Robert Hornik

Use of mass media campaigns to change health behaviour

Mass media campaigns are widely used to expose high proportions of large populations to messages through routine uses of existing media, such as television, radio, and newspapers. Exposure to such messages is, therefore, generally passive. Such campaigns are frequently competing with factors, such as pervasive product marketing, powerful social norms, and behaviours driven by addiction or habit. In this Review we discuss the outcomes of mass media campaigns in the context of various health-risk behaviours (eg, use of tobacco, alcohol, and other drugs, heart disease risk factors, sex-related behaviours, road safety, cancer screening and prevention, child survival, and organ or blood donation). We conclude that mass media campaigns can produce positive changes or prevent negative changes in health-related behaviours across large populations. We assess what contributes to these outcomes, such as concurrent availability of required services and products, availability of community-based programmes, and policies that support behaviour change. Finally, we propose areas for improvement, such as investment in longer better-funded campaigns to achieve adequate population exposure to media messages.

Social influences on the sexual behavior of youth at risk for HIV exposure.

OBJECTIVES Adolescents are increasingly at risk for infection with human immunodeficiency virus (HIV) and other sexually transmitted diseases, especially in poor urban minority communities. To aid the design of interventions in these communities, this study investigated the role of knowledge, attitudes, perceived parental monitoring, and peer behavior in the onset and progression of sexual behavior in children at risk for exposure to HIV. METHODS A computerized personal interview was administered to 300 African-American 9- to 15-year-old children living in six public housing developments in a large US city. RESULTS Although childrens knowledge about the hazards of sex increased with age, their sexual activity also increased (from 12% sexually experienced at 9 years of age to more than 80% experienced at 15 years of age). Parental monitoring appeared able to influence sexual activity. However, the perceived behavior of friends was associated with the rate at which sexual activity progressed with age and the degree to which condom use was maintained with age. CONCLUSIONS The early onset and prevalence of sexual behavior and the importance of peer group influence call for early interventions that simultaneously influence the parents and peers in childrens social networks.

Cancer Information Scanning and Seeking Behavior is Associated with Knowledge, Lifestyle Choices, and Screening

Previous research on cancer information focused on active seeking, neglecting information gathered through routine media use or conversation (“scanning”). It is hypothesized that both scanning and active seeking influence knowledge, prevention, and screening decisions. This study uses Health Information National Trends Survey (HINTS, 2003) data to describe cancer-related scanning and seeking behavior (SSB) and assess its relationship with knowledge, lifestyle behavior, and screening. Scanning was operationalized as the amount of attention paid to health topics, and seeking was defined as looking for cancer information in the past year. The resulting typology included 41% low-scan/no-seekers; 30% high-scan/no-seekers; 10% low-scan/seekers, and 19% high-scan/seekers. Both scanning and seeking were significantly associated with knowledge about cancer (B=.36; B=.34) and lifestyle choices that may prevent cancer (B=.15; B=.16) in multivariate analyses. Both scanning and seeking were associated with colonoscopy (OR = 1.38, for scanning and OR=1.44, for seeking) and with prostate cancer screening (OR=4.53, scanning; OR=10.01, seeking). Scanning was significantly associated with recent mammography (OR=1.46), but seeking was not. Individuals who scan or seek cancer information are those who acquire knowledge, adopt healthy lifestyle behaviors, and get screened for cancer. Causal claims about these associations await further research.

Creating Demand for Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising

PURPOSE American television viewers see as many as 16 hours of prescription drug advertisements (ads) each year, yet no research has examined how television ads attempt to influence consumers. This information is important, because ads may not meet their educational potential, possibly prompting consumers to request prescriptions that are clinically inappropriate or more expensive than equally effective alternatives. METHODS We coded ads shown during evening news and prime time hours for factual claims they make about the target condition, how they attempt to appeal to consumers, and how they portray the medication and lifestyle behaviors in the lives of ad characters. RESULTS Most ads (82%) made some factual claims and made rational arguments (86%) for product use, but few described condition causes (26%), risk factors (26%), or prevalence (25%). Emotional appeals were almost universal (95%). No ads mentioned lifestyle change as an alternative to products, though some (19%) portrayed it as an adjunct to medication. Some ads (18%) portrayed lifestyle changes as insufficient for controlling a condition. The ads often framed medication use in terms of losing (58%) and regaining control (85%) over some aspect of life and as engendering social approval (78%). Products were frequently (58%) portrayed as a medical breakthrough. CONCLUSIONS Despite claims that ads serve an educational purpose, they provide limited information about the causes of a disease or who may be at risk; they show characters that have lost control over their social, emotional, or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health.

Examining the dimensions of cancer-related information seeking and scanning behavior.

Recent decades have witnessed a growing emphasis on patients as active consumers of health information. The literature about cancer-related information focuses on active and purposeful information seeking, but a great deal of exposure to cancer-relevant information may happen less purposively (termed information scanning). This article presents results from an in-depth interview study that examined information seeking and scanning behavior in the context of cancer prevention and screening decisions among a diverse sample of people living in a major metropolitan area. Results suggest that information scanning is quite common, particularly for information related to screening tests. Information seeking is rarer and occurs primarily among those who also are information scanners. Respondents report using a greater variety of sources for information scanning than for information seeking, but participants were much more likely to report that their decisions were influenced by information received through seeking than through scanning. These findings shed new light on how individuals navigate the media environment and suggest future research should examine predictors and effects of less purposeful efforts to obtain cancer-related information.

Matching With Doses in an Observational Study of a Media Campaign Against Drug Abuse.

Multivariate matching with doses of treatment differs from the treatment-control matching in three ways. First, pairs must not only balance covariates, but also must differ markedly in dose. Second, any two subjects may be paired, so that the matching is nonbipartite, and different algorithms are required. Finally, a propensity score with doses must be used in place of the conventional propensity score. We illustrate multivariate matching with doses using pilot data from a media campaign against drug abuse. The media campaign is intended to change attitudes and intentions related to illegal drugs, and the evaluation compares stated intentions among ostensibly comparable teens who reported markedly different exposures to the media campaign.

Effects of the National Youth Anti-Drug Media Campaign on youths.

OBJECTIVES We examined the cognitive and behavioral effects of the National Youth Anti-Drug Media Campaign on youths aged 12.5 to 18 years and report core evaluation results. METHODS From September 1999 to June 2004, 3 nationally representative cohorts of US youths aged 9 to 18 years were surveyed at home 4 times. Sample size ranged from 8117 in the first to 5126 in the fourth round (65% first-round response rate, with 86%-93% of still eligible youths interviewed subsequently). Main outcomes were self-reported lifetime, past-year, and past-30-day marijuana use and related cognitions. RESULTS Most analyses showed no effects from the campaign. At one round, however, more ad exposure predicted less intention to avoid marijuana use (gamma = -0.07; 95% confidence interval [CI] = -0.13, -0.01) and weaker antidrug social norms (gamma = -0.05; 95% CI = -0.08, -0.02) at the subsequent round. Exposure at round 3 predicted marijuana initiation at round 4 (gamma = 0.11; 95% CI = 0.00, 0.22). CONCLUSIONS Through June 2004, the campaign is unlikely to have had favorable effects on youths and may have had delayed unfavorable effects. The evaluation challenges the usefulness of the campaign.

Can We Measure Encoded Exposure? Validation Evidence From a National Campaign

Exposure is often cited as an explanation for campaign success or failure. A lack of validation evidence for typical exposure measures, however, suggests the possibility of either misdirected measurement or incomplete conceptualization of the idea. If whether people engage campaign content in a basic, rudimentary manner is what matters when we talk about exposure, a recognition-based task should provide a useful measure of exposure, or what we might call encoded exposure, that we can validate. Data from two independent sources, the National Survey of Parents and Youth (NSPY) and purchase data from a national antidrug campaign, offer such validation. Both youth and their parents were much more likely to recognize actual campaign advertisements than to claim recognition of bogus advertisements. Also, gross rating points (GRPs) for a campaign advertisement correlated strikingly with average encoded exposure for an advertisement among both youth (r = 0.82 ) and their parents (r = 0.53 ).

“Talking” computers: A reliable and private method to conduct interviews on sensitive topics with children

To obtain valid results, interviews on sex‐related topics not only require confidentiality but also privacy. However, the typical solutions to this problem, self‐administered questionnaires or telephone interviews, may not be appropriate for pre‐ and early adolescents who may require face‐to‐face (FTF) interviews. In this research, we tested the hypothesis that interviews delivered by talking computers would elicit more reports of sexual experience and positive feelings toward sex than FTF interviews with children. To test the hypothesis, we compared the results of both interview methods administered to separate samples of 300 and 96 Black children ages 9 to 15 living in public housing. The results supported the hypothesis. In addition, a subsample of the children (n = 31) who had completed both interviews reported more favorable feelings toward sex in the computer interview. Computer interviews were reliable and did not produce higher levels of missing responses than FTF interviews. The results suggest t...

Cancer Information Scanning and Seeking in the General Population

The amount of cancer-related information available in the media and other sources continues to increase each year. We wondered how people make use of such content in making specific health decisions. We studied both the information they actively seek (“seeking”) and that which they encounter in a less purposive way (“scanning”) through a nationally representative survey of adults aged 40–70 years (n = 2,489) focused on information use around three prevention behaviors (dieting, fruit and vegetable consumption, and exercising) and three screening test behaviors (prostate-specific antigen, colonoscopy, mammogram). Overall, respondents reported a great deal of scanning and somewhat less seeking (on average 62% versus 28% for each behavior), and they used a range of sources including mass media, interpersonal conversations, and the Internet, alongside physicians. Seeking was predicted by female gender, age of 55–64 vs. 40–44, higher education, Black race and Hispanic ethnicity, and being married. Scanning was predicted by older age, female gender, and education. Respondents were fairly consistent in their place on a typology of scanning and seeking across behaviors. Seeking was associated with all six behaviors, and scanning was associated with three of six behaviors.