Daniela B. Friedman

Cigarette Warning Label Policy Alternatives and Smoking-Related Health Disparities

BACKGROUND Pictorial health warning labels on cigarette packaging have been proposed for the U.S., but their potential influences among populations that suffer tobacco-related health disparities are unknown. PURPOSE To evaluate pictorial health warning labels, including moderation of their influences by health literacy and race. METHODS From July 2011 to January 2012, field experiments were conducted with 981 adult smokers who were randomized to control (i.e., text-only labels, n=207) and experimental conditions (i.e., pictorial labels, n=774). The experimental condition systematically varied health warning label stimuli by health topic and image type. Linear mixed effects (LME) models estimated the influence of health warning label characteristics and participant characteristics on label ratings. Data were analyzed from January 2012 to April 2012. RESULTS Compared to text-only warning labels, pictorial warning labels were rated as more personally relevant (5.7 vs 6.8, p<0.001) and effective (5.4 vs 6.8, p<0.001), and as more credible, but only among participants with low health literacy (7.6 vs 8.2, p<0.001). Within the experimental condition, pictorial health warning labels with graphic imagery had significantly higher ratings of credibility, personal relevance, and effectiveness than imagery of human suffering and symbolic imagery. Significant interactions indicated that labels with graphic imagery produced minimal differences in ratings across racial groups and levels of health literacy, whereas other imagery produced greater group differences. CONCLUSIONS Pictorial health warning labels with graphic images have the most-pronounced short-term impacts on adult smokers, including smokers from groups that have in the past been hard to reach.

Disaster communication on the internet: a focus on mobilizing information

While local television news is the most cited source for seeking news and information, many individuals also report finding their news from the Internet. During a disaster, people need access to accurate information and clear, specific instructions to help them act appropriately. Therefore, it is important to assess the volume and scope of emergency information being disseminated on local television news websites. This study analyzed the content of 293 emergency-related stories on 119 local television news websites. Mobilizing information (MI), information found in news that can cue people to act on preexisting attitudes, also was explored. Results showed that emergency information was present on nearly all (96%) of the sites examined. A majority of news stories focused on natural disasters (52%) and most frequently discussed multiple disasters (e.g., hurricanes and pandemics). Mobilizing information was present in fewer than half of the stories (44%); stories were more likely to contain identificational MI than either locational or tactical MI (p < .05). There were also significant differences in type of MI present according to U.S. region. More stories by wire and syndicated services included MI (p < 0.05). Implications for future research on inclusion of MI in general health and emergency stories are discussed.

Knowledge, Beliefs, and Behaviors: Examining Human Papillomavirus-Related Gender Differences among African American College Students.

Abstract Objective: Given recent approval for administration of a human papillomavirus (HPV) vaccine to men, it is important to assess the HPV-related perspectives of men and women. The purpose of this study was to examine gender differences in HPV knowledge, beliefs, and vaccine acceptance among college students attending 3 historically black colleges/universities in the Southeast. Participants and Methods: A nonprobability sample of 575 students completed a self-report questionnaire. Results: Males were significantly less likely to have heard of HPV, scored lower in HPV knowledge, were less likely to perceive HPV health outcomes as severe and that there was a benefit to vaccinate, reported fewer cues for vaccine acceptance, and perceived more barriers to vaccination compared to females (all p < .05). Conclusions: The gender disparities demonstrated in this study highlight the need to increase HPV-related communication/education to include men and to extend HPV research to a broader segment of the college population.

Effective Recruitment Strategies and Community-Based Participatory Research: Community Networks Program Centers' Recruitment in Cancer Prevention Studies

Background: Community-based participatory research (CBPR) approaches that involve community and academic partners in activities ranging from protocol design through dissemination of study findings can increase recruitment of medically underserved and underrepresented racial/ethnic minority populations into biomedical research. Methods: Five cancer screening and prevention trials in three National Cancer Institute (Bethesda, MD)–funded Community Networks Program Centers (CNPC), in Florida, Kansas, and South Carolina, were conducted across diverse populations. Data were collected on total time period of recruitment, ratios of participants enrolled over potential participants approached, selected CBPR strategies, capacity-building development, and systematic procedures for community stakeholder involvement. Results: Community-engaged approaches used included establishing colearning opportunities, participatory procedures for community–academic involvement, and community and clinical capacity building. A relatively large proportion of individuals identified for recruitment was actually approached (between 50% and 100%). The proportion of subjects who were eligible among all those approached ranged from 25% to more than 70% (in the community setting). Recruitment rates were very high (78%–100% of eligible individuals approached) and the proportion who refused or who were not interested among those approached was very low (5%–11%). Conclusions: Recruitment strategies used by the CNPCs were associated with low refusal and high enrollment ratios of potential subjects. Adherence to CBPR principles in the spectrum of research activities, from strategic planning to project implementation, has significant potential to increase involvement in biomedical research and improve our ability to make appropriate recommendations for cancer prevention and control programming in underrepresented diverse populations. Impact: CBPR strategies should be more widely implemented to enhance study recruitment. See all articles in this CEBP Focus section, “Community Network Program Centers.” Cancer Epidemiol Biomarkers Prev; 23(3); 416–23. ©2014 AACR.

It Takes Two to Talk about Prostate Cancer: A Qualitative Assessment of African-American Men’s and Women’s Cancer Communication Practices and Recommendations

Prostate cancer (PrCA) is the most commonly diagnosed nonskin cancer among men. African American (AA) men in South Carolina have a PrCA death rate 150% higher than that of European American (EA) men. This in-depth qualitative research explored AA men’s and women’s current practices, barriers, and recommended strategies for PrCA communication. A purposive sample of 43 AA men and 38 AA spouses/female relatives participated in focus groups (11 male groups; 11 female groups). A 19-item discussion guide was developed. Coding and analyses were driven by the data; recurrent themes within and across groups were examined. Findings revealed AA men and women agreed on key barriers to discussing PrCA; however, they had differing perspectives on which of these were most important. Findings indicate that including AA women in PrCA research and education is needed to address barriers preventing AA men from effectively communicating about PrCA risk and screening with family and health care providers.

Prostate Cancer Communication Strategies Recommended by Older African-American Men in South Carolina: A Qualitative Analysis

Background. Mortality from prostate cancer (PrCA) in African-American (AA) men is significantly higher than in European-American (EA) men. Methods. Purposive sampling identified 25 AA men ≥45 years for interviews/focus groups. Participants were asked about cancer information-seeking behaviors, capacity to use information, and recommendations for messages and message delivery. Transcripts were analyzed for themes about PrCA communication. Results. Barriers to information seeking were fear, poor resources, and limited family communication. Participants requested messages stressing men’s “ownership” of PrCA delivered “word-of-mouth” by clergymen, AA women, and AA PrCA survivors. Conclusions. Direct and timely messages about PrCA should be developed for AA men.Background. Mortality from prostate cancer (PrCA) in African-American (AA) men is significantly higher than in European-American (EA) men. Methods. Purposive sampling identified 25 AA men ≥45 years for interviews/focus groups. Participants were asked about cancer information-seeking behaviors, capacity to use information, and recommendations for messages and message delivery. Transcripts were analyzed for themes about PrCA communication. Results. Barriers to information seeking were fear, poor resources, and limited family communication. Participants requested messages stressing men’s “ownership” of PrCA delivered “word-of-mouth” by clergymen, AA women, and AA PrCA survivors. Conclusions. Direct and timely messages about PrCA should be developed for AA men.

African American Men's Perspectives on Promoting Physical Activity: “We're Not That Difficult to Figure Out!”

African American men report poorer health than do White men and have significantly greater odds for developing chronic diseases partly because of limited physical activity. Understanding how to encourage healthy behaviors among African American men will be critical in the development of effective physical activity messages and programs. Guided by principles of cultural sensitivity and social marketing, this research examined middle-aged and older African American mens recommended strategies for promoting physical activity to African American men of their age. The authors report results from 49 interviews conducted with middle-aged (45–64 years) and older (65–84 years) African American men in South Carolina. Four groups of African American men were recruited: middle-aged active men (n = 17), middle-aged inactive men (n = 12), older active men (n = 10), older inactive men (n = 10). Themes related to marketing and recruitment strategies, message content, and spokesperson characteristics emerged and differed by age and physical activity level. Recommended marketing strategies included word of mouth; use of mass media; partnering with churches, businesses, and fraternities; strategic placement of messages; culturally appropriate message framing; and careful attention to selection of program spokespersons. Findings will help in the marketing, design, implementation, and evaluation of culturally appropriate interventions to encourage physical activity among middle-aged and older African American men in the South.

Methods and Management of the Healthy Brain Study: A Large Multisite Qualitative Research Project

PURPOSE OF THE STUDY To describe processes used in the Healthy Brain project to manage data collection, coding, and data distribution in a large qualitative project, conducted by researchers at 9 universities in 9 states. DESIGN AND METHODS Project management protocols included: (a) managing audiotapes and surveys to ensure data confidentiality, data tracking and distribution; (b) managing qualitative data to ensure the accuracy and confidentiality of transcription; (c) training in qualitative methods and use of qualitative software; and (d) managing participant survey data and analysis. RESULTS The project team coded and managed qualitative and survey data for 69 focus groups with more than 500 participants. Multiple interactive training sessions in qualitative data analysis and use of qualitative software (ATLAS.ti) were conducted. To develop a codebook, 2 teams used an open-coding process to identify codes and develop definitions; 2 team members integrated and conceptually organized these results into an initial codebook. For the audio-recordings from each research site, 2 or 3 team members hand coded 1 transcript and calculated interrater agreement (.80 or higher). IMPLICATIONS Using clear protocols, participatory training sessions, team-based coding, and frequent communication among team members via e-mail and regular in-person meetings promotes effective management of large-scale qualitative research projects.

Knowledge of, attitudes toward, and use of low-dose computed tomography for lung cancer screening among family physicians

The results of the National Lung Screening Trial showed a 20% reduction in lung cancer mortality and a 6.7% reduction in all‐cause mortality when high‐risk patients were screened with low‐dose computed tomography (LDCT) versus chest x‐ray (CXR). The US Preventive Services Task Force has issued a grade B recommendation for LDCT screening, and the Centers for Medicare and Medicaid Services and private insurers now cover the screening cost under certain conditions. The purpose of this study was to assess the knowledge of, attitudes toward, and use of LDCT screening for lung cancer among family physicians.

Developing Partnerships and Recruiting Dyads for a Prostate Cancer Informed Decision Making Program: Lessons Learned From a Community-Academic-Clinical Team

Prostate cancer (PrCA) is the most commonly diagnosed non-skin cancer among men. PrCA mortality in African-American (AA) men in South Carolina is ~50% higher than for AAs in the U.S as a whole. AA men also have low rates of participation in cancer research. This paper describes partnership development and recruitment efforts of a Community-Academic-Clinical research team for a PrCA education intervention with AA men and women that was designed to address the discordance between high rates of PrCA mortality and limited participation in cancer research. Guided by Vesey’s framework on recruitment and retention of minority groups in research, recruitment strategies were selected and implemented following multiple brainstorming sessions with partners having established community relationships. Based on findings from these sessions culturally appropriate strategies are recommended for recruiting AA men and women for PrCA education research. Community-based research recruitment challenges and lessons learned are presented.