George I. Balch

Explanations of ethnic and gender differences in youth smoking: A multi-site, qualitative investigation

Two of the most powerful predictors of adolescent smoking are ethnicity and gender, but little research has focused on understanding how these factors play a role in adolescent smoking. This paper reports results from a qualitative, multi-site investigation of explanations for ethnic and gender differences in cigarette smoking with five ethnic groups: whites, African-Americans, Hispanics, Native Americans, and Asian-American/Pacific Islanders. Across 11 states, we conducted 178 focus groups with a total of 1175 adolescents. The groups explored such major research themes as reasons for smoking and not smoking; images of smoking and smokers; messages youth receive about smoking and not smoking; and the social context of smoking. We synthesized data from the focus groups through multiple cross-site collaborations and discussions, with an emphasis on identifying consistent themes across a majority of groups and sites. Striking differences emerged across ethnic and gender sub-groups in reasons for not smoking. African-American females in particular viewed not smoking as a positive identity marker. Asian-American/Pacific Islander females similarly reported strong mandates not to smoke. Youths perceptions of family messages about smoking also varied by ethnicity and gender, with African-American, Hispanic, and Asian-American/Pacific Islander youth consistently reporting strong, clear anti-smoking messages from family. These findings, notable in their consistency across geographic regions, may shed light on the discrepant prevalence of smoking across ethnic and gender groups.

The Effect of Antismoking Advertisement Executional Characteristics on Youth Comprehension, Appraisal, Recall, and Engagement

ABSTRACT This article examines how two executional characteristics of antismoking advertising may interact with other relevant advertising features to affect youth comprehension, appraisal, recall of, and engagement with antismoking ads. Fifty antismoking ads made by tobacco control agencies, tobacco companies, and pharmaceutical companies were appraised by 268 youth using an audience response methodology with a follow-up component. Analyses show that thematic and executional characteristics varied both across and within ad sponsor, and that executional characteristics of “personal testimonial” and “visceral negative” clearly had the strongest and most consistent effect on appraisal, recall, and level of engagement. Antismoking advertisements are not alike in their ability to engage youth. Advocates attempting to develop increasingly successful antismoking campaigns should consider the executional characteristics of proposed ads.

Appraisal of anti-smoking advertising by youth at risk for regular smoking: a comparative study in the United States, Australia, and Britain

Objective: To compare the similarity in how youth in the United States, Australia, and Britain appraise anti-smoking advertisements with different characteristics. Design: Each participant viewed and evaluated a set of 10 anti-smoking adverts (from an overall total of 50 adverts) in a controlled experimental context using an audience response methodology. A structured telephone interview was completed one week after viewing the adverts, in which recall and engagement with the adverts by participants was evaluated. Subjects: 615 youths who were experimenting with smoking or were susceptible nonsmokers. Main outcome measures: Measures of advert appraisal and engagement. Results: Youth in the United States, Australia, and Britain responded in very similar ways to the same anti-smoking advertisements. In full multivariate models, the target audience of the advert and the advert theme were not related to the main outcome measures employed in this study. However, adverts with visceral negative or personal testimonial executional characteristics were appraised more positively by youths and were more likely to be recalled, thought about, and discussed at follow up one week later. Conclusions: Youths in three different countries responded to anti-smoking advertisements in very similar ways, suggesting that such adverts might be more actively shared among nations. The appraisal of, and engagement with, the anti-smoking adverts, however, varied substantially depending on executional characteristics. In the design of effective anti-smoking adverts, due attention needs to be paid to those characteristics that appear to most engage youth across different social and cultural environments.

Caring for Patients with Limited English Proficiency: The Perspectives of Small Group Practitioners

BACKGROUNDLanguage barriers in medical care are a large and growing problem in the United States. Most research has focused on how language barriers affect patients. Less is known of the physician perspective and the efforts they are making to overcome these barriers.OBJECTIVETo learn about current approaches to communicating with limited English-proficient (LEP) patients and the associated financial and nonfinancial constraints that private practice physicians and managers perceive in providing these services.DESIGNComputer-assisted telephone focus groups with open-ended discussion guide.SETTINGSmall private practices in geographic areas that have experienced recent dramatic increases in LEP populations.PARTICIPANTSPrimary care physicians, specialists, and practice managers.APPROACHFocus group transcripts were systematically coded using grounded theory analysis. The research team then identified common themes that arose across the groups.RESULTSCiting the cost, inaccessibility, and inconvenience of using professional interpreters, physicians commonly used family and friends as interpreters. Few recalled any actual experience with professional interpreters or were well-informed about the cost of their services. Physicians and office managers voiced uniform concern about how language barriers impede quality and safety of patient care and increased malpractice risk.CONCLUSIONSHealth care providers in private practice recognize the importance of overcoming language barriers. However, perceived barriers to implementing cost-effective strategies to these barriers are high. Physicians in private practice would benefit from information about how to best overcome language barriers in their practices efficiently and affordably.

Probing Consumer Benefits and Barriers for the National 5 A Day Campaign: Focus Group Findings

Abstract This research identifies benefits that target consumers from the national 5 A Day for Better Health media program find motivating, as well as barriers that these benefits must overcome. Conventional and “piggyback” focus groups were conducted with the target audience and with a comparison group (people who already eat five or more servings a day of fruits and vegetables). Consistent with prior research, target group participants saw little urgency to eating more fruits and vegetables and were not very involved with food planning. Benefits that seemed likely to encourage more consumption of fruits and vegetables were immediate benefits—such as feeling more energetic—rather than long-term benefits related to reducing health risks.Target consumers rejected as implausible or irrelevant other benefits that strategists had considered appropriate: feeling less stress and more in control and reducing ones risk of cancer. The target audience saw barriers of time and inconvenience in the “normal steps” in the comparison groups routine. Results have been used to develop communications. The findings suggest that nutrition educators should use messages with immediate consumer benefits and, consistent with prior research and theory, should offer “quick and easy” tips for consumers to attain the desired health-related behavior. The findings also underscore the importance of direct consumer research to ensure that program messages and strategies are relevant to the target audience.The study also illustrates the utility of piggyback groups to clarify differences and similarities between target and comparison segments and to assess how, if at all, comparison segments can effectively model desired consumer behavior.

Bringing 5 A Day Consumers into Focus: Qualitative Use of Consumer Research to Guide Strategic Decision Making

Abstract As part of the national 5 A Day for Better Health program, a communication strategy based on a social marketing model was developed to guide the programs media campaign. Using this approach, the campaign focused on consumer wants and needs to help increase the prospects of influencing consumer behavior.The work discussed herein describes how consumer research was used to select and profile a target audience for the national 5 A Day media campaign. It shows how formative consumer research data from multiple sources were integrated to make practical strategic campaign decisions based on the target consumers perspective.

Statistical manipulation in the study of issue consistency: The gamma coefficient

Issue consistency involves predicting a persons position on one issue from his or her position on another. Goodman and Kruskals (1954) coefficient gamma measures the preponderance of concordant pairs among ordered pairs of cases. Its widespread use in the research literature to measure issue consistency is of doubtful value, due to conceptual, descriptive, and inferential properties of gamma. Conceptual problems include that gamma (1) predicts for pairs of persons, not from one attitude to another for the same person; (2) it predicts for a single ordering of variables, even if this is not appropriate; (3) it can be low when issue differences are small; and (4) it underestimates consistency for consensual items. Statistical problems include descriptive and inferential concerns. Gamma is hard to interpret or compare because (1) it underpredicts bidirectional association; (2) it becomes unrepresentative and volatile as ties increase, and (3) it can reach unity in various ways. Relating gamma to a sampling distribution might permit comparison of probability levels for statistical inference. The research literature has not done this. Instead, it has computed “mean gammas” of doubtful descriptive and inferential value.

Benefits, Barriers and Enablers of University—Community Research Collaboration: Input from Health and Social Service Agencies

Increasingly, it has become clear to social marketers and others that partnerships among organizations are needed to accomplish behavior change and achieve social objectives. While many still take an organization- centered approach, there has been a marked increase in the number of community-based collaborative research endeavors connecting academics and community agencies in mutual investigation of salient problems. Currently, much of the literature on these efforts is reported by academicians and reflects their perspectives or perceptions of agency viewpoints. More input is needed from the agency perspective to ensure a more balanced understanding of the significant role community partners play in the development and implementation of research that leads to improved health status of communities and other social objectives. To this end, focus groups were conducted to give community-based agencies the opportunity to share their insights and give their perspective regarding the benefits and barriers to effective collaboration. Representatives of agencies from the Chicago area with experience in collaborative research participated, and results were reviewed and corroborated by additional community agencies. The most common benefits sought by agencies were evaluation and needs assessment. Participants cite the failure of researchers and agencies to take the time to understand and try to meet each others needs as the main barrier to effective collaborative efforts.