing to prevent COVID-19 infection), and response efficacy (ie, a person's perception of whether wearing a face mask and social distancing can prevent COVID-19 infection). Key independent variables included digital HISB for self, digital HISB for another person, political party identification, and COVID-19 testing status. RESULTS: Millennials reported lower levels of perceived susceptibility than the other three preventive perceptions (ie, severity, self-efficacy, and response efficacy), as well as fairly high levels of preventive behaviors. Unlike HISB for another person, digital HISB for self was positively associated with preventive perceptions and behaviors. In Study 1, respondents with higher levels of digital HISB for self had significantly higher perceptions of severity (ß=.22, P<.001), self-efficacy (ß=.15, P=.02), and response efficacy (ß=.25, P<.001) as well as, at nearing significance, higher perceptions of susceptibility (ß=.11, P=.07). In Study 2, respondents with higher levels of digital HISB for self had significantly higher perceptions of severity (ß=.25, P<.001), susceptibility (ß=.14, P<.001), and preventive behaviors (ß=.24, P<.001). Preventive behaviors did not vary significantly according to political party identification, but preventive perceptions did. In Study 1, respondents who identified as being more Republican had significantly lower perceptions of self-efficacy (ß=-.14, P=.02) and response efficacy (ß=-.13, P=.03) and, at nearing significance, lower perceptions of severity (ß=-.10, P=.08) and susceptibility (ß=-.12, P=.06). In Study 2, respondents who identified as being more Republican had significantly lower perceptions of severity (ß=-.08, P=.009). There were mixed effects of COVID-19 testing status on preventive perceptions, with respondents who had tested positive for COVID-19 having significantly higher perceptions of susceptibility in Study 1 (ß=.17, P=.006) and significantly lower perceptions of severity in Study 2 (ß=-.012, P<.001). CONCLUSIONS: As the largest and most digitally savvy generation, US millennials saw COVID-19 as a severe threat, but one that they were less susceptible to. For millennials, digital HISB for self, but not for another person, was critical to the development of preventive perceptions and behaviors.

Emotions in the time of coronavirus: Antecedents of digital and social media use among Millennials.

Increasingly, people are turning to digital and social media to address health threats. While research has commonly investigated the psychosocial antecedents of digital health information seeking behavior (digital HISB) and social media use (SMU), there has been limited research on the independent effects of emotions and no research on the interactive effects of emotions. In the context of the coronavirus COVID-19 pandemic, this study investigates the affective, personal relevance, and socio-demographic antecedents of digital HISB and SMU, using data from an online survey of U.S. Millennials (N = 1037) in April-May 2020. Linear regression results show the effects of socio-demographic and personal relevance factors. For the independent effects of emotions, fear and sadness were associated with digital HISB; fear, joy, and disgust were associated with high-informational SMU; and joy and disgust were associated with low-informational SMU. Three interactive effects of discrete negative emotions suggest that an increase in one emotion can amplify the effect of another emotion on a measure of digital and social media use. In the fourth interaction of two negative emotions with strong biological regulatory processes, there is evidence that an increase in one emotion can diminish the effect of another emotion. Implications for theory and practice are discussed.

The Role of Enjoyment in a Serious Game for Binge Drinking Prevention: Pretest-Posttest Quasi-Experimental Study.

BACKGROUND: Although binge drinking peaks at age 21 to 25 years, there is limited research on the effects of serious games in this population, as well as on the process by which playing serious games impacts alcohol-related outcomes. Designed with both health behavioral theory and game theory, One Shot is an online serious game that aims to prevent binge drinking. OBJECTIVE: This study utilized a conceptual model for serious video game processes. Using One Shot, the model assessed the following process stages: (1) Alcohol Use Disorders Identification Test-Concise (AUDIT-C); (2) in-game factors of game time and risky alcohol decisions; (3) game enjoyment; and (4) postgame outcomes of intention to drink less and drinking refusal self-efficacy. METHODS: In a one-group pretest-posttest quasi-experimental design, a sample (N=550) of young adults (age 21-25 years) who reported recent binge drinking played the One Shot game. Intention to drink less and drinking refusal self-efficacy were measured at pregame and postgame, with their effects lagged in statistical analysis. Participants were presented with various scenarios in the game that pertained to risky alcohol decisions, which, along with game time, were unobtrusively recorded by the server. A structural equation model (SEM) was used to test the conceptual model, with assessments made to determine if enjoyment mediated the effects of game time and risky alcohol decisions on the 2 postgame alcohol-related outcomes. RESULTS: A well-fitting SEM demonstrated support for the multistep model, with AUDIT-C predicting risky alcohol decisions (ß=.30). Risky alcohol decisions (ß=-.22) and game time (ß=.18) predicted enjoyment, which, in turn, predicted intention to drink less (ß=.21) and drinking refusal self-efficacy (ß=.16). Enjoyment significantly (P<.001) mediated the effects of game time and risky alcohol decision on intention to drink less and drinking refusal self-efficacy. CONCLUSIONS: The results support a conceptual model in which staggered individual and in-game factors influence alcohol-related outcomes. Enjoyment is important for participants' intentions to drink less and beliefs that they can refuse alcohol.

The Outcome Evaluation of a CHW Cancer Prevention Intervention: Testing Individual and Multilevel Predictors Among Hispanics Living Along the Texas-Mexico Border.

This paper evaluates the effectiveness of community health workers/promotores (CHWs) in promoting cancer preventive behaviors in the 2011-2013 Education to Promote Improved Cancer Outcomes (ÉPICO) project. The ÉPICO project utilized CHWs to disseminate cancer education to predominately Spanish-speaking Hispanics living in colonias in the Lower Rio Grande Valley of Texas. The CHWs received training to become Texas-certified CHW instructors and specialized training in message tailoring, and they delivered more than 5000 units of resident education on cancer prevention/detection, treatment, and survivorship for breast, cervical, and colorectal cancer. Using panel data to examine overtime changes in cancer knowledge among Lower Rio Grande Valley residents, the evaluation found significant changes from baseline to both times 1 and 2. Additional individual-level analysis indicated that the increase in resident cancer knowledge was predicted by residents' perceptions of CHW credibility and intention to change their lifestyles. Multilevel analysis also showed that the increase in cancer prevention knowledge among residents was predicted by attributes of the CHWs who taught them. In particular, CHWs with higher education levels had the most impact on residents' increased knowledge over time. Unexpectedly, CHWs with more years of experience were less effective teachers than their early-career counterparts.

Testing the Validity of Campaign Ad Exposure Measures: A Family Planning Media Campaign in Pakistan.

Although prior research has tested the nomological validity of media campaign exposure, including the related comparative validity of some measures, it has not well studied predictive validity or made extensions to other types of media campaign exposure. To help build on research in this area, the current study tested the nomological and predictive validity of 5 ad recall and recognition measures specific to the Touch condom media campaign in Pakistan. Between-effects regression of panel survey data confirmed the nomological validity of each of the 5 measures of Touch ad exposure. In addition, 2 sets of panel regression models (i.e., fixed-effects models and fixed-effects with lag models) confirmed the predictive validity of each of the 5 ad exposure measures. Results on comparative validity were quite similar for nomological and predictive validity, indicating that confirmed ad recall and recognition measures tend to have greater validity than unconfirmed measures.

Smoking Prevention in China: A Content Analysis of an Anti-Smoking Social Media Campaign.

The China Tobacco Control Media Campaign on Sina Weibo is novel in the context of smoking prevention and cessation in China and has not to date been evaluated. This study draws on health behavior theories and dialogic theory in public relations to analyze microblog campaign postings and their relationships with the outcome of online audience engagement. Microblog postings from May 2011 to January 2015 were content analyzed, showing that the most common persuasive content characteristic was perceived risk, followed by subjective norms and self-efficacy. Perceived risk and self-efficacy postings positively influenced online audience engagement, whereas subjective norm postings was a nonsignificant predictor. Postings were more likely to share information than aim to interact with audience members. However, both information sharing and audience interaction postings were positive predictors of online audience engagement. There was also evidence of main and interactive effects of message originality on online audience engagement. The current study has, to the best of our knowledge, broken new ground in 2 regards: (a) using health behavior theories as a basis for analyzing the content of an anti-smoking social media campaign and (b) examining the content of an anti-smoking media campaign of any type in China.

Estimating Causal Effects With Propensity Score Models: An Evaluation of the Touch Condom Media Campaign in Pakistan.

Rapid population growth in Pakistan poses major risks, including those pertinent to public health. In the context of family planning in Pakistan, the current study evaluates the Touch condom media campaign and its effects on condom-related awareness, attitudes, behavioral intention, and behavior. This evaluation relies on 3 waves of panel survey data from men married to women ages 15-49 living in urban and rural areas in Pakistan (N = 1,012): Wave 1 was March 15 to April 7, 2009; Wave 2 was August 10 to August 24, 2009; and Wave 3 was May 1 to June 13, 2010. Analysis of variance provided evidence of improvements in 10 of 11 condom-related outcomes from Wave 1 to Wave 2 and Wave 3. In addition, there was no evidence of outcome decay 1 year after the conclusion of campaign advertising dissemination. To help compensate for violating the assumption of random assignment, propensity score modeling offered evidence of the beneficial effects of confirmed Touch ad recall on each of the 11 outcomes in at least 1 of 3 time-lagged scenarios. By using these different time-lagged scenarios (i.e., from Wave 1 to Wave 2, from Wave 1 to Wave 3, and from Wave 2 to Wave 3), propensity score modeling permitted insights into how the campaign had time-variant effects on the different types of condom-related outcomes, including carryover effects of the media campaign.

Motivations, Barriers, and Behaviors Related to Obtaining and Discussing Family Health History: A Sex-Based Comparison Among Young Adults.

BACKGROUND: Genetic predisposition is a risk factor for many chronic diseases, yet little is known about the frequency in which college students seek out their family health history or with whom they communicate relevant information. PURPOSE: This study examines motivations and barriers associated with obtaining one's family health history and discussing it with others. METHODS: Data were analyzed from 625 college students using an internet-delivered questionnaire, which comprised of questions about intentions and motivations to obtain and share family health history as well as barriers encountered when obtaining family health history. Responses were bifurcated by participants' sex. Chi-squared and t statistics were used to identify response differences by sex. RESULTS: Females were significantly more likely than males to be motivated to obtain their family health history, and more likely to have shared their family health history with others; state that they would share their family health history with others; and express a preference for sharing their family health history with a wider range of people. DISCUSSION: Educational interventions and improved student health services could be effective mechanisms to increase college students' knowledge, awareness, and perceived importance of obtaining their family health history.

Using Community-Based Participatory Research to Disseminate a Mass Media Campaign Into Rural Communities.

The authors present the results of a media documentary, Weight of the Nation, disseminated in rural communities in the Brazos Valley region of east central Texas. Researchers relied on a community-based participatory research strategy to assure community participation in the implementation and evaluation of the media documentary in rural communities. To measure the short-term effects of the documentary, the research team used a mixed-methods approach of quantitative panel data from a pre/post survey, qualitative meeting notes, and observations from facilitated discussion groups. Results showed short-term increases in behavioral intention, as well as an increase in self and collective efficacy of participants to make healthy changes at individual and community levels to reduce obesity. The findings suggest that Weight of the Nation is a catalyst for increasing awareness about obesity and initiating changes in intention and efficacy perceptions.

Apps seeking theories: results of a study on the use of health behavior change theories in cancer survivorship mobile apps.

BACKGROUND: Thousands of mobile health apps are now available for use on mobile phones for a variety of uses and conditions, including cancer survivorship. Many of these apps appear to deliver health behavior interventions but may fail to consider design considerations based in human computer interface and health behavior change theories. OBJECTIVE: This study is designed to assess the presence of and manner in which health behavior change and health communication theories are applied in mobile phone cancer survivorship apps. METHODS: The research team selected a set of criteria-based health apps for mobile phones and assessed each app using qualitative coding methods to assess the application of health behavior change and communication theories. Each app was assessed using a coding derived from the taxonomy of 26 health behavior change techniques by Abraham and Michie with a few important changes based on the characteristics of mHealth apps that are specific to information processing and human computer interaction such as control theory and feedback systems. RESULTS: A total of 68 mobile phone apps and games built on the iOS and Android platforms were coded, with 65 being unique. Using a Cohen's kappa analysis statistic, the inter-rater reliability for the iOS apps was 86.1 (P<.001) and for the Android apps, 77.4 (P<.001). For the most part, the scores for inclusion of theory-based health behavior change characteristics in the iOS platform cancer survivorship apps were consistently higher than those of the Android platform apps. For personalization and tailoring, 67% of the iOS apps (24/36) had these elements as compared to 38% of the Android apps (12/32). In the area of prompting for intention formation, 67% of the iOS apps (34/36) indicated these elements as compared to 16% (5/32) of the Android apps. CONCLUSIONS: Mobile apps are rapidly emerging as a way to deliver health behavior change interventions that can be tailored or personalized for individuals. As these apps and games continue to evolve and include interactive and adaptive sensors and other forms of dynamic feedback, their content and interventional elements need to be grounded in human computer interface design and health behavior and communication theory and practice.

Utilization of an interorganizational network analysis to evaluate the development of community capacity among a community-academic partnership.

BACKGROUND: Following a community health assessment the Brazos Valley Health Partnership (BVHP) organized to address fragmentation of services and local health needs. This regional partnership employs the fundamental principles of community-based participatory research, fostering an equitable partnership with the aim of building community capacity to address local health issues. OBJECTIVES: This article describes changes in relationships as a result of capacity building efforts in a community-academic partnership. Growth in network structure among organizations is hypothesized to be indicative of less fragmentation of services for residents and increased capacity of the BVHP to collectively address local health issues. METHODS: Each of the participant organizations responded to a series of questions regarding its relationships with other organizations. Each organization was asked about information sharing, joint planning, resource sharing, and formal agreements with other organizations. The network survey has been administered 3 times between 2004 and 2009. RESULTS: Network density increased for sharing information and jointly planning events. Growth in the complexity of relationships was reported for sharing tangible resources and formal agreements. The average number of ties between organizations as well as the strength of relationships increased. CONCLUSION: This study provides evidence that the community capacity building efforts within these communities have contributed to beneficial changes in interorganizational relationships. Results from this analysis are useful for understanding how a community partnership's efforts to address access to care can strengthen a community's capacity for future action. Increased collaboration also leads to new assets, resources, and the transfer of knowledge and skills.

Developing an evidence-based fall prevention curriculum for community health workers.

This perspective paper describes processes in the development of an evidence-based fall prevention curriculum for community health workers/promotores (CHW/P) that highlights the development of the curriculum and addresses: (1) the need and rationale for involving CHW/P in fall prevention; (2) involvement of CHW/P and content experts in the curriculum development; (3) best practices utilized in the curriculum development and training implementation; and (4) next steps for dissemination and utilization of the CHW/P fall prevention curriculum. The project team of CHW/P and content experts developed, pilot tested, and revised bilingual in-person training modules about fall prevention among older adults. The curriculum incorporated the following major themes: (1) fall risk factors and strategies to reduce/prevent falls; (2) communication strategies to reduce risk of falling and strategies for developing fall prevention plans; and (3) health behavior change theories utilized to prevent and reduce falls. Three separate fall prevention modules were developed for CHW/P and CHW/P Instructors to be used during in-person trainings. Module development incorporated a five-step process: (1) conduct informal focus groups with CHW/P to inform content development; (2) develop three in-person modules in English and Spanish with input from content experts; (3) pilot-test the modules with CHW/P; (4) refine and finalize modules based on pilot-test feedback; and (5) submit modules for approval of continuing education units. This project contributes to the existing evidence-based literature by examining the role of CHW/P in fall prevention among older adults. By including evidence-based communication strategies such as message tailoring, the curriculum design allows CHW/P to personalize the information for individuals, which can result in an effective dissemination of a curriculum that is evidence-based and culturally appropriate.

A panel study of peer norms and adolescent alcohol consumption: developing strategies for communication interventions.

Given that alcohol consumption and binge drinking among adolescents in the United States remain prevalent, this study assesses changes in the influence of peer norms-and their interactions with time, gender, and ethnicity-on alcohol consumption. Panel survey interviews of adolescents (N = 1,607) were completed in 9th grade and then again in 12th grade with students from Louisiana. Fixed effects multiple regression assessed the relations between the changes in 2 types of peer norms (i.e., descriptive norms and injunctive norms) and 2 alcohol consumption measures: 30-day alcohol prevalence and binge drinking. Increases in 30-day alcohol prevalence and binge drinking were associated with only descriptive norms. The effects of both types of peer norms intensified over time, and the effects of descriptive norms varied according to gender and ethnicity. Specifically, the influence of descriptive norms was greater on boys than on girls and on Caucasians than on African Americans. Communication interventions that target adolescents in the context of alcohol consumption should consider the temporal variability of peer normative influence and how it varies by gender and ethnicity.

Media use and perceived risk as predictors of marijuana use.

OBJECTIVES: To assess the influence of media use and perceived risk on marijuana use outcomes. METHODS: With survey data from 750 US young adults, structural equation modeling tested how attitudes, behaviors, and behavioral intention specific to marijuana use are influenced by perceived personal and societal risk of marijuana use, media campaign exposure, and news use. RESULTS: Perceived societal risk had significant effects, though not as strong as perceived personal risk. Campaign exposure had favorable effects whereas those of news use were mixed. CONCLUSIONS: Perceived personal risk and perceived societal risk should be considered when designing preventive media campaigns.

Assessing a thematic condom advertising campaign on condom use in urban Pakistan.

This study aims to assess communication processes involving a thematic condom advertising campaign in Pakistan in 2009. To evaluate the social marketing campaign for Touch condoms, the authors conducted a nationally representative survey of 1,606 men married to women aged 15-49 years. About 15% of urban married men were aware of Touch advertising. After controlling for a range of other variables including daily television viewership, confirmed awareness of Touch advertising was associated with a higher level of belief in the effectiveness of condoms, reduced embarrassment in negotiating condom use, reduced embarrassment in purchasing condoms, increased discussion of family planning, and increased use of condoms and other contraceptive methods. The findings have implications for the further development and dissemination of contraceptive advertising in Pakistan, as well as the broader construction of scientific knowledge on how advertising can influence contraceptive and other critical health behaviors in other contexts.

Health information seeking, diet and physical activity: an empirical assessment by medium and critical demographics.

PURPOSE: Research over the past decade has conveyed a dramatic rise in health information seeking via the Internet and articulated various profiles and outcomes of health information seeking. In building upon this research, the current study is innovative in considering predictors of health information seeking by medium, as well as outcomes of health information seeking by medium and by critical demographics. METHODS: OLS regression and logistic regression are conducted on data from a telephone survey of American adults in 2007 (N=700). RESULTS: Profiles of health information seekers vary dramatically by medium (Internet versus newspapers versus television). In terms of outcomes, newspaper health information seeking is associated with fruit and vegetable consumption, while television health information seeking is associated with sweetened soft drink consumption. There are four significant interaction terms between these two health information seeking variables and unhealthy snack consumption. Internet health information seeking has no significant effects. CONCLUSIONS: In comparison to the Internet, newspaper and television media have more favorable associations with recommended levels of lifestyle behaviors that may be critical in efforts to decrease obesity in the United States.

Hurricane Katrina: addictive behavior trends and predictors.

OBJECTIVES: Post-disaster trends in alcohol consumption and cigarette smoking, as well as their predictors, were identified. Methods. Data from cross-sectional and panel surveys of African American adults in New Orleans, Louisiana, were used from before (2004: n = 1,867; 2005: n = 879) and after (2006a: n = 500; 2006b: n = 500) Hurricane Katrina. RESULTS: Alcohol consumption increased significantly from pre- to post-Hurricane Katrina, while cigarette smoking remained constant. In 2006, posttraumatic stress disorder (PTSD) was associated with cigarette smoking, whereas "news attention" and "provided social support" were inversely associated with cigarette smoking. "News attention" was also inversely associated with cigarette smoking frequency, while "neighborliness" was associated with alcohol consumption. In addition, the effects of PTSD on alcohol consumption were moderated by "neighborliness." CONCLUSIONS: In the wake of Hurricane Katrina, there were complex predictive processes of addictive behaviors involving PTSD, news information, and social capital-related measures.

Evaluating a media campaign that targeted PTSD after Hurricane Katrina.

This study evaluates a media campaign that targeted posttraumatic stress disorder (PTSD) in New Orleans following Hurricane Katrina. Evaluation data come from telephone survey interviews of African Americans (N = 968), who were the target audience of the media campaign. Ordinary Least Squares (OLS) regression indicates over-time improvements in campaign attention, PTSD beliefs, and PTSD preventive behaviors, whereas PTSD remained constant. Structural equation modeling offers support for a multistep model in which campaign attention influences PTSD beliefs, which influence PTSD preventive behaviors, which, in turn, influence PTSD. There is one across-step path from campaign attention directly to PTSD preventive behaviors. These two sets of findings signify the media campaign's positive role in influencing beliefs and preventive behaviors. Although PTSD remained unchanged, the improvements in PTSD beliefs and preventive behaviors may have been a means to subsequent abatement in PTSD.