Developmental Programming: Priming Disease Susceptibility for Subsequent Generations.

Racial and/or ethnic minorities carry the highest burden of many adverse health outcomes intergenerationally We propose a paradigm in which developmental programming exacerbates the effects of racial patterning of adverse environmental conditions, thereby contributing to health disparity persistence. Evidence that developmental programming induces a heightened response to adverse exposures ("second hits") encountered later in life is considered. We evaluated the evidence for the second hit phenomenon reported in animal and human studies from three domains (air, stress, nutrition). Original research including a gestational exposure and a childhood or adulthood second hit exposure was reviewed. Evidence from animal studies suggest that prenatal exposure to air pollutants is associated with an exaggerated reaction to postnatal air pollution exposure, which results in worse health outcomes. It also indicates offspring exposed to prenatal maternal stress produce an exaggerated response to subsequent stressors, including anxiety and hyper-responsiveness of the hypothalamic-pituitary-adrenal axis. Similarly, prenatal and postnatal Western-style diets induce synergistic effects on weight gain, metabolic dysfunction, and atherosclerotic risk. Cross-domain second hits (e.g., gestational air pollution followed by childhood stressor) were also considered. Suboptimal gestational environments induce exaggerated offspring responses to subsequent environmental and social exposures. These developmental programming effects may result in enhanced sensitivity of ongoing, racially patterned, adverse exposures in race/ethnic minorities, thereby exacerbating health disparities from one generation to the next. Empirical assessment of the hypothesized role of priming processes in the propagation of health disparities is needed. Future social epidemiology research must explicitly consider synergistic relationships among social environmental conditions to which gestating females are exposed and offspring exposures when assessing causes for persistent health disparities.

The drug Czar's anti-drug media campaign: continuing concerns.

In reviewing the anti-drug media campaign organized by the Office of National Drug Control Policy (ONDCP), we expressed concern about both its strategic direction and execution (Journal of Health Communication, 1999, 4:2 155-160). The response from ONDCP's director, General Barry R. McCaffrey, still leaves us concerned about the campaign's chances for success. We review ONDCP's strong opposition to including alcohol in the campaign, its continued reliance on fear appeals, and its relative inattention to building support for environmental prevention strategies. We voice again our concerns about ONDCP's underutilization of an expert review committee of behavioral scientists.

The California Violence Prevention Initiative: advancing policy to ban Saturday night specials.

The California Violence Prevention Initiative (VPI) was conceived in 1993 as a 5-year, $35 million comprehensive community, media, research, and policy advocacy effort to reduce violence among youth. The VPI included an emphasis on three broad policy areas: shifting society's definition of violence to include a public health perspective, reducing access to alcohol and other drugs, and limiting availability of handguns. For the first 3 years of the VPI, the policy focus was on reducing the availability of handguns to youth through efforts to ban the manufacture and sale of Saturday night specials (SNSs). Prior to the VPI, there were no local SNS bans. Now, there are bans in 41 California jurisdictions, including major population centers. After two vetoes of a statewide legislative ban by the former governor, an SNS ban was signed by a newly elected governor.

A critical perspective on the drug czar's antidrug media campaign.

The US government's Office of National Drug Control Policy (ONDCP) launched its new antidrug media campaign in July 1998. The campaign is likely to increase awareness of the youth drug problem, but shortcomings in the campaign's early implementation raise questions about its potential for changing behavior. Shortcomings include: a) The first wave of ONDCP's television advertisements are focused on reinforcing problem awareness but do not model skills or provide other information necessary for behavior change; b) the campaign provides insufficient focus on promoting drug treatment and citizen involvement in local prevention activities, including political action; c) the campaign is being implemented without a major new investment in drug-treatment programs or community-based prevention programs; d) The campaign does not substantively address alcohol and tobacco, which pose a clear threat to health and serve as a "gateway" to illicit drug use; and e) the first wave of television advertisements use exaggerated fear appeals, a strategy shown by research rarely to be successful. Only time will tell whether the ONDCP media campaign will succeed or fail. Using past research as a guide, there is legitimate reason for concern that the campaign will not live up to expectations.

Youth and violence on local television news in California.

OBJECTIVES: This study explores how local television news structures the public and policy debate on youth violence. METHODS: A content analysis was performed on 214 hours of local television news from California. Each of the 1791 stories concerning youth, violence, or both was coded and analyzed for whether it included a public health perspective. RESULTS: There were five key findings. First, violence dominated local television news coverage. Second, the specifics of particular crimes dominated coverage of violence. Third, over half of the stories on youth involved violence, while more than two thirds of the violence stories concerned youth. Fourth, episodic coverage of violence was more than five times more frequent than thematic coverage, which included links to broader social factors. Finally, only one story had an explicit public health frame. CONCLUSIONS: Local television news provides extremely limited coverage of contributing etiological factors in stories on violence. If our nation's most popular source of news continues to report on violence primarily through crime stories isolated from their social context, the chance for widespread support for public health solutions to violence will be diminished.

Media advocacy: a strategy for advancing policy and promoting health.

The purpose of media advocacy is to promote public health goals by using the media to strategically apply pressure for policy change. It provides a framework for moving the public health discussion from a primary focus on the health behavior of individuals to the behavior of the policymakers whose decisions structure the environment in which people act. It addresses the power gap rather than just the information gap. Media advocacy focuses on public policy rather than personal behavior. This article uses two case studies to illustrate key aspects of media advocacy. The first is a 5-year statewide violence prevention initiative for young people in California. The second focuses on the activities of a mothers' group working to improve public housing. The "new public health," with its focus on participation, policy development, and political processes, could benefit from incorporating media advocacy.

Television beer advertising and drinking knowledge, beliefs, and intentions among schoolchildren.

OBJECTIVES: The relationships between television beer advertising and drinking knowledge, beliefs, and intentions were investigated in a survey of schoolchildren. The research was guided by a theoretical model specifying that awareness of advertising, and not mere exposure, is necessary for it to have an effect on beliefs or behaviors. METHODS: Participants were a random sample of 468 fifth- and sixth-grade schoolchildren from a northern California community. Data were collected in the home with a combination of self-administered questionnaires and structured interviews. RESULTS: Nonrecursive statistical modeling indicated that awareness of television beer advertising was related to more favorable beliefs about drinking, to greater knowledge of beer brands and slogans, and to increased intentions to drink as an adult. The effects of advertising awareness on knowledge, beliefs, and intentions were maintained when the reciprocal effects of beliefs, knowledge, and intentions on awareness were controlled. CONCLUSIONS: The findings suggest that alcohol advertising may predispose young people to drinking. As a result, efforts to prevent drinking and drinking problems among young people should give attention to countering the potential effects of alcohol advertising.

Media advocacy: a strategy for empowering people and communities.

Media advocacy is a new strategy that is emerging in the public health community. It has been particularly visible in communities of color. Media advocacy is defined as the strategic use of mass media to advance public policy initiatives. Media advocacy is rooted in community advocacy and has as its goal the promotion of healthy public policies. It can be differentiated from traditional mass media strategies in a number of ways. Media advocacy shifts the focus from the personal to the social, from the individual to the political, from the behavior or practice to the policy or environment. While traditional media approaches try to fill the "knowledge gap," media advocacy addresses the "power gap." Improvements in health status are believed to come about primarily from gaining more power over the policy environment rather than simply gaining more knowledge about health behaviors.

Advertising health: the case for counter-ads.

Public service advertisements have been used by many in hopes of "selling" good health behaviors. But selling good behavior--even if it could be done more effectively--is not the best goal for using mass media to prevent health problems. Personal behavior is only part of what determines health status. Social conditions and the physical environment are important determinants of health that are usually ignored by health promotion advertising. Public service advertising may be doing more harm than good if it is diverting attention from more effective socially based health promotion strategies. Counter-ads are one communications strategy that could be used to promote a broader responsibility for rectifying health problems. In the tradition of advocacy advertising directly promoting policy rather than products, counter-ads promote views consistent with a public health perspective. Counter-ads set the agenda for health issues, conferring status on policy-oriented strategies for addressing health problems. The primary purpose of counter-ads is to challenge the dominant view that public health problems reflect personal health habits. They are controversial because they place health issues in a social and political context. Advertising strategies for health promotion range over a spectrum from individually oriented public service advertising to socially oriented counter-advertising. The recent anti-tobacco campaign from the California Department of Health Services represents advertisements across the spectrum. Counter-ads that focus on a politically controversial definition for health problems are an appropriate and necessary alternative to public service advertising.

A critical analysis of "moderation" advertising sponsored by the beer industry: are "responsible drinking" commercials done responsibly?

This analysis reveals several important advertising trends by the U.S. beer industry, whose purported aim has been to promote "moderation" in drinking. First, the brewers' prevailing interest in promoting consumption has resulted in the use of slogans and messages that ignore the fact that certain people should not drink at all, and, in certain circumstances, that no one should drink. Second, these ads do not consistently make clear that the acts of drinking and driving should remain entirely separate. Third, several aspects of these commercials undermine whatever moderation message they may provide, in particular the use of themes and images that are similar to the beer companies' regular brand promotions. In order to present an acceptable public health message, moderation advertising must not be dominated by glamorous presentations of alcohol consumption. In short, it must be done more responsibly.

Advertising for all by the year 2000: public health implications for less developed countries.

This paper argues that the development of global advertising has significant implications for the public health of less developed countries. These implications can be seen in three areas. First, it is clear that advertising and marketing of lethal or health-compromising products like alcohol and tobacco not only can increase the level of death and disease, but can also produce serious indirect effects upon families, communities, and entire societies. Second, advertising promotes a consumption ethic which can have far-reaching effects that go beyond individual behavior, significantly altering social relationships, and influencing public policies and allocation of scarce resources. Third, advertising can restrict the public's knowledge about health issues by substituting distorted and manipulative sales messages for vital, accurate health information. In addition, revenues from advertising are a primary support for many mass media systems and this further limits the presentation of critical information.

PIP: It is unlikely that the 1978 Declaration of Alma-Ata goal of health for all by the year 2000 will be realized by the turn of the century. The authors consider the potential public health impact of advertising on developing countries, highlighting key advertising issues. The advertising of processed foods, soft drinks, cigarettes, beer and wine, drugs, and toiletries account for 80-90% of all international advertising expenditures. The new communications technologies make it possible for advertisers to bypass national boundaries and pay less attention to the regulations and/or values of individual target countries. The emergence of global advertising and the various categories of advertising's effects are discussed. The effects of advertising are so diverse and broadly distributed across various sectors of society, the specific effects of advertising are virtually impossible to isolate. The promotion of alcohol and tobacco is nonetheless discussed, followed by consideration of the promotion of consumerism and limits on the flow of health information.

The role of designated driver programs in the prevention of alcohol-impaired driving: a critical reassessment.

We review the "designated driver" concept and the current debate over its role in preventing alcohol-impaired driving. In our view, the focus on this strategy by broadcasters, the alcohol industry, and various public service groups has deflected attention from other alcohol-related problems that account for the vast majority of deaths and injuries associated with alcohol use. This focus has also distracted many public health advocates and policymakers from the bigger and more important jobs of increasing public awareness of the social, environmental, and economic factors that influence alcohol consumption and promoting debate on legislation and other public policy solutions to alcohol-impaired driving. As part of a comprehensive strategy, we strongly encourage a renewed focus on "sobriety checkpoints," strict enforcement of laws against alcohol sales to minors, alcohol advertising reform, increased excise taxes, and other public policy initiatives supported by the Surgeon General. These measures will curb underage and heavy alcohol consumption and will create a legal and social environment in which individuals are motivated to avoid impaired driving through several alternative strategies, including but not limited to the use of designated drivers.

Health messages on television commercials.

BACKGROUND AND PURPOSE: Television is an important source of health information in the United States, yet little research has focused on the presentation of general health issues on television. This preliminary study reports on the health-related content of television commercials found on a typical television day. METHODS: We conducted a content analysis of a composite day of television comprising 20 hours randomly selected over a three week period (April-May 1989). Findings are presented regarding health messages found in commercial time--advertisements, public service announcements (PSAs), editorials, and promotions for upcoming programs. RESULTS: Overall, 31% of the 654 commercial spots contained health messages. Most health messages were claims of good nutrition in food and beverage advertisements. PSAs comprise 1.4% of the 20-hour sample and 5.8% of the commercial time. Health messages appeared in 38% of PSAs, accounting for less than seven minutes. Not one PSA addressed tobacco, alcohol, or diet--the three leading behavioral risk factors for poor health. DISCUSSION: PSAs are usually seen as a mechanism by which the public health community can alert the public to important health issues. Given the declining pool of PSA time, public health educators will need to seek alternative strategies for influencing television content, such as media advocacy. In addition, further research on audience interpretation and response to commercial messages is suggested.

Portrayals of alcohol on prime-time television.

Alcohol portrayals were analyzed for a 3-week composite sample of prime-time fictional television programs aired in the fall of 1986. Approximately 64% of the 195 episodes contained one or more appearances of alcohol. Alcohol was ingested on 50% of all programs. Overall, there were 8.1 alcohol drinking acts per hour. Movies made-for-television had the highest rate of drinking acts per hour (10.0) followed by situation comedies (9.2) and then theatrical movies (7.4) and dramas (7.4). Within the category of dramas, evening soap operas stand out with 13.3 acts per hour. Drinking and nondrinking characters were compared on a number of attributes relevant to role modeling. Regularly appearing characters were more likely to drink than nonregular characters. Drinking characters also tended to be of high status, largely being white, upper-class professionals. A time trend analysis showed a regular increase in alcohol on television from 1976 to 1984, reaching 10.2 acts in 1984. After 1984 the trend appears to reverse.

Alcohol advertising in college newspapers: a 7-year follow-up.

The authors report on the frequency and nature of alcohol advertisements in a representative sample of college newspapers from 1984/85 and compare these with results of a similar study conducted 7 years earlier, in 1977/78. On average, nearly 24 column inches of space per issue were devoted to national alcohol advertisements in 1984/85. This represents a significant decrease from an earlier period. The space devoted to national alcohol advertisements, however, still far exceeded that for comparison products (books, soft drinks). Local alcohol advertisements averaged 20 column inches per issue and were somewhat more frequent than in the previous study. The content of the advertisements differed markedly from the messages presented 7 years earlier. Although national alcohol advertisements in 1977/78 frequently ridiculed education and study, none did so in 1984/85, when appeals were to taste and product quality instead. Fantasy themes also were relatively common. Very few national alcohol advertisements featured athletes or group drinking. Sponsorship of campus activities by the alcohol industry, however, had increased since the earlier study. In contrast to national advertisements, many local advertisements consisted of inducements to drink through special offers and happy hours. Some encouraged irresponsible and heavy drinking. Interestingly, alcohol advertisements were just as frequent in papers from states with higher minimum drinking ages and were more frequent in papers from campuses with higher proportions of women students.