Influence of a counteradvertising media campaign on initiation of smoking: the Florida "truth" campaign.

OBJECTIVES: The purpose of this study was to assess the short-term effects of television advertisements from the Florida "truth" campaign on rates of smoking initiation. METHODS: A follow-up survey of young people aged 12 to 17 years (n = 1820) interviewed during the first 6 months of the advertising campaign was conducted. Logistic regression analyses were used to estimate the independent effects of the campaign on smoking initiation while other factors were controlled for. RESULTS: Youths scoring at intermediate and high levels on a media effect index were less likely to initiate smoking than youths who could not confirm awareness of television advertisements. Adjusted odds ratios between the media index and measures of initiation were similar within categories of age, sex, susceptibility, and whether a parent smoked. CONCLUSIONS: Exposure to the "truth" media campaign lowered the risk of youth smoking initiation. However, the analysis did not demonstrate that all such media programs will be effective.

The Florida "truth" anti-tobacco media evaluation: design, first year results, and implications for planning future state media evaluations.

OBJECTIVES: To outline the design and present selected findings from the evaluation of a state counter-advertising, anti-tobacco media campaign. The appropriateness of the design for states developing media evaluations is discussed. DESIGN: Four cross sectional, telephone surveys of the 12--17 year old population were used to track and monitor advertising and campaign awareness, confirmed awareness, and receptivity. The Florida baseline and one year surveys were used with two parallel national surveys in a quasi-experimental design to assess attitude and smoking related behaviour change attributable to the campaign. MEASURES: Awareness was measured by self report, confirmed awareness by unaided description, and receptivity by self reports of how well advertisements were liked, talked to friends about, and made one think about whether or not to smoke. Eleven attitude and three smoking behaviour items for Florida (treatment) and a national (control) population were compared at baseline and after 12 months. RESULTS: Significant increases in ad specific awareness, confirmed, receptivity, and campaign awareness, and confirmed awareness were reached by the sixth week. They continued to rise through the first year. No attitude and only minor behaviour differences were noted between the treatment and comparison populations at baseline. By the end of the first year, Florida youth had stronger anti-tobacco attitudes and better behaviour patterns than the comparison population. CONCLUSIONS: The industry manipulation strategy used in the Florida campaign resulted in high rates of recall, significant changes in attitudes/beliefs, and reduced rates of smoking behaviour among youth.

HIV transmission risks of females and males in paired partner relationships.

As the HIV/AIDS epidemic has evolved, heterosexual behaviors have come to be an increasingly important mode of transmission and rates of infection have increased faster among women generally and minority women in particular. Most of what we known about heterosexual risk taking is based on survey data collected from either women or men. These data have been useful for helping to understand different levels and types of risk taking by women and men. However, they provide little information about the levels of risk taking that exist for paired partners in main partner relationships, the types of risks each partner brings to the relationship and how the contribution of partner risks varies. Using data from the pretest of a pilot project designed to test a behavioral intervention to reduce HIV/AIDS transmission among main sex partners, the authors developed four subscales of sexual risk taking for each partner. The association between subscales within and between genders are examined and the subscales are combined to obtain measures of couple risks. Particular attention is given to the gender contribution of partners to couple risk and the differential contribution of types of risk to total risk. The data suggest that, even though men bring relatively higher risks to their main partner relationship than women, this varies inversely with the level of couple risk.

Florida's "truth" campaign: a counter-marketing, anti-tobacco media campaign.

The "truth" campaign was created to change youth attitudes about tobacco and to reduce teen tobacco use throughout Florida by using youth-driven advertising, public relations, and advocacy. Results of the campaign include a 92 percent brand awareness rate among teens, a 15 percent rise in teens who agree with key attitudinal statements about smoking, a 19.4 percent decline in smoking among middle school students, and a 8.0 percent decline among high school students. States committed to results-oriented youth anti-tobacco campaigns should look to Florida's "truth" campaign as a model that effectively places youth at the helm of anti-tobacco efforts.

The industry manipulation attitudes of smokers and nonsmokers.

A cross-sectional random sample was obtained of Florida youth between the ages of 12-17. Data were collected through a telephone survey after obtaining parent and child consent. Industry manipulation attitudes of three groups (self-identified nonsmokers who did not use cigarettes in the past 30 days, self-identified nonsmokers who used cigarettes in the past 30 days, and self-identified smokers who used cigarettes in the past 30 days) were compared. Constraints resulting from the method of data collection resulted in a conservative estimate of the strength of the association between industry manipulation attitudes and smoking behavior.

Relationship dynamics, ethnicity and condom use among low-income women.

CONTEXT: Women's protection against HIV and sexually transmitted diseases (STDs) depends upon their ability to negotiate safer sex. It is important to know how cultural norms and gender roles, which vary by ethnicity, may either constrain or encourage negotiation of condom use. METHODS: Questionnaires were completed by 393 low-income non-Hispanic black, Hispanic and non-Hispanic white women who were sexually active and attending family planning and STD clinics and other public health and social service centers in Miami in 1994 and 1995. Multivariate logit techniques were used to identify ethnic differences in relationship dynamics and to determine couple- and individual-level factors associated with consistent use, occasional use or nonuse of condoms. RESULTS: Black and Hispanic women reported higher levels of consistent condom use (15-17%) than did white women (4%). Nearly all black and white women (90-95%) said that they were extremely or somewhat comfortable talking about condoms with their partner, whereas 76% of Hispanic women did so. A larger proportion of Hispanic women (55%) reported joint contraceptive decision-making than did black women (26%) or white women (31%). Among women who reported that their partner made contraceptive decisions, 28% used condoms consistently or occasionally, compared with 24% among women who made the decision themselves. When the couple made the decision jointly, 41% of them were condom users. Hispanic women scored the lowest on a scale of condom-related self-efficacy, yet also reported the highest levels of confidence in their condom negotiating skills. Multivariate analysis indicated that, compared with white women, black and Hispanic women were more likely to be consistent condom users than nonusers (odds ratios, 10.2 and 18.9, respectively). Women who shared financial decision-making with their partner were almost 80% less likely to be a consistent condom user, and women who did not participate in financial decisions were more than 90% less likely to do so, than were women who made monetary decisions independently. CONCLUSIONS: HIV prevention and intervention programs should emphasize birth control discussion between partners and the development of condom-related self-efficacy and negotiation skills, and these programs also should customize prevention messages according to ethnicity and social context.

Dual-method use among an ethnically diverse group of women at risk of HIV infection.

CONTEXT: Few U.S. women protect themselves against both pregnancy and sexually transmitted diseases (STDs) by using an efficient contraceptive method and a condom. Understanding the factors that influence dual-method use could help improve interventions aimed at encouraging protective behaviors. METHODS: Interviews were conducted with 552 low-income women at risk of HIV who attended public health or economic assistance facilities in Miami in 1994 and 1995. Multinomial logit analyses were used to determine the influence of women's background characteristics, perceived vulnerability to pregnancy and AIDS, and relationship characteristics on the odds of dual-method use. RESULTS: Overall, 20% of the women used dual methods. Women who were not married, who worried about both pregnancy and AIDS, who had ever had an STD, who were confident they could refuse a sexual encounter in the absence of a condom and who made family planning decisions jointly with their partner were the most likely to use dual methods rather than a single method (odds ratios, 2.0-3.5); those who considered the condom only somewhat effective in preventing AIDS or who shared economic decision-making with their partner were the least likely to use dual methods rather than a single method (0.5-0.6). The results were generally similar in analyses examining the odds of dual-method use involving an efficient contraceptive, except that black and Hispanic women were significantly more likely than whites to use condoms in conjunction with efficient contraceptives (3.3-7.1). CONCLUSIONS: Both women's individual characteristics and the context of their sexual relationships influence whether they simultaneously protect themselves from pregnancy and HIV. The involvement of male partners in family planning decision-making and women's control over economic decision-making ensure greater protection against HIV infection.

PIP: Promotion of condom use among women who use efficient contraception is essential to protect them from sexually transmitted diseases (STDs), including HIV, as well as pregnancy. However, fear of negative reactions from a male partner may prohibit dual method use among women who are economically dependent on men. To understand the factors that influence dual method use, interviews were conducted with 522 low-income US women at risk of HIV who attended 21 public health, family planning (FP), and STD clinics or economic assistance centers in Miami, Florida (US), in 1994-95. 54% were concerned about both pregnancy and AIDS; 32% were worried about AIDS only and 5% about pregnancy only. 20% of respondents reported dual method use; overall, 36% of women used condoms (either alone or along with another method). The rate of dual method use was 16% among Whites, 24% among Blacks, and 21% among Hispanics. The likelihood of dual method use was significantly enhanced (odds ratio, 2.0-3.5) among women who were not married, worried about both pregnancy and AIDS, had ever had an STD, were confident they could refuse sex with a man who would not use a condom, and made FP decisions jointly with their partner. Women who regarded condoms as only somewhat effective in preventing HIV infection or who shared economic decision-making with their partner rather than making such decisions alone were least likely to use dual methods. Black and Hispanic women were significantly more likely than White women to use condoms in conjunction with efficient contraception.

Ethnic differences in sexual decisions and sexual behavior.

Previous investigators have reported ethnic differences in the expression of sexual decision making and sexual behaviors in women. In a sample of women of low socioeconomic status between ages 18 and 45, we examined the influence of ethnicity and other variables (age, education, marital status, and comfort in discussing sex) on (i) who makes decisions on the timing and type of sex, (ii) whether a woman engages in vaginal, oral, and anal sex, (iii) the frequencies of each type of sex, and (iv) whether or not a woman has multiple partners. Multivariate analyses showed that, independent of other independent variables, ethnicity had little direct effect on most variables. The notable exception was that ethnicity influenced joint decision making regarding the timing and type of sexual activities for Hispanic but not for African American women. We conclude that ethnicity contributes to differences in sexual behaviors but that other variables are equally important.

Magic Johnson and children's conceptions of AIDS.

Longitudinal data for a heterogeneous sample of 609 elementary school children are used to assess the long-term effects of Magic Johnson's announcement on children's HIV and AIDS conceptions. Four hypotheses are tested concerning these relationships, and background variables measured prior to Johnson's announcement are controlled. Findings suggest that Johnson's announcement increased children's HIV and AIDS knowledge and reduced their prejudice toward a hypothetical child with AIDS. No relationship is evident between the announcement and perceived vulnerability to HIV and AIDS. Males are more likely to be aware of Johnson's announcement, but its effects are more pronounced among blacks. Findings from the present research affirm the potential for celebrities like Johnson in HIV and AIDS education campaigns directed toward children.

Factors associated with use of the female condom.

Black, Hispanic and white women recruited for an HIV prevention intervention were instructed in the use of the female condom and encouraged to try the device. Of the 231 women who completed the intervention, 29% tried the condom over the course of a month; 30% of those who tried it used it during at least half of their sexual encounters. Both ethnicity and age were associated with trying the device: Nearly 40% of black women and 30% of Hispanic women did so, compared with 18% of white women; 37% of those aged 25-34 tried the female condom, compared with 22% of women younger than 25. Trying the device was more likely among women living with a partner, those with a history of sexually transmitted disease infection, women who had had an HIV test, those who did not believe that the method afforded them a greater degree of overall control than did the male condom and those who had no prior knowledge of the device. Among women who used the device during at least half of their sexual encounters, 27% were black and 44% were Hispanic: 38% were younger than 25, and 43% were single. More regular users were about half as likely as less regular users to experience difficulty with insertion and one-eighth as likely to report the device slipping during use; they were more likely than less regular users to report that sex was more pleasurable with the female condom than with the male condom.

PIP: As part of a project to test a behavioral intervention for women at risk of human immunodeficiency virus (HIV), women recruited from sexually transmitted disease clinics, family planning clinics, and state economic service centers in Miami, Florida (US), during 1994-95 were offered free supplies of the female condom. 66 of 231 program participants (29%) tried the female condom; 20 (30%) used it for more than half of their sexual encounters in a 1-month period. Both ethnicity and age were associated with acceptance of female condoms. 40% of Black women, 30% of Hispanic women, and 18% of White women tried the female condom; 37% of those 25-34 years old compared with 22% of women younger than 25 years used the device. Among women who used the female condom for more than half their sexual encounters, 27% were Black and 44% were Hispanic; 38% were under 25 years old and 43% were single. 47% of users had a positive response to the method at first use; after 1 month of use, this rate rose to 75%. 85% of women felt more in control of disease protection for themselves when using the female condom than the male condom. Finally, regular users were about half as likely as irregular users to experience difficulty with condom insertion and more likely to report that sex was more pleasurable with the female condom than the male condom. These findings suggest the female condom could be an important element in HIV prevention campaigns, especially those targeted to Black and Hispanic women, and that method satisfaction increases with regular use.

The association between substance use, condom use and sexual risk among low-income women.

Substance use is frequently assumed to be associated with higher levels of sexual risk-taking and lower levels of condom use. An analysis of 668 black, Hispanic and white low-income women at public health and public assistance facilities in Miami show that 19% engaged in risky sexual behavior over the preceding six months, 24% in substance use and 31% in condom use. Overall, substance users are nearly four and one-half times more likely to take sexual risks than nonusers, but are about half as likely to have relied on condoms. When the probability of condom use is considered in the context of both substance use and sexual risk, substance users who take sexual risks appear just as likely to rely on condoms as are nonusers who take sexual risks and those who do not (odds of 0.43-0.49). However, substance users who do not take sexual risks are much less likely to use condoms (odds of 0.15). This pattern holds among black, Hispanic and white women, and suggests that perceptions of risk and the risks that partners bring to sexual encounters may be more important determinants of condom use than substance use per se.

PIP: 668 Black, White, and Hispanic low-income women at 21 public health, sexually transmitted disease (STD), and family planning clinics or state economic service centers in Miami provided data on their sex behavior, drug and alcohol consumption, and condom use. The data were collected from September 1994 through February 1995. Any participant who reported having had sex with three or more partners in the preceding 6 months, exchanging sex for drugs or money in the preceding 6 months, or having a sex partner who they believe has had sex with men or had injected drugs was classified as a sexual risk-taker. Any woman who had taken any recreational drugs in the past 6 months or had drank alcohol before having sex over the same period was classified as a substance user. 19% of the women engaged in risky sex behavior over the preceding 6 months, 24% in substance use, and 31% in condom use. Overall, the substance users are almost 4.5 times more likely to take sexual risks than nonusers, and about half as likely to have used condoms. Substance users who take sexual risks seem just as likely to use condoms as nonusers who take sexual risks and those who do not. However, substance users who do not take sexual risks are far less likely to use condoms. This pattern holds among Black, White, and Hispanic women, and suggests that perceptions of risk and the risks that partners bring to sexual encounters may be more important determinants of condom use than substance use alone.

The Development and Implementation of a Cognitive-Based Intervention Aimed at Culturally Diverse Women at Risk for HIV/AIDS.

The development and implementation of a culturally and gender sensitive, cognitive behavioral-intervention program aimed at preventing high-risk sexual and drug-use behaviors among culturally diverse women at risk for HIV/AIDS is described. The intervention stressed education, cultural/social barriers to change, and assertiveness/negotiation skill building. Methodological problems and their solutions are presented. The article stresses ways to recruit poor at-risk women, how to reduce attrition using incentives such as providing transportation, having food and child care at the intervention sessions, financial rewards, and a tracking system that includes many friends and family members of the participant. Preliminary findings indicated that the intervention was successful in promoting knowledge about HIV/AIDS. At the end of the six-week intervention protocol, the intervention group compared to the control group showed significant improvements in HIV/AIDS knowledge items dealing with clinical aspects of the disease, transmission knowledge, and partner risk knowledge. Knowledge, along with motivation to reduce risk and negotiation skills are essential in changing behaviors that put one at risk.

Early childhood differentials in mother-child AIDS-information interaction.

To date there have been no systematic inquiries into 1) the extent of parent-child AIDS interaction; or 2) the factors that influence whether young children and their parents talk about AIDS. In our sample, from a medium-sized Southern metropolitan area, 70 percent of mothers of children in the first, third, and fifth grades said they had talked to their child about AIDS, but only 41 percent of the mothers said their child had asked them questions about AIDS. Fourteen hypotheses about factors which might influence mother-child AIDS interaction are derived from the health/sex socialization literature. In the process of testing these bivariate hypotheses it is shown that, although sons and daughters are equally likely to ask their mother questions about AIDS, mothers are more likely to talk to their daughters than their sons about AIDS. This pattern maintains even after controls are introduced. It is suggested that discussing AIDS with young children as a health issue rather than waiting until adolescence and discussing it as a sex issue may be a more effective socialization route. Mothers may be able to do this with young daughters in the context of women's health, but because most AIDS education for adults generally is sex- rather than health-oriented they may lack the knowledge and framework to do this with their sons.

Population policies in industrialized nations: reactive or proactive?

PIP: This paper considers policy shifts regarding demographic behavior in industrialized countries in light of both trends in such behavior over the recent past as well as projections of this behavior according to the United Nations mid-range assessments prepared in 1988. Recent trends in population change and their projections were presented in a group of four industrialized regions and the appropriateness of policy and policy change in light of perceptions was also considered for future policy direction. Demographic change in industrialized nations from 1965 to 2025 revealed that the population would grow to 1.5 billion; however, the share of northern and western Europe would decline from 21% to 16%. Fertility would remain 5-10% below replacement level. There would also be a further increase of 4 years in life expectancy until 2025, with the longest extensions in eastern Europe (5 years or 8%). During the past several decades the industrial regions' populations residing in urban areas has risen from 62% to 72%, and this is projected to continue to rise to 79% by 2025, with the greatest increases in southern and eastern Europe. The share of dependents who are at least 65 years old is likely to double from its initial level of about 25%. Government views on demographic behavior from 1976 and 1989 are also compared and summarized. Perception and policies on the rate of population growth changed in 6 countries between 1976 and 1989. Cyprus and Hungary had shifted policies towards enhancing the rate of population growth. Regarding the fertility rates, 8 countries changed perceptions; in Switzerland, Cyprus, and Romania the policy regarding access to contraception was changed. Regarding international migration, 10 governments reported a shift in their perception and 4 indicated previous dissatisfaction for the change, which became more restrictive. Regarding mortality, 8 countries considered that the level had become unacceptable, 4 of these in eastern Europe.^ieng

Number and timing failures among births in Indonesia.

PIP: The 1987 Indonesian Demographic and Health Survey was used to find out if each birth a women had in the 5 years preceding the survey was wanted when she became pregnant, wanted later, or not wanted at all. Data collection took place from mid-September to the third week of December and it covered nearly 15,000 households where 11,884 ever married women ages 15-49 were interviewed. The wantedness of births was divided into: 1) wanted then, 2) timing failure (wanted, but at a later time), and 3) number failure (not wanted at all). Results showed that 72.2% of these births in the last 5 years were wanted then, 21% were timing failures, and 6.8% were number failures. Among current pregnancies 13.5% were not wanted compared to 8% among the last births. And also among current pregnancies 21.8% were timing failures compared to 23% of last births. Birth prevention behavior and contraceptive use were also examined. 4.2% were pregnant contraception users who got pregnant in spite of efforts to avoid pregnancy; 24.4% were interval users who used some kind of method during the interval preceding pregnancy; 23.6% were past users who used a method but not during the interval preceding the pregnancy occurrence; and 47.7% were never users of any contraceptive method. Among births classified as wanted later, 17.6% were to pregnant users, 22.3% to interval users, and only 38.3% to never users. Altogether 43% of the births were preceded by the use of the pill; 18.1% by the use of IUD; and 15.6% by the use of injections. Logistic multiple regression analysis also showed that the urban residence as an indicator of exposure to modernism was positively related to number and timing failure. However, maternal education and frequent radio listening were positively associated with timing failure but not with number failure. Controlling reproduction in a high fertility country like Indonesia may be focused on postponing births because this may be more socially acceptable than restricting it.^ieng

Young children's awareness, knowledge, and beliefs about AIDS: observations from a pretest.

Starting from the assumption that AIDS education can be most effective when initiated prior to the age when AIDS risk behaviors emerge, a number of researchers and public health officials have advocated AIDS education for preadolescents. Yet there have been few published reports assessing children's awareness, knowledge, and attitudes about AIDS and persons with AIDS. In this paper, basic data are presented for each of these dimensions broken down by race, gender, and grade. The data suggest that, although many students are aware of AIDS by the first grade, it is not until the fifth grade that nearly all students are aware of the existence of the disease. Over all, nearly 44% of the students who know about the disease believe that they or someone they know will get it. Students in the fifth grade have a higher level of AIDS knowledge than those in the first grade, but even the former are relatively uniformed and have a number of misconceptions about the disease and persons with it. Children's attitudes reflect confusion and some anxiety over AIDS and the treatment of persons with it. Some significant race and gender differentials are noted.

Proximate determinants of child mortality in Liberia.

The study looks at the effects of maternal sociodemographic characteristics and the quality of the environment on child survival through two intervening variables, breast-feeding and prenatal care. A linear structural equation modelling approach was used to examine infant and child survival based on a weighted sample of 5180 Liberian children aged 0-5 years. The findings confirm previous studies, but also reveal complex relationships of the role of education, maternal age and breast-feeding in enhancing child survival.

PIP: The hypothesis that female education has a positive direct influence on child survival was investigated through the use of data from the 1986 Demographic and Health Survey of Liberia. Of the 5180 children born in the 5 years preceding the survey, 873 (17%) had died. Even when other socioeconomic variables were controlled, maternal education had a significant positive direct effect (0.167) on child survival at 5 years of age. The percentage of child loss was 17.9% among mothers with no education, 15.5% among those with a primary education, and 14.0% among mothers with an education above the primary level. This effect was weak, however, when compared to that of breastfeeding. The proportion of child mortality was 41.7% among non-breastfeeding mothers compared to only 8.9% among breastfeeding mothers. To the extent that high maternal educational decreased the propensity to breastfeed in this sample, education has a negative indirect effect on child survival--an effect that is counterbalanced somewhat by the tendency of education to increase the likelihood of obtaining prenatal care, the most important source of knowledge about child health. Moreover, prenatal care has the strongest direct effect on breastfeeding status. The excess risk of child mortality among teenage mothers in this survey (19.8%, compared to 14.9% among mothers 35 years of age and above) is believed to reflect to decreasing prevalence of breastfeeding in younger age groups. Overall, the risk of child death was greater in rural areas (17.75) than urban ones (15.6%), but, for breastfed children, the risk was lower in rural areas. These findings indicate a need for greater attention toward promoting breastfeeding as the central element of child survival campaigns.

The component structure of elderly population growth in the Netherlands: 1950-1980.

"While there is no doubt about the magnitude of the growth of older age groups in industrialized nations, its structural components are less well understood. This paper examines the roles played by cohort succession and mortality in the process for the Netherlands during the period 1950 to 1980. While the size of the population aged 65 and over has increased for both males and females, increases in the size of succeeding cohorts explain all of the growth in the older male population. Reductions in mortality at the older old ages play a much greater role than do reductions at younger old ages; the latter reductions occur among females only." (SUMMARY IN FRE)

The impact of children on the components of parental savings: the case of rural Syria.

"This study is based on a survey conducted by the two authors in 1980 on family income and costs in the rural areas of [Syria. It] examines the indirect impact of children on family savings...with the hypothesis that the number of children has a positive effect on parents' income and a negative effect on their costs.... The conclusions point out that children play a major role in affecting the types of parents' income and expenditure and that increasing the number of children leads to increasing the time during which the parents undertake productive economic activities...."