Shawnika J. Hull

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.

Barriers and facilitators of hepatitis C screening among people who inject drugs: a multi-city, mixed-methods study

BackgroundPeople who inject drugs (PWID) are at high risk of contracting and transmitting and hepatitis C virus (HCV). While accurate screening tests and effective treatment are increasingly available, prior research indicates that many PWID are unaware of their HCV status.MethodsWe examined characteristics associated with HCV screening among 553 PWID utilizing a free, multi-site syringe exchange program (SEP) in 7 cities throughout Wisconsin. All participants completed an 88-item, computerized survey assessing past experiences with HCV testing, HCV transmission risk behaviors, and drug use patterns. A subset of 362 clients responded to a series of open-ended questions eliciting their perceptions of barriers and facilitators to screening for HCV. Transcripts of these responses were analyzed qualitatively using thematic analysis.ResultsMost respondents (88%) reported receiving a HCV test in the past, and most of these (74%) were tested during the preceding 12 months. Despite the availability of free HCV screening at the SEP, fewer than 20% of respondents had ever received a test at a syringe exchange site. Clients were more likely to receive HCV screening in the past year if they had a primary care provider, higher educational attainment, lived in a large metropolitan area, and a prior history of opioid overdose. Themes identified through qualitative analysis suggested important roles of access to medical care and prevention services, and nonjudgmental providers.ConclusionsOur results suggest that drug-injecting individuals who reside in non-urban settings, who have poor access to primary care, or who have less education may encounter significant barriers to routine HCV screening. Expanded access to primary health care and prevention services, especially in non-urban areas, could address an unmet need for individuals at high risk for HCV.

Identifying the Causal Pathways from Religiosity to Delayed Adolescent Sexual Behavior

This study used the Integrative Model as a framework to examine whether religiosity delays onset of coitus among a longitudinal sample of virgins, and investigated the causal pathways of this relationship. In addition, this study examined the behavioral beliefs about the consequences of engaging in sex, which distinguishes between youth who vary in level of religiosity. A further analysis was also conducted to examine whether religiosity offers protective effects in terms of progression toward sexual intercourse on a sexual behavior index. The sexual behavior index assumes a progressive nature of sexual behaviors, and includes the following seven behaviors: kissing, having breasts touched (touching for boys), genital touching, receiving oral sex, vaginal intercourse, giving oral sex, and receiving (or giving) anal sex. Religiosity at baseline was negatively associated with sexual debut one year later. This relationship was mediated through attitudes toward personally engaging in sexual intercourse. Religiosity at baseline was also negatively associated with scores on the sexual behavior index one year later. These results suggest that religiosity offers protective effects for both coital and noncoital sexual behaviors.

How do cancer patients navigate the public information environment? Understanding patterns and motivations for movement among information sources.

Little is known about how patients move among information sources to fulfill unmet needs. We interviewed 43 breast, prostate, and colorectal cancer patients. Using a grounded theory approach, we identified patterns and motivations for movement among information sources. Overall, patients reported using one source (e.g., newspaper) followed by the use of another source (e.g., Internet), and five key motivations for such cross-source movement emerged. Patients’ social networks often played a central role in this movement. Understanding how patients navigate an increasingly complex information environment may help clinicians and educators to guide patients to appropriate, high-quality sources.

Perceived Risk as a Moderator of the Effectiveness of Framed HIV-Test Promotion Messages Among Women: A Randomized Controlled Trial

OBJECTIVE Researchers argue that gain-framed messages should be more effective for prevention behaviors, while loss frames should be more effective for detection behaviors (Rothman & Salovey, 1997). Evidence for this taxonomy has been mixed. This study examines whether the effects of gain- and loss-framed messages on HIV-testing intentions is moderated by perceived risk of a positive result. METHOD This experiment was conducted online and utilized a single factor (frame: gain/loss) between subjects design, with a separate HIV-test promotion control and a no message control to examine whether perceived risk of a positive test result moderates the effects of framed messages on intentions to seek an HIV test in the next 3 months. The sample (N = 1052; M age = 22, SD = 2.22), recruited through Survey Sampling International, included 51% Black women (49% White women). RESULTS HIV-test promotion messages were more effective than no message, but there were no other main effects for condition. Results also demonstrated a significant interaction between message frame and perceived risk, which is mediated through elaborative processing of the message. The interaction demonstrated an advantage for the loss-framed message among women with some perceived risk and an advantage for the gain-framed message among women with low perceived risk. CONCLUSION Results imply that the prevention/detection function of the behavior may be an inadequate distinction in the consideration of the effectiveness of framed messages promoting HIV testing. Rather, this study demonstrates that risk perceptions are an important moderator of framing effects.

Using Theory to Inform Practice The Role of Formative Research in the Construction and Implementation of the Acceptance Journeys Social Marketing Campaign to Reduce Homophobia

We describe the use of formative research in the construction and dissemination of the Acceptance Journeys campaign. This campaign aims to increase acceptance of gay men of color as a means to combat the broad disparities in HIV/AIDS experienced by this group in Milwaukee County, Wisconsin (United States). A situation analysis and systematic formative research in the form of a readiness assessment, in-depth interviews, preproduction focus groups, and postproduction concept testing were used to inform our conceptualizations of the problem (homophobia), product (acceptance), promotion (Acceptance Journeys branding), and channel selection. Implications for the application of social marketing techniques to social determinants of health are discussed.

High uptake of naloxone-based overdose prevention training among previously incarcerated syringe-exchange program participants.

BACKGROUND Incarceration is common among people who inject drugs. Prior research has shown that incarceration is a marker of elevated risk for opioid overdose, suggesting that the criminal justice system may be an important, under-utilized venue for implementing overdose prevention strategies. To better understand the feasibility and acceptability of such strategies, we evaluated the utilization of naloxone-based overdose prevention training among people who inject drugs with and without a history of incarceration. METHODS We surveyed clients who utilize a multi-site syringe exchange program (SEP) in 2 cities in the Midwestern United States. Participants completed an 88-item, computerized survey assessing history of incarceration, consequences associated with injection, injecting practices, and uptake of harm reduction strategies. RESULTS Among 543 respondents who injected drugs in the prior 30 days, 243 (43%) reported prior incarceration. Comparing those with and without a history of incarceration, there were no significant differences with respect to age, gender, or race. Those who observed an overdose, experienced overdose, and received training to administer or have administered naloxone were more likely to report incarceration. Overall, 69% of previously incarcerated clients had been trained to administer naloxone. CONCLUSION People who inject drugs with a history of incarceration appear to have a higher risk of opioid overdose than those never incarcerated, and are more willing to utilize naloxone as an overdose prevention strategy. Naloxone training and distribution is an important component of comprehensive prevention services for persons with opioid use disorders. Expansion of services for persons leaving correctional facilities should be considered.

Evaluation of the Acceptance Journeys Social Marketing Campaign to Reduce Homophobia.

Objectives To evaluate the effectiveness of the Acceptance Journeys social marketing campaign to reduce homophobia in the Black community in Milwaukee, Wisconsin. Methods We assessed the campaigns effectiveness using a rolling cross-sectional survey. Data were collected annually online between 2011 and 2015. Each year, a unique sample of Black and White adults, aged 30 years and older, were surveyed in the treatment city (Milwaukee) and in 2 comparison cities that did not have antihomophobia campaigns (St. Louis, MO, and Cleveland, OH; for total sample, n = 3592). Results Black self-identification and Milwaukee residence were significantly associated with exposure to the campaign, suggesting successful message targeting. The relationship between exposure and acceptance of gay men was significantly mediated through attitudes toward gay men, perceptions of community acceptance, and perceptions of the impact of stigma on gay men, but not through rejection of stereotypes. This model accounted for 39% of variance in acceptance. Conclusions This evidence suggests that the Acceptance Journeys model of social marketing may be a promising strategy for addressing homophobia in US Black communities.

Sensation Seeking as a Moderator of Gain- and Loss-Framed HIV-Test Promotion Message Effects

This study used an experiment (N = 504) to test whether the fit between sensation-seeking disposition and frame enhances the persuasiveness of gain- and loss-framed HIV test promotion messages. Gain- and loss-framed messages may be consistent with low and high sensation seekers’ disposition with respect to risk behavior. We hypothesized that a loss-framed message would be more persuasive for high sensation seekers and that a gain-framed message should be more effective for low sensation seekers. We also expected elaboration to mediate the interaction. Results demonstrated the hypothesized interaction. When the message frame fit with the viewers way of thinking, the persuasive power of the message was enhanced. The mediation hypothesis was not supported. Practical implications for targeting and message design are discussed.

Computerized Tailored Interventions to Enhance Prevention and Screening for Hepatitis C Virus Among People Who Inject Drugs: Protocol for a Randomized Pilot Study

Background Hepatitis C virus (HCV) infection is a growing problem among people who inject drugs. Strategies to reduce disease transmission (eg, syringe exchange programs) and facilitate HCV screening and linkage are available but are under-utilized in many communities affected by injection drug use. Novel approaches to increasing the use of these strategies are needed. Objective The goals of this project are to (1) develop and pilot test a computerized tailored intervention for increasing HCV screening and decreasing risky drug use behavior among people who inject drugs and (2) determine the feasibility of disseminating such an intervention using peer-based referrals in the setting of a community-based syringe exchange program. Methods This 2-arm, randomized pilot study is being conducted in a large-volume, multisite syringe exchange program in southern Wisconsin. A social network–based strategy was used to recruit a total of 235 adults who reported past-month injection of opioids, cocaine, or methamphetamine. Network recruiters were identified among clients requesting services from the syringe exchange program and were enlisted to refer eligible peers to the study. All participants completed a computer-adapted questionnaire eliciting information about risk behaviors and their knowledge, attitudes, and prior experiences related to HCV screening. Subjects were then randomly assigned to receive usual care, consisting of standard counseling by syringe exchange staff, or the Hep-Net intervention, which provides algorithm-based, real-time tailored feedback and recommendations for behavior change in the style of motivational interviewing. Changes in drug use behaviors and attitudes will be assessed during a second session between 90 and 180 days after the baseline visit. Frequency of repeat HCV testing and HCV incidence will be assessed through a database search 1 year after study completion. Results Recruitment for this study was completed in April 2015. Follow-up of enrolled participants is expected to continue until March 2016. Network recruiters were enrolled who referred a total of 195 eligible peers (overall N=235). At baseline, the median age was 34 years; 41.3% (97/235) were non-white; and 86.4% (203/235) reported predominantly injecting heroin. Most participants (161/234, 68.8%) reported sharing injection equipment in the past and of these, 30.4% (49/161) had never been tested for HCV. Conclusions This study will provide preliminary evidence to determine whether incorporating computerized behavioral interventions into existing prevention services at syringe exchange programs can lead to adoption of healthier behaviors. Trial Registration ClinicalTrials.gov NCT02474043; https://clinicaltrials.gov/ct2/show/NCT02474043 (Archived by WebCite at http://www.webcitation.org/6dbjUQG7J)