Jay M. Bernhardt

Mobile Text Messaging for Health: A Systematic Review of Reviews

The aim of this systematic review of reviews is to identify mobile text-messaging interventions designed for health improvement and behavior change and to derive recommendations for practice. We have compiled and reviewed existing systematic research reviews and meta-analyses to organize and summarize the text-messaging intervention evidence base, identify best-practice recommendations based on findings from multiple reviews, and explore implications for future research. Our review found that the majority of published text-messaging interventions were effective when addressing diabetes self-management, weight loss, physical activity, smoking cessation, and medication adherence for antiretroviral therapy. However, we found limited evidence across the population of studies and reviews to inform recommended intervention characteristics. Although strong evidence supports the value of integrating text-messaging interventions into public health practice, additional research is needed to establish longer-term intervention effects, identify recommended intervention characteristics, and explore issues of cost-effectiveness.

The Scientific Foundation for Personal Genomics: Recommendations from a National Institutes of Health–Centers for Disease Control and Prevention Multidisciplinary Workshop

The increasing availability of personal genomic tests has led to discussions about the validity and utility of such tests and the balance of benefits and harms. A multidisciplinary workshop was convened by the National Institutes of Health and the Centers for Disease Control and Prevention to review the scientific foundation for using personal genomics in risk assessment and disease prevention and to develop recommendations for targeted research. The clinical validity and utility of personal genomics is a moving target with rapidly developing discoveries but little translation research to close the gap between discoveries and health impact. Workshop participants made recommendations in five domains: (1) developing and applying scientific standards for assessing personal genomic tests; (2) developing and applying a multidisciplinary research agenda, including observational studies and clinical trials to fill knowledge gaps in clinical validity and utility; (3) enhancing credible knowledge synthesis and information dissemination to clinicians and consumers; (4) linking scientific findings to evidence-based recommendations for use of personal genomics; and (5) assessing how the concept of personal utility can affect health benefits, costs, and risks by developing appropriate metrics for evaluation. To fulfill the promise of personal genomics, a rigorous multidisciplinary research agenda is needed.

A Prospective Study of Exposure to Rap Music Videos and African American Female Adolescents’ Health

Rap music videos are a media genre that is attracting considerable attention. Rap music has evolved from African American music forms, with influences from rhythm and blues, fusion, contemporary gospel, and bebop.1–3 Although there is considerable concern regarding the themes and images expressed in rap music videos, limited empirical research has examined the effect of rap music videos on adolescents’ behavior.4 This investigation sought to determine whether exposure to rap music videos at baseline could predict the occurrence of health risk behaviors and sexually transmitted diseases among African American adolescent females over a 12-month follow-up period.

Stages of change and psychosocial correlates of fruit and vegetable consumption among rural African-American church members

Purpose. This study examined the relationship between stages of change, other psychosocial factors, and fruit and vegetable (F&V) consumption among rural African-Americans participating in a 5 a Day study. Design. The cross-sectional design assessed associations between F&V intake, stage of change, self-efficacy, beliefs, barriers, and social support. Setting. Participants were surveyed by telephone. Subjects. Subjects were 3557 adult church members (response rate, 79.1%), aged 18 and over from 10 North Carolina counties. Measures. A seven-item food frequency measured F&V intake. Stage of change was measured using four items; other psychosocial variables were measured using Likert scales. Chi-square tests and analysis of variance were used in statistical analyses. Results. The majority of participants (65 %) were in the preparation stage of change. Individuals in action/maintenance consumed an average of 6.5 daily F&V servings compared to 3.3 to 3.5 servings for those in precontemplation, contemplation, and preparation. Self-efficacy, social support, and belief about how many daily F&V servings are needed, were positively associated with stage. Barriers were most prevalent among precontemplators. Conclusions. The findings support the applicability of the stages-of-change model to dietary change among rural African-Americans. The relationship between stage, self-efficacy, social support, and barriers supports using a multicomponent intervention strategy.

Health Information–Seeking Behaviors, Health Indicators, and Health Risks

OBJECTIVES We examined how different types of health information-seeking behaviors (HISBs)-no use, illness information only, wellness information only, and illness and wellness information combined-are associated with health risk factors and health indicators to determine possible motives for health information seeking. METHODS A sample of 559 Seattle-Tacoma area adults completed an Internet-based survey in summer 2006. The survey assessed types of HISB, physical and mental health indicators, health risks, and several covariates. Covariate-adjusted linear and logistic regression models were computed. RESULTS Almost half (49.4%) of the sample reported HISBs. Most HISBs (40.6%) involved seeking a combination of illness and wellness information, but both illness-only (28.6%) and wellness-only (30.8%) HISBs were also widespread. Wellness-only information seekers reported the most positive health assessments and the lowest occurrence of health risk factors. An opposite pattern emerged for illness-only information seekers. CONCLUSIONS Our findings reveal a unique pattern of linkages between the type of health information sought (wellness, illness, and so on) and health self-assessment among adult Internet users in western Washington State. These associations suggest that distinct health motives may underlie HISB, a phenomenon frequently overlooked in previous research.

Direct-to-consumer drug advertisements on network television: an exploration of quantity, frequency, and placement.

Prescription and over-the-counter (OTC) drug advertisements that appear on television are among the most common forms of health communication reaching the U.S. public, but no studies to date have explored the quantity, frequency, or placement of these ads on television. We explored these questions by recording all programs and advertisements that appeared on network television in a southeastern city during a selected week in the summer of 2001 and coding each prescription and OTC drug ad for its frequency, length, and placement by time of day and television program genre. A total of 18,906 ads appeared in the 504-hour sample, including 907 OTC drug ads (4.8%) and 428 prescription (Rx) drug ads (2.3%), which together occupied about 8% of all commercial airtime. Although OTC drug ads were more common, Rx drug ads on average were significantly longer. Direct-to-consumer drug ads appeared most frequently during news programs and soap operas and during the middle-afternoon and early-evening hours. Overall, we found that direct-to-consumer drug advertisements occupy a large percentage of network television commercial advertising and, based on time and program placement, many ads may be targeted specifically at women and older viewers. Our findings suggest that Americans who watch average amounts of television may be exposed to more than 30 hours of direct-to-consumer drug advertisements each year, far surpassing their exposure to other forms of health communication.

Reframing the Dissemination Challenge: A Marketing and Distribution Perspective

A fundamental obstacle to successful dissemination and implementation of evidence-based public health programs is the near-total absence of systems and infrastructure for marketing and distribution. We describe the functions of a marketing and distribution system, and we explain how it would help move effective public health programs from research to practice. Then we critically evaluate the 4 dominant strategies now used to promote dissemination and implementation, and we explain how each would be enhanced by marketing and distribution systems. Finally, we make 6 recommendations for building the needed system infrastructure and discuss the responsibility within the public health community for implementation of these recommendations. Without serious investment in such infrastructure, application of proven solutions in public health practice will continue to occur slowly and rarely.

Crowdsourcing applications for public health.

Crowdsourcing is an online, distributed, problem-solving, and production model that uses the collective intelligence of networked communities for specific purposes. Although its use has benefited many sectors of society, it has yet to be fully realized as a method for improving public health. This paper defines the core components of crowdsourcing and proposes a framework for understanding the potential utility of crowdsourcing in the domain of public health. Four discrete crowdsourcing approaches are described (knowledge discovery and management; distributed human intelligence tasking; broadcast search; and peer-vetted creative production types) and a number of potential applications for crowdsourcing for public health science and practice are enumerated.

Communication at the core of effective public health

Years from now, we may remember the fall of 2001 as the traumatic period in our country’s history when public health became visible throughout society. While the dust was still settling from the terrorist attacks and the country grappled with fears of anthrax in our mail, the American public learned what professionals have known for years: the health and security of our nation depend heavily on a robust public health system. An additional revelation from this turbulent time was the critical role of strategic, timely, and effective communication in public health. The realization that both science and communication are essential to promoting and protecting the health of the public was a major milestone in the emerging discipline of public health communication, reinforcing its vital role as a new core component of public health.

Varying the message source in computer-tailored nutrition education

The effect of message source on message recall and perceived credibility was examined in a randomized study comparing two different computer-tailored bulletins promoting fruit and vegetable consumption among rural African American church members. An expert oriented (EXP) bulletin was compared with a spiritual and pastor-oriented (SPIR) bulletin and a control group. Both bulletins had the same format and used an identical set of dietary and psychosocial variables for tailoring. At follow-up, the majority of both intervention groups recalled receiving the bulletin, however message trust was higher in the SPIR group (P < 0.05). The EXP group reported higher trust of health and nutrition information coming from scientific research (P < 0.01), and the SPIR group reported higher trust of information coming from the pastor (P < 0.05). Both bulletin groups increased fruit and vegetable consumption significantly compared to the control group; however, this difference could not be solely attributed to the tailored intervention which was part of a multi-component program.