Jonathan S. Slater

Behavioral Consequences of Conflict-Oriented Health News Coverage: The 2009 Mammography Guideline Controversy and Online Information Seeking

Building on channel complementarity theory and media-system dependency theory, this study explores the impact of conflict-oriented news coverage of health issues on information seeking online. Using Google search data as a measure of behavior, we demonstrate that controversial news coverage of the U.S. Preventive Services Task Forces November 2009 recommendations for changes in breast cancer screening guidelines strongly predicted the volume of same-day online searches for information about mammograms. We also found that this relationship did not exist 1 year prior to the coverage, during which mammography news coverage did not focus on the guideline controversy, suggesting that the controversy frame may have driven search behavior. We discuss the implications of these results for health communication scholars and practitioners.

Effect of Direct Mail as a Population-Based Strategy to Increase Mammography Use among Low-Income Underinsured Women Ages 40 to 64 Years

Women with inadequate health insurance have lower mammography rates than the general population. Finding successful strategies to enroll eligible women is an ongoing challenge for the National Breast and Cervical Cancer Early Detection Program. To test the effectiveness of a population-based strategy to increase mammography utilization among low-income underinsured women ages 40 to 64 years, a randomized trial was conducted to assess the effect of two mailed interventions on mammography utilization through Sage, the National Breast and Cervical Cancer Early Detection Program in Minnesota. Women (N = 145,467) ages 40 to 63 years [mean (SD), 49.7 (6.8)] with estimated household incomes below

The availability of community ties predicts likelihood of peer referral for mammography: Geographic constraints on viral marketing

50,000 (47.9% were <

Interpersonal Communication and Smoking Cessation in the Context of an Incentive-Based Program: Survey Evidence From a Telehealth Intervention in a Low-Income Population

35,000) from a commercial database were randomized to three groups: Mail, Mail Plus Incentive, or Control. Both the Mail and the Mail Plus Incentive groups received two simple mailings prompting them to call a toll-free number to access free mammography services. The Mail Plus Incentive intervention offered a small monetary incentive for a completed mammogram. After 1 year, both intervention groups had significantly higher Sage mammography rates than the Controls, and the Mail Plus Incentive group had a significantly higher rate than the Mail group. The Mail and Mail Plus Incentive interventions were estimated to produce increases in Sage screening rates of 0.23% and 0.75%, respectively, beyond the composite Control rate of 0.83%. Direct mail is an effective strategy for increasing mammography use through Sage. Coupling direct mail with an incentive significantly enhances the interventions effectiveness. Direct mail should be considered as a strategy to increase mammography use among low-income, medically underserved women.

Connecting low-income smokers to tobacco treatment services.

Engaging social networks to encourage preventive health behavior offers a supplement to conventional mass media campaigns and yet we do not fully understand the conditions that facilitate or hamper such interpersonal diffusion. One set of factors that should affect the diffusion of health campaign information involves a persons community. Variables describing geographic communities should predict the likelihood of residents accepting campaign invitations to pass along information to friends, family, and others. We investigate two aspects of a community--the availability of community ties and residential stability--as potential influences on diffusion of publicly-funded breast cancer screening in the United States in 2008-2009. In a survey study of 1515 participants living in 91 zip codes across the State of Minnesota, USA, we focus on the extent to which women refer others when given the opportunity to nominate family, friends, and peers to receive free mammograms. We predicted nomination tendency for a particular zip code would be a function of available community ties, measured as religious congregation density in that zip code, and also expected the predictive power of available ties would be greatest in communities with relatively high residential stability (meaning lower turnover in home residence). Results support our hypotheses. Congregation density positively predicted nomination tendency both in bivariate analysis and in Tobit regression models, and was most predictive in zip codes above the median in residential stability. We conclude that having a local infrastructure of social ties available in a community predicts the diffusion of available health care services in that community.

Campaigns in context: promotion, seasonal variation, and resource factors predict mammography program participation

The tobacco epidemic disproportionately affects low-income populations, and telehealth is an evidence-based strategy for extending tobacco cessation services to underserved populations. A public health priority is to establish incentive-based interventions at the population level in order to promote long-term smoking cessation in low-income populations. Yet randomized clinical trials show that financial incentives tend to encourage only short-term steps of cessation, not continuous smoking abstinence. One potential mechanism for increasing long-term cessation is interpersonal communication (IPC) in response to population-level interventions. However, more research is needed on IPC and its influence on health behavior change, particularly in the context of incentive-based, population-level programs. This study used survey data gathered after a population-level telehealth intervention that offered

Does it pay to pay people to share information? Using financial incentives to promote peer referral for mammography among the underinsured.

20 incentives to low-income smokers for being connected to Minnesotas free quitline in order to examine how perceived incentive importance and IPC about the incentive-based program relate to both short-term and long-term health behavior change. Results showed that IPC was strongly associated with initial quitline utilization and continuous smoking abstinence as measured by 30-day point prevalence rates at 7-month follow-up. Perceived incentive importance had weak associations with both measures of cessation, and all associations were nonsignificant in models adjusting for IPC. These results were found in descriptive analyses, logistic regression models, and Heckman probit models that adjusted for participant recruitment. In sum, a behavioral telehealth intervention targeting low-income smokers that offered a financial incentive inspired IPC, and this social response was strongly related to utilization of intervention services as well as continuous smoking abstinence.

Why Addressing the Poor and Underinsured is Vexing

The Affordable Care Act calls for using population-level incentive-based interventions, and cigarette smoking is one of the most significant health behaviors driving costs and adverse health in low-income populations. Telehealth offers an opportunity to facilitate delivery of evidence-based smoking cessation services as well as incentive-based interventions to low-income populations. However, research is needed on effective strategies for linking smokers to services, how to couple financial incentives with telehealth, and on how to scale this to population-level practice. The current paper evaluates primary implementation and follow-up results of two strategies for connecting low-income, predominantly female smokers to a telephone tobacco quitline (QL). The population-based program consisted of participant-initiated phone contact and two recruitment strategies: (1) direct mail (DM) and (2) opportunistic telephone referrals with connection (ORC). Both strategies offered financial incentives for being connected to the QL, and all QL connections were made by trained patient navigators through a central call center. QL connections occurred for 97% of DM callers (N=870) and 33% of ORC callers (N=4550). Self-reported continuous smoking abstinence (i.e., 30 smoke-free days at seven-month follow-up) was 20% for the DM group and 16% for ORC. These differences between intervention groups remained in ordered logistic regressions adjusting for smoking history and demographic characteristics. Each recruitment strategy had distinct advantages; both successfully connected low-income smokers to cessation services and encouraged quit attempts and continuous smoking abstinence. Future research and population-based programs can utilize financial incentives and both recruitment strategies, building on their relative strengths.

Coupling Financial Incentives With Direct Mail in Population-Based Practice A Randomized Trial of Mammography Promotion

We consider the impact of health promotion efforts on the timing of health behavior in a real-world setting alongside effects of temporally predictable and other environmental factors. By better understanding the systemic context of promotions, we sought to explain, and suggest timing strategies to enhance, campaign effectiveness in ways often overlooked by health promotion staff. We assessed call volume in response to promotions from May 2004 to December 2008 by a state program in the United States that provides free mammograms to underinsured women. Weekly data were analyzed using OLS regression, using predictor variables representing program promotions, breast cancer awareness, season, and other factors. Call volume was greater following television or direct mail promotions, during periods with higher unemployment rates, during school-term time, and in favorable climate conditions. These results highlight predictable temporal variations in the response to these promotions, suggesting important implications for the timing of health promotion efforts.

The Efficacy of Direct Mail, Patient Navigation, and Incentives for Increasing Mammography and Colonoscopy in the Medicaid Population: A Randomized Controlled Trial

Purpose. Efforts to screen underinsured women for breast cancer face challenges in reaching desired audiences. One option is viral marketing through peer referral. We sought the optimal way to solicit nominations of peers. Design. An experiment (N = 2968) compared impact of incentives on peer nomination. Women were offered a