My primary research interests are media effects, health communication, and public policy. Here are some readings in each of these areas.

Media Effects

Bryant and Zillmann’s Media Effects: Advances in Theory and Research (Bryant and Zillmann 1994) describes the way that mass media or specialized media might affect people's knowledge, attitude and behavior. One way in which media influence behavior is by providing role models for observational learning. Role models can be a positive model for learning, or they can reinforce negative messages and stereotypes, especially among youth (Bandura 1994).

Gerbner discusses the cultivation effect of television (Gerbner, Gross et al. 1994). Widespread exposure to television can skew people’s sense of reality. TV has become the common symbolic environment that interacts with most of the things we think & do. Rogers’ social diffusion process (Rogers 1962) may not hold up in the era of new media. Bandura notes that communication technology has transformed the two-step process. Instead of taking cues from opinion leaders and personal communication, people may change their behavior after personal exposure to media, though they are inclined to seek verification from other sources before they act (Bandura 1994).

The best known cognitive response theory in advertising research is Petty & Cacioppo's Elaboration Likelihood Model (ELM). It posits a number of specific characteristics that influence the likelihood of cognitive response, esp. the ability of the receiver to use the information and the involvement of the receiver (Stewart and Ward 1994).

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Health Communication Theory

Rogers & Storey (1987) describe a communication campaign as:
- purposive
- aimed at a large audience
- has define time frame
- involves organized set of communication activities.

Gatekeepers at each stage include elected officials, stakeholders, media, and the evaluation team (McGrath 1995).

In designing a campaign, Bandura's social cognitive theory can be used with the transtheoretical stages-of-change model. with five stages. This combination can help us understand why people do what they do and how they change what they do. This is an advancement over health campaigns that assume that everyone is ready and willing to change behavior (Maibach and Cotton 1995).
Behavioral change is most likely when multiple media channels are mixed with interpersonal support. A particularly effective way is to involve campaign activities at the community level (Rice and Atkin 1994). In complicated behavioral changes, such as prescription drug compliance, no single intervention is enough – both educational and behavioral components are needed (Hammond 1995).

Health and Human Services (1989) has a model called the health communication wheel. Based on social marketing, its six stages are:
- planning and strategy
- selecting channels and materials
- developing materials and pretesting
-implementation
-assessing effectiveness
- feedback and refinement.

The most effective campaigns are those that systematically use research both to identify the audience(s) and to assess what the audience currently wants, thinks, feel, and does regarding the health issue. Ideally this is an ongoing process throughout the campaign, with the information fed forward for the purpose of refining campaign messages to the changing situation and needs of audience members (Maibach and Parrott 1995). For messages to be effective with a target population, they must be crafted in response to group's needs. This is often done with segmentation techniques taken from consumer marketing (Lefebvre, Doner et al. 1995). Segmentation strategies include focus groups and key informant interviews. If the segments are not known, a literature search can be added. If a health behavior is determined by one or two risk factors, these can drive the segmentation model (Slater 1995).

Media

Here are some issues related to the news media and health campaigns:
- Early in the history of an issue, reporters & editors may have considerable latitude in choosing among frames. Later the options narrow as elites take positions and media content begins to show consensus (McLeod, Kosicki et al. 1994).
- In attracting media interest, it is good to personalize stories. Abstract issues are difficult to portray visually, and some require specialized knowledge seldom found among news staffs. These stories have difficulty getting onto the media agenda (McLeod, Kosicki et al. 1994).
- Media coverage of health issues tends to focus on individual responsibility rather than fundamental systemic causes (McLeod, Kosicki et al. 1994).
- Media play a significant role in establishing the public agenda of important issues and reinforcing the salience of an issue. However, media can dilute the effects of intervention studies by creating a secular trend, effecting changes in public knowledge and perceptions as issue becomes universally accepted (Viswanath 2002).
- Behavioral journalism could be employed, with health educators writing stories for media placement or working with reporters to develop case studies to support a campaign (McAlister 2002).

Audiences pay attention when presentation is novel and a discrepancy exists between expectations and reality. This explains why comic book and soap opera presentations of health issues work (Parrott 1995)

Television can be particularly effective with black households, which watch more TV than other households (Greenberg and Brand 1994).

New media allow audiences to be more selective. It will become more difficult to reach target audiences through traditional media, but there will be more opportunities to reach precisely defined audiences with optimal messages.(Stewart and Ward 1994).

Messages

Campaign design can borrow from advertising industry, which has hypothesized a relationship between the cumulative number of exposures and knowledge or behavior People selectively attend to information based on its relevance to them at a given point in time (Stewart and Ward 1994).
In campaigns, it is generally more effective to emphasize current rewards and positive behavior changes rather than distant outcomes and negative consequences. It remains a challenge for campaigns to increase the salience of collective benefits over individual benefits (Rice and Atkin 1994). Health messages should avoid ambiguous language and use immediate, specific language. It is good to use second person - "you" - and present tense (Parrott 1995).

Depending on the behavior to be targeted, we might want to design a campaign focused on sensation-seekers, who are more likely to engage in high-risk behaviors, and who can be reached through specific media (Palmgreen, Donohew et al. 2002). Social inoculation can counter peer pressure, especially among young people (Pfau 1995).

Enforcement messages and new information are significantly correlated with campaign effects (Snyder 2002; Williams, Wells et al. 2002).

Role model campaigns were found to be actually less effective than others. Communication campaigns aimed at simple behaviors, such as not giving aspirin to a child with the flu, or vaccinating children against measles, can be highly effective (Soumerai, Ross-Degnan et al. 2002; Zimicki, Hornik et al. 2002)

Fear appeals are common in health communication, but rare in commercial advertising. Research shows that ads that arouse positive emotions generate positive feelings toward product and greater intent to comply (Monahan 1995). Fear appeals can be effective with certain audiences, but can trigger defensive avoidance with others. Successful fear appeals contain an action (efficacy) component. Fear appeals are more effective with older audiences (not children) and when the threat is severe, the target is vulnerable, and solutions are easy and effective (Cantor 1994, Hale and Dillard 1995).

Risk communication techniques can be effective, but research has shown that people have difficulty processing probabilities. They tend to underestimate cumulative risks. They respond differently depending on how statistics are framed. Their life experiences may influence how they view risk, especially long-term risk of diseases with long latency periods (Holtgrave, Tinsley et al. 1995).

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Evaluation

Formative evaluation provides data and perspectives to improve messages during the course of creation. Preproduction research can identify the target audiences, specify the target behavior, elaborate intermediate responses, and ascertain channel use. This is followed by pretesting research, which helps develop the concept and execute the test message. Summative evaluation measures audience, implementation, effectiveness, impacts, cost, causal processes (Rice and Atkin 1994).

Three general evaluation models are:
- advertising model - focuses on the early stages of the communication hierarchy (exposure, recall, liking, intentions)
- impact-monitoring - focuses on distal stages and social impacts archival or epidemiological info)
- experimental model - testing hypothesized causal changes through controlled manipulation of treatments (Rice and Atkin 1994).

The Hornik book,, Public Health Communication: Evidence for Behavior Change (2002), offers an account of successes and failures of past public health campaigns. Particularly, it discusses the susceptibility of community interventions studies to secular trends. Fan (2002) proposes time series methods as a way to address these influences.

Even knowing the limitations, it was instructive to read about several quasi-experimental studies, such as Kincaid et al’s work on vasectomy in Brazil (Kincaid, Merritt et al. 2002). One long-term success story is the National High Blood Pressure Education Program. Over 25 years, increase public knowledge on HBP and stroke. More people seeing their doctors. Decline in age-adjusted death rates at least partially attributable to program (Rocella 2002). A short-term success story was Hill et. al’s "Slip, slop, slap" campaign to increase sunscreen use in Australia. It used a stages of change model (Hill, White et al. 2002).

Three evaluative questions that are important to funding sources and policy makers are:
- Efficacy (did it work?)
- Replicability (will it work for other problems?)
- Sustainability (will it work forever?) (Smith 2002).

Evaluation can:
- set measurable social goals
- identify objectives in terms of behaviors that influence the goal
- define behavior as a combination of action, audience, and circumstance
- use research to define intervention opportunities
- identify theory-based determinants of behavior, describe how interventions are intended to influence determinants, achieve sufficient scope/exposure to accomplish the objectives
- ensure fidelity of intervention delivery
- monitor the intervention
- adapt the intervention to meet the changing needs of the audience (Smith 2002).

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Public Policy

Despite weak evidence, many public agencies assume that public health communication is a powerful tool for behavior change.(Hornik 2002).

At the personal level, media can affect health attitudes and behaviors. At the public level, media may raise awareness of health issues among policy makers and, thus, contribute to changing the context in which people make choices about their health (Brown and Walsh-Childers 1994).
Policy considerations are important in designing a public health campaign. Unless they are enlisted, policy-makers could work against a campaign (Parrott, Kahl et al. 1995).

Communication campaigns are vulnerable to lobbying, such as the tobacco industry effort that curtailed a state-funded antismoking campaign in California (Pierce, Emery et al. 2002) and the drug industry efforts to counter a Reyes’ syndrome campaign (Soumerai, Ross-Degnan et al. 2002). The Swiss government became nervous about an AIDS prevention campaign emphasizing condom use and tried to impose a pro-monogamy agenda, which was later withdrawn because of public backlash (Wellings 2002).

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References

Bandura, A. (1994). Social cognitive theory of mass communication. Media Effects: Advances in Theory and Research. J. Bryant and D. Zillmann. Hillsdale, NJ, Lawrence Erlbaum Associates.

Brown, J. D. and K. Walsh-Childers (1994). Effects of media on personal and public health. Media Effects: Advances in Theory and Research. J. Bryant and D. Zillmann. Hillsdale, N.J., Lawrence Erlbaum Associates: 389-415.

Bryant, J. and D. Zillmann (1994). Media Effects: Advances in Theory and Research. Hillsdale, NJ, Lawrence Erlbaum Associates.

Cantor, J. (1994). Fright reactions to mass media. Media Effects: Advances in Theory and Research. J. Bryant and D. Zillmann. Hillsdale, NJ, Lawrence Erlbaum Associates.

Fan, D. P. (2002). Impact of persuasive information on secular trends in health-related behaviors. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, NJ, Lawrence Erlbaum Associates: 251-264.

Gerbner, G., L. Gross, et al. (1994). Growing up with television: The cultivation perspective. Media Effects: Advances in Theory and Research. J. Bryant and D. Zillmann. Hillsdale, NJ, Lawrence Erlbaum Associates.

Greenberg, B. S. and J. E. Brand (1994). Minorities and the mass media: 1970s to 1990s. Media Effects: Advances in Theory and Research. J. Bryant and D. Zillmann. Hillsdale, N.J., Lawrence Erlbaum Associates: 273-314.

Hale, J. L. and J. P. Dillard (1995). Fear appeals in health promotion campaigns: Too much, too little, or just right? Designing Health Messages: Approaches from Communication Theory and Public Health Practice. E. Maibach and R. L. Parrott. Thousand Oaks, CA, Sage Publications: 65-80.

Hammond, S. L. (1995). Supplementing health campaign messages: Recent developments in informing patients about their prescription drugs. Designing Health Messages: Approaches from Communication Theory and Public Health Practice. E. Maibach and R. L. Parrott. Thousand Oaks, CA, Sage Publications: 249-269.

Hill, D., V. White, et al. (2002). Changes in sun-related attitudes and behaviors, and reduced sunburn prevalence in a population at high risk of melanoma. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, N.J., Lawrence Erlbaum Associates.

Holtgrave, D. R., B. J. Tinsley, et al. (1995). Encouraging risk reduction: A decision-making approach to message design. Designing Health Messages: Approaches from Communication Theory and Public Health Practice. E. Maibach and R. L. Parrott. Thousand Oaks, CA, Sage Publications: 24-40.

Hornik, R. C. (2002). Preface. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, N.J., Lawrence Erlbaum Associates.

Kincaid, D. L., A. P. Merritt, et al. (2002). Impact of a mass media vasectomy promotion campaign in Brazil. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, NJ, Lawrence Erlbaum Associates: 179-195.

Lefebvre, R. C., L. Doner, et al. (1995). Use of database marketing and consumer-based health communication in message design: An example from the Office of Cancer Communications' "5 a day for better health" program. Designing Health Messages: Approaches from Communication Theory and Public Health Practice. E. Maibach and R. L. Parrott. Thousand Oaks, CA, Sage Publications: 217-246.

Maibach, E. and E. W. Cotton (1995). Moving people to behavior change: A staged social cognitive approach to message design. Designing Health Messages: Approaches from Communication Theory and Public Health Practice. E. Maibach and R. L. Parrott. Thousand Oaks, CA, Sage Publications: 41-64.

Maibach, E. and R. L. Parrott (1995). Introduction. Designing Health Messages: Approaches from Communication Theory and Public Health Practice. E. Maibach and R. L. Parrott. Thousand Oaks, CA, Sage Publications.

McAlister, A. L., Fernandez, M. (2002). "Behavioral journalism" accelerates diffusion of healthy innovations. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, NJ, Erlbaum Associates: 315-326.

McGrath, J. (1995). The gatekeeping process: The right combinations to unlock the gates. Designing Health Messages: Approaches from Communication Theory and Public Health Practice. E. Maibach and R. L. Parrott. Thousand Oaks, CA, Sage Publications: 199-216.

McLeod, J. M., G. M. Kosicki, et al. (1994). The expanding boundaries of political communication effects. Media Effects: Advances in Theory and Research. J. Bryant and D. Zillmann. Hillsdale, NJ, Lawrence Erlbaum Associates: 123-162.

Monahan, J. L. (1995). Thinking positively: Using positive affect when designing health messages. Designing Health Messages: Approaches from Communication Theory and Public Health Practice. E. Maibach and R. L. Parrott. Thousand Oaks, CA, Sage Publications: 81-98.

Palmgreen, P., L. Donohew, et al. (2002). Television campaigns and sensation seeking targeting of adolescent marijuana use: Controlled time series approach. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, N.J., Lawrence Erlbaum Associates.

Parrott, R. L. (1995). Motivation to attend to health messages: Presentation of content and linguistic considerations. Designing Health Messages: Approaches from Communication Theory and Public Health Practice. E. Maibach and R. L. Parrott. Thousand Oaks, CA, Sage Publications: 7-23.

Parrott, R. L., M. L. Kahl, et al. (1995). Enabling health: Policy and administrative practices at a crossroads. Designing Health Messages: Approaches from Communication Theory and Public Health Practice. E. Maibach and R. L. Parrott. Thousand Oaks, CA, Sage Publications: 270-283.

Pfau, M. (1995). Designing messages for behavioral inoculation. Designing Health Messages: Approaches from Communication Theory and Public Health Practice. E. Maibach and R. L. Parrott. Thousand Oaks, CA, Sage Publications: 99-113.

Pierce, J. P., S. Emery, et al. (2002). The California tobacco control program: A long-term health communication project. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, N.J., Lawrence Erlbaum Associates.

Rice, R. E. and C. K. Atkin (1994). Principles of successful public communication campaigns. Media Effects: Advances in Theory and Research. J. Bryant and D. Zillmann. Hillsdale, N.J., Lawrence Erlbaum Associates: 365-387.

Rocella, E. J. (2002). The contributions of public health education toward the reduction of cardiovascular disease mortality: Experiences from the National High Blood Pressure Education Program. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, N.J., Lawrence Erlbaum Associates.

Rogers, E. M. (1962). Diffusion of Innovations. New York, The Free Press.

Slater, M. D. (1995). Choosing audience segmentation strategies and methods for health communication. Designing Health Messages: Approaches from Communication Theory and Public Health Practice. E. Maibach and R. L. Parrott. Thousand Oaks, CA, Sage Publications: 186-198.

Smith, W. (2002). From prevention vaccines to community care: New ways to look at program success. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, NJ, Lawrence Erlbaum Associates: 327-356.

Snyder, L. B., Hamilton, M.A. (2002). A meta-analysis of US health campaign effects on behavior: Emphasize enforcement, exposure, and new information, and beware the secular trend. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, N.J., Lawrence Erlbaum Associates: 357-383.

Soumerai, S. B., D. Ross-Degnan, et al. (2002). The effects of professional and media warnings about the association between aspirin use in children and Reye's Syndrome. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, NJ, Lawrence Erlbaum Associates: 265-288.

Stewart, D. W. and S. Ward (1994). Media effects on advertising. Media Effects: Advances in Theory and Research. J. Bryant and D. Zillmann. Hillsdale, N.J., Lawrence Erlbaum Associates: 315-363.

Viswanath, K., Finnegan, J.R. Jr. (2002). Reflections on community health campaigns: Secular trends and the capacity to effect change. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, N.J., Lawrence Erlbaum Associates.

Wellings, K. (2002). Evaluating AIDS public education in Europe: A cross-national comparison. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, N.J., Lawrence Erlbaum Associates.

Williams, A. F., J. K. Wells, et al. (2002). Increasing seat belt use in North Carolina. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, N.J., Lawrence Erlbaum Associates.

Zimicki, S., R. C. Hornik, et al. (2002). Improving vaccination coverage in urban areas through a health communication campaign: The 1990 Philippines experience. Public Health Communication: Evidence for Behavior Change. R. C. Hornik. Mahwah, NJ, Lawrence Erlbaum Associates: 197-217.

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