A 10-year systematic review of HIV/AIDS mass communication campaigns: Have we made progress?

The purpose of the current study was to conduct a 10-year systematic review of HIV/AIDS mass communication campaigns focused on sexual behavior, HIV testing, or both (1998-2007) and to compare the results with the last comprehensive review of such campaigns, conducted by Myhre and Flora (2000). A comprehensive search strategy yielded 38 HIV/AIDS campaign evaluation articles published in peer-reviewed journals, representing 34 distinct campaign efforts conducted in 23 countries. The articles were coded on a variety of campaign design and evaluation dimensions by two independent coders. Results indicated that compared with the previous systematic review (1986-1998 period), campaigns increasingly have employed the following strategies: (1) targeted defined audiences developed through audience segmentation procedures; (2) designed campaign themes around behavior change (rather than knowledge change); (3) used behavioral theories; (4) achieved high message exposure; (5) used stronger research designs for outcome evaluation; and (6) included measures of behavior (or behavioral intentions) in outcome assessments. In addition, an examination of 10 campaign efforts that used more rigorous quasi-experimental designs revealed that the majority (8 of 10) demonstrated effects on behavior change or behavioral intentions. Despite these positive developments, most HIV/AIDS campaigns continue to use weak (i.e., preexperimental) outcome evaluation designs. Implications of these results for improved design, implementation, and evaluation of HIV/AIDS campaign efforts are discussed.

Illicit use of prescription ADHD medications on a college campus: a multimethodological approach

OBJECTIVE

The authors used quantitative and qualitative methodologies to investigate college students' perceptions and use of illegal Attention Deficit Hyperactivity Disorder (ADHD) stimulants during spring and summer 2006.

PARTICIPANTS

From fall 2005 through fall 2006, the authors studied 1,811 undergraduates at a large, public, southeastern research university in the United States.

METHODS

The authors administered surveys to these students and conducted 175 in-depth interviews.

RESULTS

Of the study participants, 34% reported the illegal use of ADHD stimulants. Most illegal users reported using ADHD stimulants primarily in periods of high academic stress and found them to reduce fatigue while increasing reading comprehension, interest, cognition, and memory. Furthermore, most had little information about the drug and found procurement to be both easy and stigmafree.

CONCLUSIONS

This study supplies a rich understanding of the growing national trend of illegal ADHD stimulant use. The authors discuss strategies for stemming the tide of ADHD stimulant use.

Behavioral interventions to reduce HIV-related sexual risk behavior: review and synthesis of meta-analytic evidence

Over the past 25 years, scores of behavioral interventions to reduce HIV-related sexual risk behavior have been developed and evaluated. The purpose of the current study was to synthesize what is known about such interventions by systematically reviewing and synthesizing extant meta-analyses of the literature. Comprehensive search procedures resulted in a set of 18 meta-analyses that targeted HIV-related sexual risk behavior in a defined target population. The median meta-analysis in the review contained k = 19 primary studies with a cumulative N = 9,423 participants. All meta-analyses (11/11) that examined condom use found a statistically significant increase (median effect: OR = 1.34); 9/11 for reducing unprotected sex (median effect: OR = .76); 3/8 for reducing numbers of sexual partners (median effect: OR = .87); 4/6 for reduction of STDs (median effect: OR = .74); and 5/5 for reducing composite sexual risk (median effect: OR = .78). Summaries of moderator analyses suggested particular participant, intervention, and methodological characteristics that may influence the success of interventions. Implications include achieving a broader understanding of intervention moderators as well as increasing effectiveness trials and translation/dissemination of efficacious interventions to those populations most at risk.

Applying health behavior theory to multiple behavior change: considerations and approaches

BACKGROUND

There has been a dearth of theorizing in the area of multiple behavior change. The purpose of the current article was to examine how health behavior theory might be applied to the growing research terrain of multiple behavior change.

METHODS

Three approaches to applying health behavior theory to multiple behavior change are advanced, including searching the literature for potential examples of such applications.

RESULTS

These three approaches to multiple behavior change include (1) a behavior change principles approach; (2) a global health / behavioral category approach, and (3) a multiple behavioral approach. Each approach is discussed and explicated and examples from this emerging literature are provided.

CONCLUSIONS

Further study in this area has the potential to broaden our understanding of multiple behaviors and multiple behavior change. Implications for additional theory-testing and application of theory to interventions are discussed.

Longitudinal test of a multiple domain model of adolescent condom use

A comprehensive multiple domain model (MDM) to understand condom use in adolescents was proposed and tested using structural equation modeling of data at three time points. The proposed model integrates social psychological theory, demographic and personality factors, social environment, and situational/contextual variables. Adolescents who were sexually active at time 2 (6 months after baseline) and time 3 (1 year after time 2) and completed surveys at all three time points were included in the analyses (N = 511). An iterative process of model testing resulted in a structural equation model that provided a good fit to the data (CFI = .92, RMSEA = .04). Models comparing gender and race as moderators also were calculated and supported the generalizability of the model. Results provide support for an MDM that goes beyond traditional social psychological models for a broader understanding of condom use in adolescents. Implications for further theory testing and safer sexual interventions are discussed.

Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions

Although there is a large and growing literature on tailored print health behavior change interventions, it is currently not known if or to what extent tailoring works. The current study provides a meta-analytic review of this literature, with a primary focus on the effects of tailoring. A comprehensive search strategy yielded 57 studies that met inclusion criteria. Those studies-which contained a cumulative N = 58,454-were subsequently meta-analyzed. The sample size-weighted mean effect size of the effects of tailoring on health behavior change was found to be r = .074. Variables that were found to significantly moderate the effect included (a) type of comparison condition, (b) health behavior, (c) type of participant population (both type of recruitment and country of sample), (d) type of print material, (e) number of intervention contacts, (f) length of follow-up, (g) number and type of theoretical concepts tailored on, and (h) whether demographics and/or behavior were tailored on. Implications of these results are discussed and future directions for research on tailored health messages and interventions are offered.

Conducting Internet-based HIV/STD prevention survey research: considerations in design and evaluation

The aim of this paper is to advance rigorous Internet-based HIV/STD Prevention quantitative research by providing guidance to fellow researchers, faculty supervising graduates, human subjects' committees, and review groups about some of the most common and challenging questions about Internet-based HIV prevention quantitative research. The authors represent several research groups who have gained experience conducting some of the first Internet-based HIV/STD prevention quantitative surveys in the US and elsewhere. Sixteen questions specific to Internet-based HIV prevention survey research are identified. To aid rigorous development and review of applications, these questions are organized around six common criteria used in federal review groups in the US: significance, innovation, approach (broken down further by research design, formative development, procedures, sampling considerations, and data collection); investigator, environment and human subjects' issues. Strategies promoting minority participant recruitment, minimizing attrition, validating participants, and compensating participants are discussed. Throughout, the implications on budget and realistic timetabling are identified.

Effects of a televised two-city safer sex mass media campaign targeting high-sensation-seeking and impulsive-decision-making young adults

This study evaluates the ability of a safer sex televised public service announcement (PSA) campaign to increase safer sexual behavior among at-risk young adults. Independent, monthly random samples of 100 individuals were surveyed in each city for 21 months as part of an interrupted-time-series design with a control community. The 3-month high-audience-saturation campaign took place in Lexington, KY, with Knoxville, TN, as a comparison city. Messages were especially designed and selected for the target audience (those above the median on a composite sensation-seeking/impulsive-decision-making scale). Data indicate high campaign exposure among the target audience, with 85%-96% reporting viewing one or more PSAs. Analyses indicate significant 5-month increases in condom use, condom-use self-efficacy, and behavioral intentions among the target group in the campaign city with no changes in the comparison city. The results suggest that a carefully targeted, intensive mass media campaign using televised PSAs can change safer sexual behaviors.

Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions

Although there is a large and growing literature on tailored print health behavior change interventions, it is currently not known if or to what extent tailoring works. The current study provides a meta-analytic review of this literature, with a primary focus on the effects of tailoring. A comprehensive search strategy yielded 57 studies that met inclusion criteria. Those studies-which contained a cumulative N = 58,454-were subsequently meta-analyzed. The sample size-weighted mean effect size of the effects of tailoring on health behavior change was found to be r = .074. Variables that were found to significantly moderate the effect included (a) type of comparison condition, (b) health behavior, (c) type of participant population (both type of recruitment and country of sample), (d) type of print material, (e) number of intervention contacts, (f) length of follow-up, (g) number and type of theoretical concepts tailored on, and (h) whether demographics and/or behavior were tailored on. Implications of these results are discussed and future directions for research on tailored health messages and interventions are offered.

An interventionist's guide to AIDS behavioral theories

Although numerous individual-level AIDS behavioral theories (ABTs) exist in the literature, there is currently no consensus as to which theory is most precise in explaining or predicting HIV risk behavior. In the absence of empirical evidence favoring one ABT over another, how should an interventionist go about choosing a theory for one's particular prevention efforts? The current article provides an overview of and conceptually compares 13 ABTs in an attempt to provide guidance regarding this critical decision. A variety of criteria upon which one might judge ABTs are proposed and discussed, including empirical support for variables that make up the theory, whether or not theories are belief-based, AIDS-specific, message-based, intervention-based and behavior or behavioral-change focused. While all of the theories have strengths and weaknesses, the task for an interventionist is to choose the theory of best fit for one's particular prevention efforts. The suggestions provided in the current article may help with such a choice.

Condom use measurement in 56 studies of sexual risk behavior: review and recommendations

Despite numerous studies that measure self-reported condom use, there is currently no agreed upon "gold standard" in terms of the best way to assess condom use. The purpose of the current study was to review measures of self-reported condom use within correlational studies of sexual risk behavior, and to evaluate such measures on the basis of suggestions from the methodological literature. An additional purpose was to examine specifically whether measures published in the correlational literature have improved over time. A systematic review of studies was undertaken and specific review criteria were used to guide the inclusion of studies. A final set of 56 studies that contained 72 measures of self-reported condom use were included in the review. These measures were coded and evaluated on 12 dimensions, including measure type, number of response categories, recall period, sex partner specificity, and sex act specificity. Results indicated a great amount of diversity in terms of how condom use has been measured in the literature. Although results indicated that measures published between 1996 and 2003 were of higher quality on a number of dimensions as compared to 1989-1995, a number of these gains were minimal and in some cases measures have decreased in quality. The overall conclusion is that the sexual risk behavior literature should implement more of the recommendations made by methodological scholars in this area. Specific recommendations are summarized and presented in a way that may be helpful in guiding the development of future measures of self-reported condom use.

Why communication is crucial: meta-analysis of the relationship between safer sexual communication and condom use

The purpose of this study was to quantitatively synthesize the growing literature on the relationship between safer sexual communication (SSC) among sexual partners and condom use, and to systematically examine a number of conceptual and methodological moderators of this relationship. Data from 53 articles published in 27 journals met criteria for the study. Fifty-five independent effect sizes coded from samples totaling N=18,529 were meta-analyzed. Results indicate that the mean sample-size weighted effect size of the SSC-condom use relation was r=.22, and a number of conceptual variables were found to moderate this relationship. Specifically, communication about condom use (r=.25) and sexual history (r=.23) had significantly (p<.05) larger effect sizes than communication about safer sex (r=.18). In addition, SSC measures operationalized differently had significantly (p<.05) different effect sizes. From largest to smallest, these were behavioral format (r=.29), intentional format (r=.18), and self-efficacy format (r=.13). Measures that tried to assess persuasion attempts as compared with informational exchanges were not found to have significantly different effect sizes (p>.05). Further, methodological moderators tended to be unrelated to effect size. Implications for the future study of safer sexual communication as well as the importance of emphasizing communication skills in HIV preventive interventions are discussed.

In pursuit of cumulative knowledge in health communication: the role of meta-analysis

A major goal in health communication and related disciplines is the building of cumulative knowledge across numerous lines of inquiry. Traditionally, attempts to synthesize research and build knowledge have been achieved through narrative or integrative research reviews. However, the advent of meta-analysis in the late 1970s gave researchers a more sophisticated approach to synthesizing quantitative research literatures. This article (a) provides an overview of the meta-analytic approach, (b) discusses the historical context of meta-analysis, (c) examines the role that meta-analysis has played in the synthesis of health communication research, and (d) suggests future applications of the technique within health communication. It appears that meta-analysis has only recently been applied to the health communication field in a substantive way, and that its potential for moving the field forward has thus only begun to be realized.

A 10-year retrospective of research in health mass media campaigns: where do we go from here?

Mass media campaigns have long been a tool for promoting public health. How effective are such campaigns in changing health-related attitudes and behaviors, however, and how has the literature in this area progressed over the past decade? The purpose of the current article is threefold. First, I discuss the importance of health mass media campaigns and raise the question of whether they are capable of effectively impacting public health. Second, I review the literature and discuss what we have learned about the effectiveness of campaigns over the past 10 years. Finally, I conclude with a discussion of possible avenues for the health campaign literature over the next 10 years. The overriding conclusion is the following: The literature is beginning to amass evidence that targeted, well-executed health mass media campaigns can have small-to-moderate effects not only on health knowledge, beliefs, and attitudes, but on behaviors as well, which can translate into major public health impact given the wide reach of mass media. Such impact can only be achieved, however, if principles of effective campaign design are carefully followed.

Review of interactive safer sex Web sites: practice and potential

The Internet is increasingly being viewed as a health promotion tool with enormous potential. However, this potential cannot be realized if Web sites do not utilize the features that make the Internet a "hybrid" mass and interpersonal communication medium. The purpose of this study was to examine interactive safer sex Web sites on a number of dimensions. A comprehensive search that included Internet search engines, links from well-known sites, and previously published reviews yielded 21 Web sites that met criteria. Web sites were coded on dimensions including targeting of the Web sites, safer sex messages presented, theoretical strategies utilized, interactivity, and other characteristics. Results indicate that a moderate amount of targeting of Web sites exists, especially on age group (e.g., teenagers); the most prevalent safer sex messages were to "use condoms" and "be sexually abstinent"; raising the perceived threat of sexually transmitted diseases and HIV was the most prevalent theoretical strategy used to motivate safer sex; and finally, a moderate amount of interactivity was found on the Web sites, with most Web sites containing 4 or 5 features out of 15 features examined. Evidence that Web sites were tailoring information or messages to individuals was not found. Implications of these results for improving safer sex Web sites and developing interventions online are discussed.

Integrating personality and psychosocial theoretical approaches to understanding safer sexual behavior: implications for message design

The purpose of this study was to propose and conduct tests of a multivariate model of condom use utilizing data from 2 independent samples of young adults (City 1, N=746; City 2, N=743). The model examined the relations between personality characteristics, including sexual sensation seeking and sexual impulsive decision making; psychosocial variables, including condom attitudes, norms, and self-efficacy; and condom use behaviors, including carrying, communicating about, and using condoms. Structural equation modeling analyses indicated a good fit for both models (Confirmatory Fit Index=.93; Average Absolute Standardized Residuals=.05 for both), with each explaining 25% of the variance ( R (2)=.25) in condom use behaviors. Results support the fusion of personality and psychosocial approaches to gain a broader theoretical understanding of condom use in young adults. In addition, those developing and implementing health communication campaigns may find sexual sensation seeking and sexual impulsive decision making to be fruitful variables on which to target messages aimed at increasing safer sexual behavior.

Health Behavior Theory and cumulative knowledge regarding health behaviors: are we moving in the right direction?

Although research on Health Behavior Theory (HBT) is being conducted at a rapid pace, the extent to which the field is truly moving forward in understanding health behavior has been questioned. This issue is examined in the current article. First, we discuss the problems within the HBT literature. Second, we discuss the proliferation of HBT and why theory comparison is essential to this area of research. Finally, we reflect on ways that the field might move forward by suggesting a new agenda for HBT research. It is argued that increased recognition of the similarity of health behavior constructs as well as increased empirical comparisons of theories are essential for true scientific progress in this line of inquiry.

Rethinking positive and negative aspects of alcohol use: suggestions from a comparison of alcohol expectancies and decisional balance

OBJECTIVE

Few studies have compared similar alcohol-related constructs such as alcohol expectancies and decisional balance: two conceptualizations of the positive and negative aspects of alcohol. The purpose of this study was to compare these constructs and to examine their ability to predict alcohol use and problems.

METHOD

A sample of 406 college students recruited from Psychology courses at a mid-sized Northeastern University completed a questionnaire that included measures of alcohol expectancies, decisional balance, drinking indices and drinking problems. Of these students, N = 389 (73% female) were drinkers and were included in analyses.

RESULTS

Positive expectancies (PE) and the pros were more related to one another than were negative expectancies (NE) and the cons. The 8-item pros scale outperformed 20 items measuring PE in the prediction of alcohol problems and performed equally well in the prediction of alcohol indices. The negative relationship of cons to alcohol indices, something not found with NE, suggested that the cons scale may include components important to the measurement of negative aspects of alcohol.

CONCLUSIONS

Although expectancies, particularly PE, have been a common choice for use by researchers, these data suggest that decisional balance scales may be a better choice because their predictive ability is equal to or better than that of expectancies, and their response burden on participants is lower. Instruments that aim to measure the negative aspects of alcohol use should include severe and distal items to better capture this negative attitudinal domain.

Sexual assertiveness in heterosexually active men: a test of three samples

Heterosexually active men have great potential to increase condom use rates during sexual encounters. However, this potential cannot be realized if men are not assertive with their partners regarding condom use. This study reports on the examination of condom-specific sexual assertiveness (SA) in three independent samples of heterosexually active men. In so doing, a reliable and brief four-item measure of SA was developed from a measure previously used with women. Across all three samples, those with higher SA were significantly more likely to be further along the condom stages of change, and significantly less likely to have engaged in unprotected sex. Results suggest that SA is a meaningful construct for men and that increasing SA in men may result in subsequent increases in safer sexual behaviors.