Evaluation of smoking prevention television messages based on the elaboration likelihood model.

Progress in reducing youth smoking may depend on developing improved methods to communicate with higher risk youth. This study explored the potential of smoking prevention messages based on the Elaboration Likelihood Model (ELM) to address these needs. Structured evaluations of 12 smoking prevention messages based on three strategies derived from the ELM were conducted in classroom settings among a diverse sample of non-smoking middle school students in three states (n = 1771). Students categorized as likely to have higher involvement in a decision to initiate cigarette smoking reported relatively high ratings on a cognitive processing indicator for messages focused on factual arguments about negative consequences of smoking than for messages with fewer or no direct arguments. Message appeal ratings did not show greater preference for this message type among higher involved versus lower involved students. Ratings from students reporting lower academic achievement suggested difficulty processing factual information presented in these messages. The ELM may provide a useful strategy for reaching adolescents at risk for smoking initiation, but particular attention should be focused on lower academic achievers to ensure that messages are appropriate for them. This approach should be explored further before similar strategies could be recommended for large-scale implementation.

Youth audience segmentation strategies for smoking-prevention mass media campaigns based on message appeal.

Mass media interventions are among the strategies recommended for youth cigarette smoking prevention, but little is known about optimal methods for reaching diverse youth audiences. Grades 4 through 12 samples of youth from four states (n = 1,230) rated smoking-prevention messages in classroom settings. Similar proportions of African American, Hispanic, and White youth participated. Impact of audience characteristics on message appeal ratings was assessed to provide guidance for audience segmentation strategies. Age had a strong effect on individual message appeal. The effect of gender also was significant. Message ratings were similar among the younger racial/ethnic groups, but differences were found for older African American youth. Lower academic achievement was associated with lower appeal scores for some messages. Age should be a primary consideration in developing and delivering smoking-prevention messages to youth audiences. The unique needs of boys and girls and older African American adolescents should also be considered.

Mass media and community interventions to reduce alcohol use by early adolescents.

OBJECTIVE: Although early use of alcohol is an immediate and long-term risk for young people, proven prevention strategies are limited. Mass media interventions have been shown to be effective in reducing use of other substances by adolescents. This study tested the impact of a 4-year media campaign designed to reduce alcohol use by early adolescents. METHOD: Theory-based television and radio messages promoting avoidance of alcohol were developed and delivered to an audience of young people as they matured from Grades 4-5 to Grades 7-8. A set of eight school districts was identified as the Media Area; eight matching districts served as the Comparison Area. Independent Grade 7-8 surveys were conducted in all districts at baseline (N= 2897) and after the interventions (N=2419). Unanticipated community coalitions working to reduce youth substance use were introduced into 10 of these 16 communities during the same time period. RESULTS: Exposure of the target audience to the media messages was lower than expected, and the unplanned community coalition interventions may have favored the Comparison Area. The main analyses indicated that the media interventions did not significantly affect alcohol use or its mediators. Supplementary analyses suggested a substantial impact of community coalitions on alcohol use and several key mediators. CONCLUSIONS: The mass media interventions provided by this study had no effect on adolescent alcohol use or its psychosocial mediators. Factors external to the study reduced chances of detecting media effects. Further work is needed to develop and test mass media strategies for alcohol use prevention among early adolescents.

Self-efficacy and outcome expectations for quitting among adolescent smokers.

Relatively little is known about smoking cessation self-efficacy and outcome expectations for quitting smoking in adolescent smokers. In this study, we created measures of these two constructs and conducted factor analyses with data from a diverse sample of 1126 adolescent smokers. Results yielded a two-factor solution for the self-efficacy measure, and a four-factor solution for the outcome expectations scale. In a subset of the original sample (n=515), we re-administered the measures one year later and also examined the longitudinal associations between the baseline sub-scale scores and cigarettes smoked per week at follow-up. Results revealed significant relationships between the negative affect sub-scales of the self-efficacy and outcome expectations measures and weekly smoking level. These associations remained when adjusting for baseline smoking level and other sub-scales. The findings lend support for the possible role of affect regulation in smoking reduction in adolescents.

Potentially modifiable psychosocial factors associated with alcohol use during early adolescence.

This study was conducted to identify factors associated with alcohol use among early adolescents. A survey was administered to all Grade 7 and 8 students in 16 Vermont school districts. The questionnaire covered demographics, alcohol, tobacco, and marijuana use, and measures of psychosocial mediators of alcohol use drawn from social cognitive theory. These included positive and negative expectancies about alcohol effects, perceived peer and parent alcohol norms, perceived prevalence of adolescent alcohol use, and confidence in ability to refuse alcohol. Of the 2919 respondents, 29% reported having at least one drink of beer in the preceding 30 days. In logistic regression, factors independently related to risk of drinking beer in the past 30 days were smoking (odds ratio [OR] = 2.3, 95% confidence interval [CI] 1.8-3.0), marijuana use (OR 3.9, 95% CI 3.0-5.2), negative expectancies (OR 0.4, 95% CI 0.3-0.6), parent norms (OR 1.4, 95% CI 1.1-1.7), and estimated percentage of high school students who drink (OR 1.3, 95% CI 1.1-1.5). Gender, positive alcohol expectancies, and lack of confidence in ability to refuse alcohol all significantly interacted with peer norm, with these items more strongly associated with alcohol use when peer norm is toward "shouldn't drink." Modifiable perceptions of alcohol use were strongly associated with actual use in this adolescent sample, providing a basis for intervention program design.

Mass media interventions to reduce youth smoking prevalence.

BACKGROUND: Mass media interventions for reduction of youth cigarette smoking have been recommended based on a broad array of evidence, although few randomized community trials have been reported. DESIGN: Four matched pairs of independent media markets were identified; one member of each pair was randomized to receive the intervention. School surveys were conducted in all markets, in 2001 before (n=19,966) and in 2005 after (n=23,246) the interventions were completed. SETTING/PARTICIPANTS: Grade 7-12 students from public schools in these eight medium-sized metropolitan areas participated in the summative evaluations; Grades 4-12 students were targeted to receive mass media interventions in four of these markets. INTERVENTION: Four simultaneous campaigns consisting of specially developed messages based on behavioral theory and targeted to defined age groups of racially and ethnically diverse young people were placed in popular TV, cable, and radio programming using purchased time for 4 years. MAIN OUTCOME MEASURES: Prevalence of youth smoking and psychosocial mediators of smoking. RESULTS: No significant impacts of these interventions on smoking behaviors or mediators were found for the overall samples. A positive effect was found for one mediator in subgroups. Among Hispanic participants a marginally favorable effect on smoking prevalence and significant effects on mediators were found. General awareness of smoking prevention TV messages was slightly higher over time in the intervention areas. CONCLUSIONS: Mass media interventions alone were unable to induce an incremental difference in youth smoking prevalence, probably because of a relatively strong tobacco control environment that included a substantial national smoking prevention media campaign.

Comparison of Research Designs for Two Controlled Trials of Mass Media Interventions.

This paper compares two controlled trials of mass media interventions, factors influencing their designs, and design lessons learned from these experiences. Mass media evaluations based on a scientific research model are motivated by gaps in knowledge. The results of such research are intended to serve the needs of consensus development processes through which confident recommendations can be made for intervention strategies that should be more widely applied. For these purposes, the scientific research context emphasizes internal validity of evaluation design, such as controlled experiments. This paper describes two such trials, implemented at different times with differing social contexts for youth cigarette smoking, smoking prevention research evidence bases, and tobacco control environments. Common and unique features of the two trials are reviewed, and observations are noted about the conditions under which controlled trials of mass media interventions might be warranted.

Mass media for smoking cessation in adolescents.

Theory-driven, mass media interventions prevent smoking among youth. This study examined effects of a media campaign on adolescent smoking cessation. Four matched pairs of media markets in four states were randomized to receive or not receive a 3-year television/radio campaign aimed at adolescent smoking cessation based on social cognitive theory. The authors enrolled 2,030 adolescent smokers into the cohort (n = 987 experimental; n = 1,043 comparison) and assessed them via annual telephone surveys for 3 years. Although the condition by time interaction was not significant, the proportion of adolescents smoking in the past month was significantly lower in the experimental than comparison condition at 3-year follow-up when adjusted for baseline smoking status. The media campaign did not impact targeted mediating variables. A media campaign based on social cognitive constructs produced a modest overall effect on smoking prevalence among adolescents, but the role of theory-based constructs is unclear.

Increasing mammography screening among low-income African American women with limited access to health information.

BACKGROUND: Previous research showed low-income African American women with limited access to breast screening information through mass media to have a low likelihood of obtaining screening. This report describes a controlled evaluation of a component of a community-based breast screening promotion program focused on increasing screening among low-income African American women. METHODS: A direct-contact screening promotion component tailored to the needs of low-income African American women was conducted between 1990 and 1997 in one of two matched Florida study areas. Before and after assessments of breast screening, behavior and psychosocial mediators of screening were examined using logistic regression analyses for 1201 women with differing levels of exposure to media information about breast screening. RESULTS: Recent/repeat mammography use increased significantly in the program area for women with limited access to media information, although there was no significant program impact on hypothesized psychosocial mediators of screening. CONCLUSIONS: The program led to increased mammography use among low-income African Americans having limited access to screening information through the media. For these women, using direct contact to deliver educational messages and facilitation of access to services may be the best method available to promote regular mammography.

Patient perceptions of breast biopsy procedures for screen-detected lesions.

OBJECTIVE: This study was undertaken to compare patient perceptions of 2 common image-guided breast biopsy procedures on 3 main outcomes: decision making about which procedure to undergo, its convenience, and its side effects. METHODS: Women who had either an excisional or ultrasound-guided core needle breast biopsy in 1997 for a screen-detected lesion had telephone interviews 1 to 3 months after the biopsy. Bivariate associations were tested by using chi(2) and t test statistics. Mulitvariate analyses were used to control for effects of demographic characteristics. RESULTS: Most women (66%) could not remember being offered a choice of procedures, and of those who did have a choice, a higher proportion had an excisional biopsy. Only 2% reported being told the cost of the biopsy procedure. Women who had an excisional biopsy compared with those who had undergone a core needle biopsy reported statistically more hours and days off from work and reported more side effects 1 to 3 days after the biopsy (P<.05). Associations between side effects and type of biopsy procedure were unchanged when adjustment was made for demographic characteristics. CONCLUSION: Women who had the ultrasound-guided needle biopsy reported significantly fewer side effects and needed less time off from work. When a suspicious lesion is noticed on a screening mammogram, it is important that women and their physicians discuss the benefits and risks of the various biopsy procedures before deciding how to proceed, allowing for informed choice.

Factors influencing intention to obtain a genetic test for colon cancer risk: a population-based study.

BACKGROUND: The availability of genetic testing for cancer risk has prompted an examination of the intention of the general public to undergo testing. This study expands a previous psychosocial model of factors influencing intention to undergo genetic testing for cancer in general to the context of colon cancer. METHODS: A sample of 1,836 adult residents of Vermont, New Hampshire, and Maine were interviewed via telephone. The survey instrument included measures derived from the Health Belief Model and additional psychosocial measures adapted from the literature. Structural Equation Modeling techniques were used to examine factors associated with the likelihood to undergo genetic testing. RESULTS: Perceived barriers and benefits of testing, and perceived susceptibility to colon cancer had direct associations with likelihood. Optimism and pessimism had both direct and indirect effects. Age, socioeconomic status, family history, and awareness of genetic testing had indirect effects, and acted through the other factors. The model explained 22% of the variance in likelihood. CONCLUSIONS: Perceived barriers, benefits, susceptibility, optimism, and pessimism directly influenced likelihood, and may also mediate the effect of background factors examined in this study. These findings suggest effective educational strategies to improve decision-making concerning genetic testing for colon cancer risk in the general population.

Tobacco use across the formative years: a road map to developmental vulnerabilities.

Different vulnerabilities are launched or play a more active role at different developmental stages and different ages. Furthermore, the interplay between developmental and biological, psychosocial, and environmental vulnerabilities is expected to differ across stages of smoking. This article focuses on the intersection of vulnerability associated with adolescence with tobacco-use vulnerability resulting from biological, psychological, and environmental characteristics of an adolescent. Recommendations include the following: (a) Effectively treat childhood and adolescent behavioral and emotional disorders that place adolescents at risk; (b) target programs toward specific high-risk subgroups; (c) incorporate training in self-control, affect regulation, and healthy coping strategies into educational programs and extracurricular activities; (d) encourage youth to develop healthy sources of success and satisfaction; (e) encourage communities and states to launch environmental, policy, and regulatory initiatives to protect youth from tobacco; (f) consider bold initiatives that will require fundamental changes in public attitudes, including monetary rewards for nonsmoking, heightened penalties for facilitating and engaging in underage smoking, and government subsidies for substitute pharmacological agents.

Evaluation of a community breast screening promotion program.

BACKGROUND: This study reports results of a controlled evaluation of a comprehensive community breast screening promotion program. This program promoted increased use of mammography, clinical breast examination, and breast self-examination through community organization, physician training, and public education. METHODS: The program was conducted in one of three matched Florida study areas, with before and after assessment of breast screening behaviors, beliefs, and perceptions of women ages 40 and older. Baseline measures in 1990 were obtained by combining telephone and household survey data; follow-up measures using similar combined data were conducted with 4,096 women in 1997. RESULTS: . There was no evidence that the breast screening promotion program achieved higher levels of screening among women ages 40 and older in the program area. Mammography use and supportive beliefs and perceptions of mammography increased in all three study areas between 1990 and 1997. CONCLUSIONS: Among factors that may have reduced the differential impact of the program were public attention to breast cancer screening in the late 1980s throughout the U.S., effects of managed care, and limited penetration of a key program component. While the program was well received and served the community, its impact was overwhelmed by temporal trends observed in this study.