Julie S. Downs

TEEN EXPECTATIONS FOR SIGNIFICANT LIFE EVENTS

Managing risks is an important part of growing up. Young people must decide whether to do things that they do not like (e.g., homework) in the hopes of getting things that they do (e.g., good jobs). They must also decide whether to avoid doing things that they do like (e.g., drinking heavily) in order to reduce the risk of outcomes that they do not (e.g., auto accidents). Making these decisions effectively requires accurate assessments of the probabilities of uncertain events occurring in their lives. As a result, risk perceptions play a central role in many psychological theories of adolescent development and health behavior (e.g., Beyth-Marom and Fischhoff 1997; Feldman and Elliott 1990; Fischhoff, Downs, and Bruine de Bruin 1998; Institute of Medicine 1999; Jacobs and Ganzel 1993) and in interventions designed to improve these perceptions (e.g., Baron and Brown 1991; Millstein, Petersen, and Nightingale 1993; Schulenberg, Maggs, and Hurnelmans 1997). Risk (and benefit) perceptions are also central to economic theories of human capital formation, which hold that teens’ willingness to invest in themselves should reflect the

Why women douche and why they may or may not stop

Background Although douching is common, it is a potentially harmful habit. Goal We studied attitudes and knowledge around the behavior of douching. Study Design Of 1200 women enrolled in this multisite study, 532 douched and answered questions on a structured interview regarding douching behaviors. Results Over half had douched for 5 or more years. Douching was most often initiated on the recommendation of female relatives and practiced for reasons of hygiene. Half of women considered douching to be healthy. Those who considered douching to be unhealthy reported that douching may disrupt vaginal flora but did not cite more serious risks. Nonetheless, women who had been advised by a health professional to stop douching were less likely to consider douching healthful and were more likely to have tried to stop. Conclusion Women had a limited understanding of potential adverse health consequences associated with douching. Targeted health messages may influence women to initiate douching cessation.

Supplementing Menu Labeling With Calorie Recommendations to Test for Facilitation Effects

OBJECTIVES We examined the effect on food purchases of adding recommended calorie intake per day or per meal to the mandated calorie information posted on chain restaurant menus. METHODS Before and after New York City implemented calorie posting on chain restaurant menus in 2008, we provided daily, per-meal, or no calorie recommendations to randomized subsets of adult lunchtime customers (n = 1121) entering 2 McDonalds restaurants, in Manhattan and Brooklyn, and collected receipts and survey responses as they exited. In linear and logistic regressions, with adjustment for gender, race, age, and day, we tested for simple differences in calories consumed and interactions between variables. RESULTS Posting calorie benchmarks had no direct impact, nor did it moderate the impact of calorie labels on food purchases. The recommendation appeared to promote a slight increase in calorie intake, attributable to increased purchases of higher-calorie entrées. CONCLUSIONS These results do not support the introduction of calorie recommendations as a means of enhancing the impact of posted calorie information or reducing the contribution of restaurant dining to the obesity epidemic.

Disability, Age, and Informational Privacy Attitudes in Quality of Life Technology Applications: Results from a National Web Survey

Technology aimed at enhancing function and enabling independent living among older and disabled adults is a growing field of research. Privacy concerns are a potential barrier to adoption of such technology. Using data from a national Web survey (n=1,518), we focus on perceived acceptability of sharing information about toileting, taking medications, moving about the home, cognitive ability, driving behavior, and vital signs with five targets: family, healthcare providers, insurance companies, researchers, and government. We also examine acceptability of recording the behaviors using three methods: video with sound, video without sound, and sensors. Results show that sharing or recording information about toileting behavior; sharing information with the government and insurance companies; and recording the information using video were least acceptable. Respondents who reported current disability were significantly more accepting of sharing and recording of information than nondisabled adults, controlling for demographic variables, general technology attitudes, and assistive device use. Results for age were less consistent, although older respondents tended to be more accepting than younger respondents. The study provides empirical evidence from a large national sample of the implicit trade-offs between privacy and the potential for improved health among older and disabled adults in quality of life technology applications.

Long-Term Effects of the Booster-Enhanced READY-Girls Preconception Counseling Program on Intentions and Behaviors for Family Planning in Teens With Diabetes

OBJECTIVE To examine 12-month effects of a booster-enhanced preconception counseling (PC) program (READY-Girls) on family planning for teen girls with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS Participants 13–19 years of age (n = 109) were randomized to a standard care control group (CG) or intervention group (IG) that received PC over three consecutive clinic visits. Prepost data were collected at baseline, 3- and 6-month booster sessions, and a 12-month follow-up visit. RESULTS Mean age was 15.8 years; 9 (8%) subjects had type 2 diabetes; and 18 (17%) subjects were African American. At baseline, 20% (n = 22 of 109) had been sexually active, and of these, 50% (n = 11) had at least one episode of unprotected sex. Over time, IG participants retained greater PC knowledge (F[6, 541] = 4.05, P = 0.0005) and stronger intentions regarding PC (significant group-by-time effects) especially after boosters. IG participants had greater intentions to discuss PC (F[6, 82.4] = 2.56, P = 0.0254) and BC (F[6, 534] = 3.40, P = 0.0027) with health care providers (HCPs) and seek PC when planning a pregnancy (F[6, 534] = 2.58, P = 0.0180). Although not significant, IG participants, compared with CG, showed a consistent trend toward lower rates of overall sexual activity over time: less sexual debut (35 vs. 41%) and higher rates of abstinence (44 vs. 32%). No pregnancies were reported in either group throughout the study. CONCLUSIONS READY-Girls appeared to have long-term sustaining effects on PC knowledge, beliefs, and intentions to initiate discussion with HCPs that could improve reproductive health behaviors and outcomes. Strong boosters and providing PC at each clinic visit could play important roles in sustaining long-term effects.

Accentuate the Relevant

People need information in order to make effective choices and to feel competent in managing their own affairs Decision-making research provides tools for identifying and addressing these informational needs The tools allow formal analyses of what information is critical to particular decisions, as well as descriptive analyses of how well those facts are understood Communication should be focused on critical information that is either missing or available but not understood Decision-relevant situations range from ones posing well-formulated, imminent choices to ones in which people are trying to understand what choices are even possible This article reviews briefly the formal and descriptive approaches to dealing with such decisions Including these approaches in behavioral interventions might help people to be as systematic as they would like in their decision making It might even make them want to be more systematic

Prescriptive scientific narratives for communicating usable science

In this paper I describe how a narrative approach to science communication may help audiences to more fully understand how science is relevant to their own lives and behaviors. The use of prescriptive scientific narrative can help to overcome challenges specific to scientific concepts, especially the need to reconsider long-held beliefs in the face of new empirical findings. Narrative can captivate the audience, driving anticipation for plot resolution, thus becoming a self-motivating vehicle for information delivery. This quality gives narrative considerable power to explain complex phenomena and causal processes, and to create and reinforce memory traces for better recall and application over time. Because of the inherent properties of narrative communication, their creators have a special responsibility to ensure even-handedness in selection and presentation of the scientific evidence. The recent transformation in communication and information technology has brought about new platforms for delivering content, particularly through interactivity, which can use structured self-tailoring to help individuals most efficiently get exactly the content that they need. As with all educational efforts, prescriptive scientific narratives must be evaluated systematically to determine whether they have the desired effects in improving understanding and changing behavior.

Calorie Label Formats: Using Numeric and Traffic Light Calorie Labels to Reduce Lunch Calories

In a field experiment involving online workplace lunch orders, this study examines the impact of numeric and traffic light calorie labels on calorie intake. Employees of a large corporation ordered lunches through a website of the authors’ design, on which they were presented menus with numeric calorie labels, traffic light labels, or both together, and the authors compared the calorie content of the ordered lunches with that of diners randomized to receive no calorie information. Each label type reduced lunch calories by approximately 10%. Nutrition knowledge was not improved by any menu format. Traffic light labels achieved meaningful reductions in calories ordered even in the absence of numeric information, and the authors found no apparent benefit or detriment of combining label types. These findings suggest that consumers may benefit most from help in identifying relatively healthier choices but rely little on information about the exact caloric content of items.

Mixed Drinks and Mixed Messages: Adolescent Girls' Perspectives on Alcohol and Sexuality.

Experimentation with alcohol and sexuality is a normative aspect of adolescent development. Yet, both present distinct risks to adolescent females and are especially problematic when they intersect. Although youth are often cautioned about the dangers associated with having sex and using alcohol, popular entertainment media frequently depict the combination of alcohol and sexuality as carefree fun. It is unclear how adolescent females interpret these contradictory messages in their everyday lives. Focus group interviews were used to explore young women’s understandings of the relation between alcohol and heterosexual sexuality. Young women, aged 14–17 years (N = 97; 61% White), and their mothers were recruited through advertisements in local newspapers to participate in separate, simultaneous focus group interviews. Only data from the 15 daughters’ groups are presented here. Qualitative analysis revealed that participants recognized the risks associated with combining alcohol and sex; yet, they also perceived sexual advantages to drinking alcohol. Advantages included facilitating social and sexual interactions and excusing unsanctioned sexual behavior. Alcohol was also seen as increasing the likelihood of sexual regret and coercion through impaired judgment and self-advocacy abilities. Educational and prevention efforts need to consider adolescent developmental and social needs, as well as the influences of the larger cultural context in which youth function.

Effectiveness of Personalized and Interactive Health Risk Calculators A Randomized Trial

Background Risk calculators are popular websites that provide individualized disease risk assessments to the public. Little is known about their effect on risk perceptions and health behavior. Objective This study sought to test whether risk calculator features—namely, personalized estimates of one’s disease risk and feedback about the effects of risk-mitigating behaviors—improve risk perceptions and motivate healthy behavior. Design A web-based experimental study using simple randomization was conducted to compare the effects of 3 prediabetes risk communication websites. Setting The study was conducted in the context of ongoing health promotion activities sponsored by a university’s human resources office. Patients Participants were adult university employees. Intervention The control website presented nonindividualized risk information. The personalized noninteractive website presented individualized risk calculations. The personalized interactive website presented individualized risk calculations and feedback about the effects of hypothetical risk-mitigating behaviors. Measurements Pre- and postintervention risk perceptions were measured in absolute and relative terms. Health behavior was measured by assessing participant interest in follow-up preventive health services. Results On average, risk perceptions decreased by 2%. There was no general effect of personalization or interactivity in aligning subjective risk perceptions with objective risk calculations or in increasing healthy behaviors. However, participants who previously overestimated their risk reduced their perceptions by 16%. This was a significantly larger change than the 2% increase by participants who underestimated their risk. Limitations Results may not generalize to different populations, different diseases, or longer-term outcomes. Conclusions Compared to nonpersonalized information, individualized risk calculators had little positive effect on prediabetes risk perception accuracy or health behavior. Risk perception accuracy was improved in people who receive relatively “good news” about risk rather than “bad news.”