Galen Cole

RELATIONSHIPS AMONG MEASURES OF ALCOHOL DRINKING BEHAVIOR, LIFE-EVENTS AND PERCEIVED STRESS

Two measures of stress (life-events and perceived stress) and a measure of alcohol-drinking behavior were administered to 6,747 adult males. Analysis was carried out to examine the extent to which subjects classified into drinking-behavior groups differed on stress measures while controlling for age, income, and race. Significant differences held up under age, race, and income controls for life-events and perceived stress between the abstinence, common-use, and problem-drinking groups. Stress scores increased sequentially across the drinking-behavior groups. Apparently, men who are life-long abstainers (teetotallers) experience fewer life-events and perceive less stress than moderate drinkers, while moderate drinkers experience less stress than heavy drinkers.

Demographic Predictors of Self-Reported Loneliness in Adults

The relative magnitude of individual demographic characteristics, compared with other demographic characteristics, in the prediction or explanation of frequency of loneliness has not been examined or reported in the literature. The relative strengths of a series of demographic variables (gender, age, marital status, household income, educational attainment, race or ethnicity, employment status, and occupation) in explaining frequency of loneliness in a random sample of 8,634 adults residing in a large metropolitan county were examined. Logistic regression analysis indicated several variables significantly affected group membership as lonely vs not lonely: marital status, household income, gender, and educational attainment. The strongest predictor of all was marital status. Age group as a predictor variable approached significance, but employment status, occupation, and race/ethnicity were not significant predictors of group membership as lonely vs not lonely in the logistic regression model.

Advancing the Development and Application of Theory-based Evaluation in the Practice of Public Health

Early proponents of theory-based evaluation have provided strong reasoning for this approach. Still, tools are needed for implementing it in practice. This paper helps fill the gap by providing strategies for constructing theories. Illustrations are given in the area of public health. The suggested techniques are designed to systematize and bring objectivity to the process of theory construction. Also introduced is a framework that illustrates different levels, and processes within each level, that should be considered when constructing program theories. The framework is valuable for theory-based discrepancy evaluation, the essence of which is to determine the extent of discrepancy that exists between the expected theory, as constructed using the tools introduced here, and what is actually observed in the evaluation.

Using "stages of behavioral change" constructs to measure the short-term effects of a worksite-based intervention to increase moderate physical activity.

We evaluated a three-level incentive program to promote regular, moderate physical activity among employees working in a federal agency. The objective was to assess the short-term effects of the intervention by examining the stages people go through as they attempt to make permanent changes in physical activity. Indicators of the process by which changes in physical activity take place were based on a modified version of the Transtheoretical Model of Behavior. A one-group pretest/posttest design was used to ascertain which of the stages the 1,192 participants were in both before and after the intervention. Analysis indicated that, of the 1,192 participants, 6.5% regressed one or more stages, 30.3% did not regress or progress from one stage to another, 27.7% remained in the maintenance stage, and 35.4% progressed one (21.1%) or more (14.3%) stages during the 50-day intervention. Among those who progressed, the most common change was from preparation to late preparation (20.8%) and from late preparation to action (19.4%). Findings reinforce the notion that the stages of change concept can serve as indicators of the change process which, in turn, can be used as evidence of the short-term effectiveness of interventions. Findings also indicate this type of intervention holds promise for increasing physical activity among willing participants of a worksite population.

AIDS Knowledge Gaps: Results from the First Decade of the Epidemic and Implications for Future Public Information Efforts

Throughout the first decade of AIDS, certain populations have been disproportionately affected by its spread, particularly men, blacks, Hispanics, and the young. Just as there are population differences in the spread of the disease, there are differences in knowledge about the disease as well. This article applies the knowledge gap framework to examine the nature and magnitude of gaps in knowledge among different populations. The analysis shows that persons of low education lag behind other groups in true-transmission knowledge (i.e., knowledge about ways in which HIV/AIDS actually is transmitted) and false-transmission knowledge (i.e., misconceptions about how the disease is spread).

Discussing Uncertainty and Risk in Primary Care: Recommendations of a Multi-Disciplinary Panel Regarding Communication Around Prostate Cancer Screening

ABSTRACTBACKGROUNDShared decision making improves value-concordant decision-making around prostate cancer screening (PrCS). Yet, PrCS discussions remain complex, challenging and often emotional for physicians and average-risk men.OBJECTIVEIn July 2011, the Centers for Disease Control and Prevention convened a multidisciplinary expert panel to identify priorities for funding agencies and development groups to promote evidence-based, value-concordant decisions between men at average risk for prostate cancer and their physicians.DESIGNTwo-day multidisciplinary expert panel in Atlanta, Georgia, with structured discussions and formal consensus processes.PARTICIPANTSSixteen panelists represented diverse specialties (primary care, medical oncology, urology), disciplines (sociology, communication, medical education, clinical epidemiology) and market sectors (patient advocacy groups, Federal funding agencies, guideline-development organizations).MAIN MEASURESPanelists used guiding interactional and evaluation models to identify and rate strategies that might improve PrCS discussions and decisions for physicians, patients and health systems/society. Efficacy was defined as the likelihood of each strategy to impact outcomes. Effort was defined as the relative amount of effort to develop, implement and sustain the strategy. Each strategy was rated (1–7 scale; 7 = maximum) using group process software (ThinkTankTM). For each group, intervention strategies were grouped as financial/regulatory, educational, communication or attitudinal levers. For each strategy, barriers were identified.KEY RESULTSHighly ranked strategies to improve value-concordant shared decision-making (SDM) included: changing outpatient clinic visit reimbursement to reward SDM; development of evidence-based, technology-assisted, point-of-service tools for physicians and patients; reframing confusing prostate cancer screening messages; providing pre-visit decision support interventions; utilizing electronic health records to promote benchmarking/best practices; providing additional training for physicians around value-concordant decision-making; and using re-accreditation to promote training.CONCLUSIONSConference outcomes present an expert consensus of strategies likely to improve value-concordant prostate cancer screening decisions. In addition, the methodology used to obtain agreement provides a model of successful collaboration around this and future controversial cancer screening issues, which may be of interest to funding agencies, educators and policy makers.

How the CDC is meeting the training demands of emergency risk communication.

Communication is a relatively new discipline in the field of public health. Historically, federal public health agencies have focused on epidemiological studies, disease prevention efforts (e.g., immunization campaigns), and the provision of accurate scientific information to health professionals. Translating this scientific information for public consumption was left to the press (Freimuth, Linnan, & Potter, 2000). With the advent of AIDS, other emergent diseases, and the as-yet-unrealized threat of bioterrorism, communicating clearly to the public was recognized as a necessary component of public health practice (Freimuth et al., 2000), but it was not oriented towards emergencies. In 1993, during William Roper’s tenure as the director of the Centers for Disease Control and Prevention (CDC), CDC’s newly formed Office of Communication (OC) was charged with crafting and delivering messages and strategies, based on consumer research, to promote the health of individuals and communities. Building national capacity in health communication has become a major goal of OC, and training the public health workforce to communicate well is the paramount strategy for reaching that goal. Since 1998, CDCynergy—an interactive CD-ROM that helps users develop, plan, implement, and evaluate health communication programs—has been OC’s primary training tool (Parvanta & Freimuth, 2000). Using the systematic CDCynergy process can be lengthy, taking several months or more, but the anthrax attacks of 2001 made it apparent that most people in public health need training in rapid, effective communication during a crisis. Although the fields of risk and crisis communication are not new, communicating during a terrorist attack has presented some unique challenges. Risk communication includes strategies for framing the risks of various exposures; it is frequently used in connection with disease prevention campaigns, disease outbreaks and environmental hazards (Fearn-Banks, 2000). Crisis communication is the verbal, visual, and/or written interaction between an organization and its publics (often the news media) prior to,

The application of "integrated marketing communications" to social marketing and health communication: Organizational challenges and implications

Influencing consumer behavior is a difficult and often resource-intensive undertaking, with success usually requiring identifying, describing, and understanding target audiences; solid product and/or service positioning relative to competitors; and significant media and communication resources. Integrated marketing communication (IMC) is a new way of organizing and managing persuasive communication tools and functions which involves realigning communications to consider the flow of information from an organization from the viewpoint of end consumers. Although the application of IMC to social marketing remains relatively unexplored, the IMC literature and recent efforts by the US Centers for Disease Prevention and Control suggest that integrated communication approaches have much to offer social marketing and health communication efforts. IMC, IMC and social marketing, and implications of IMC for public and private sector social marketing programs are discussed.

Demoralization and Living Alone: Outcomes from an Urban Community Study:

The purpose of the present study was to investigate differences in demoralization between those who live in single-person households and those who live in households with others in a random sample of 8,634 urban adults. Responses to the 26-item Psychiatric Epidemiologic Research Interview did not substantiate that adults who live alone are more likely to be demoralized than those who live with others, until age and gender are considered. Men who live alone scored higher on demoralization than men who live with others, yet women who live with others scored higher on demoralization than those who live alone. An interaction for living arrangement and age group on demoralization was also observed.

From the small screen to breast cancer screening: examining the effects of a television storyline on awareness of genetic risk factors

ABSTRACT Background: The topic of breast cancer genetics entered the public discourse following Angelina Jolies 2013 announcement that she carries the BRCA1 mutation and underwent a prophylactic double mastectomy to reduce her breast cancer risk. A year prior to Jolies announcement, the teen drama 90210 ran an eight-episode story arc on the BRCA gene mutations. This study focuses on an evaluation of the impact of this particular media text within the broader context of research on the persuasive effects of entertainment narratives (i.e. entertainment education). Method: The evaluation consisted of two complementary studies of adult women: a pre-test/post-test study using a panel sample of regular television viewers who were directed to watch a particular episode (Study 1), and a cross-sectional study using a convenience sample of frequent 90210 viewers (Study 2). Results: In both studies, storyline exposure was associated with increased knowledge (familiarity with the BRCA gene, knowledge about mastectomy). Study 1 additionally saw evidence of increased fears regarding the consequences of the BRCA gene and intentions to talk to a doctor. In Study 2, the number of episodes viewed was positively related to both knowledge and behavior (finding out about ones family history of breast cancer). Conclusions: These findings suggest that despite unprecedented changes in the ways audiences engage with and consume entertainment media, television narratives remain a powerful method of educating viewers about health risks and inspiring them to take action.