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Highlights • Iron folic acid consumption can reduce anemia, but compliance remains low. • Interventions can promote interpersonal communication for behavior change. • Topic-specific and general interpersonal communication modalities appear effective. • Interpersonal communication mediated the intervention effect on iron supplement use., Objective More than half of Indian women of reproductive age are anemic. Regular iron folic acid uptake can prevent and treat anemia. This study investigated the effect of interpersonal communication on improving IFA use among women of reproductive age. Methods The Reduction in Anemia through Normative Innovations (RANI) Project is a cluster randomized trial that collected longitudinal data from control (n = 1896) and intervention (n = 1898) communities in Odisha, India at Time 1 and six months later at Time 2. Structural equation models assessed the effect of the intervention on iron folic acid use via multiple interpersonal communication pathways. Results Compared to the control arm, iron folic acid use significantly increased in the intervention arm. Both, general health interpersonal communication and anemia-specific interpersonal communication were augmented in the intervention communities. The impact of the intervention on iron folic acid use was mediated through anemia-specific interpersonal communication. Conclusion The RANI Project increased interpersonal communication among participants, resulting in increased iron folic acid use for anemia reduction. Practice implications Strategic use of targeted interpersonal communication to promote behavior change appears to be a viable strategy to increase iron folic acid use to reduce anemia.

Infectious disease outbreaks highlight the importance of trust in public health authorities to avoid fear and improve adherence to recommendations. There is currently no established and validated measure for trust in public health authorities. We aimed to develop and validate an instrument that measures trust in public health authorities and to assess the association between trust in public health authorities and vaccine attitudes. We developed 20 items to measure trust in public health authorities. After implementing a survey in January 2020, we investigated relationships between the items, reduced the number of items, and identified latent constructs of the scale. We assessed variability in trust and how trust was associated with vaccine attitudes, beliefs, and self-reported vaccine acceptance. The pool was reduced to a 14-item trust in public health authorities scale and we found that this trust model was strongly associated with acceptance of vaccines. Our scale can be used to examine the relationship between trust in public health authorities and adherence to public health recommendations. The measure needs to be validated in other settings to determine whether they are associated with other areas where the public question public health authority recommendations.

We conducted a longitidinal assessment of 806 respondents in March, 2020 in the US to examine the trustworthiness of sources of information about COVID-19. Respondents were recontacted after four months. Information sources included mainstream media, state health departments, the CDC, the White House, and a well-known university. We also examined how demographics, political partisanship, and skepticism about COVID-19 were associated with the perceived trustworthiness of information sources and decreased trustworthiness over time. At baseline, the majority of respondants reported high trust in COVID-19 information from state health departments (75.6%), the CDC (80.9%), and a university (Johns Hopkins, 81.1%). Mainstream media was trusted by less than half the respondents (41.2%), and the White House was the least trusted source (30.9%). At the 4-month follow-up, a significant decrease in trustworthiness in all five sources of COVID-19 information was observed. The most pronounced reductions were from the CDC and the White House. In multivariate analyses, factors associated with rating the CDC, state health department, and a university as trustworthy sources of COVID-19 information were political party affiliation, level of education, and skepticism about COVID-19. The most consistent predictor of decreased trust was political party affiliation, with Democrats as compared to Republicans less likely to report decreased trust across all sources.

We propose and test several hypotheses derived from the expanded theory of normative social behavior (TNSB) that also includes collective norms (with descriptive and injunctive norms). Data come from a quasi-experiment intervention to promote safer driving among adolescents in Serbia. The intervention was administered among high school students, most of whom were on the verge of receiving their driver's licenses. Longitudinal data were collected from treatment and control schools at baseline (

Contains fulltext : 219521.pdf (Publisher’s version ) (Closed access) We investigated the influence of framed norm messages about food consumption on motivation to consume, and actual consumption of, healthy and unhealthy foods. We proposed that the effects of positive and negative message frames would vary by the type of underlying norms (i.e., injunctive, descriptive). More specifically, based on information processing theories, it was expected that injunctive norms would be more effective when framed negatively compared with positively, while the opposite was expected for descriptive norms. In both experiments, participants were randomly assigned to one of four framed social norm conditions or a no-norm control condition. In Experiment 1, motivation to consume healthy and unhealthy foods was assessed by means of both indirect and self-report measures. In Experiment 2, actual food consumption was assessed. In both experiments, the predicted interaction was found. Results show that injunctive norms benefit from a negative (vs. positive) frame, while preliminary evidence suggests the opposite for descriptive norms. 33 p.

The role of mass media during a public health crisis is an ineluctable part of providing the public with critical information rapidly, particularly messages about self- and response efficacy. However, little is known about the role local news media play in disseminating efficacy information during infectious disease outbreaks. Here, we use the 2014 Ebola outbreak in Liberia as a case to explore this question. We content analyzed newspaper and radio messages disseminated between March 2014 and March 2015, during the midst of the outbreak. Results show that both radio programs and newspaper articles mentioned over 21 prevention steps at some point, with noticeable differences within which disease prevention messages were communicated most frequently to the public. At least 1 mention of self-efficacy was identified in 31.5% of radio content (n = 127), 23.6% of radio programming (n = 55), and 10.6% of newspaper content (n = 745). Response efficacy, signifying effectiveness of preventive methods, was detected in 25.2% of radio (n = 127), 16.4% of radio programming (n = 55), and 15% of newspaper content (n = 745). This is important as efficacy reporting can impact public readiness to adopt preventative measures and affect beliefs about self- and response efficacy, ultimately decreasing chances of spreading the infection and poorer health outcomes.

How social norms are formed likely has a bearing on the mechanisms underlying their effects on behavioral outcomes. We propose three mechanisms of norms formation - through direct experience, symbolically through media, or imaginatively - and introduce ideas about normative durability, normative subscription, normative volume, personal agency, and polarization of norms - that likely have a bearing on how norms affect behaviors. The COVID-19 pandemic has important implications for how norms are formed, which in turn invoke different underlying mechanisms in the relationship between social norms and behaviors. We propose a number of hypotheses for future studies to test.

Traffic road accidents are one of the leading causes of mortality in Nepal and around the world. Drivers in Nepal are not adequately educated about road safety rules. Road conditions are chaotic as traffic regulations are also not strictly enforced. Public safety campaigns may be able to alter drivers' attitudes and behaviors; however, little is known about which persuasive strategies may be most effective. Drawing on self-determination theory and the Health Belief Model, the current study used a post-only experimental design to test the impact of a short video message. The video included collective vs. individual appeals, and messages emphasizing one's ability to make the right choice (autonomy support) vs. directive language. Participants were Nepali college students (mean age 20, N = 199). Using structural equation modeling, the study found that directive messages rather than autonomy support influenced an individual seeing value in the recommended behavior (identified regulation), which in turn influenced perceived susceptibility, perceived severity, and behavioral intention. The study also proposed a behavior change model by incorporating the stage of identification with the message upon exposure. This model aims to expand the model proposed by the Health Belief Model, to include a stage of value identification before cues to action influence perception of threat. Further implications are discussed.

Medical and public health professionals recommend wearing face masks to combat the spread of the coronavirus disease of 2019 (COVID-19). While the majority of people in the United States support wearing face masks as an effective tool to combat COVID-19, a smaller percentage declared the recommendation by public health agencies as a government imposition and an infringement on personal liberty. Social media play a significant role in amplifying public health issues, whereby a minority against the imposition can speak loudly, perhaps using tactics of verbal aggression taking the form of toxic language. We investigated the role that toxicity plays in the online discourse around wearing face masks. Overall, we found tweets including anti-mask hashtags were significantly more likely to use toxic language, while tweets with pro-mask hashtags were somewhat less toxic with the exception of #WearADamnMask. We conclude that the tensions between these two positions raise doubt and uncertainty around the issue, which make it difficult for health communicators to break through the clutter in order to combat the infodemic. Public health agencies and other governmental institutions should monitor toxicity trends on social media in order to better ascertain prevailing sentiment toward their recommendations and then apply these data-driven insights to refine and adapt their risk communication messaging toward mask wearing, vaccine uptake, and other interventions.

Social norms affect human behavior, and underage drinking is no exception. Using the theory of normative social behavior (TNSB), this paper tested the proposition that the association between perceptions about the prevalence of drinking (descriptive norms) and underage drinking is strengthened when perceived pressures to conform (injunctive norms) and beliefs about the benefits of drinking (outcome expectations) are high. This proposition was tested on a nationally representative sample of underage drinkers, ages 13–20, (N = 1,031) in relation to their alcohol consumption, expanding on research with college-age youth. On average, males and females reported drinking 23 and 18 drinks per month, respectively. The main effect of descriptive norms (β = .10, p < .01) on alcohol consumption was modified by interactions with injunctive norms (β = .11, p < .01), benefit to self (β = .12, p < .001), and benefit to others (β = .10, p < .01). Underage drinkers are most vulnerable to excessive drinking if they believe that most others drink, that they themselves are expected to drink, and that drinking confers several benefits. Norms-based interventions to reduce youth alcohol use need to focus on changing not only descriptive norms, but also injunctive norms and outcome expectations.

Social norms, as a topic of inquiry, has garnered significant attention from a variety of perspectives in recent years. Because of the rapidly-growing interest in social norms from scholars in multiple disciplines, this area of scholarship is often characterized by a lack of clarity on what constitutes social norms and how key concepts are operationalized. The objectives of this article are to (a) provide a review of the fast-expanding literature on social norms, (b) delineate similarities and differences in key operational definitions, (c) review theories that explicate how norms affect behaviors, (d) propose a revised theoretical framework that helps organize our understanding of normative inf luence on behavior, and (e) provide suggestions for future research in this area. This review highlights the need to consider whether a behavior is enacted spontaneously or after deliberation. If the former, whichever attitude or norm is most salient will likely have a direct effect on behavior. If the latter, we propose that behavioral, individual, and contextual attributes will influence the extent to which norms shape behavioral intentions and subsequent behavior. Finally, this review highlights the need for more studies designed to test the causal relationship between social norms and behaviors, as well as those that study norms from a qualitative perspective.

We revisit some ideas from our previous article on social norms by conceptualizing norms as dynamic entities that both affect and are affected by human action; elaborating on the distinction between collective and perceived norms; summarizing key findings from studies that have adopted the theory of normative social behavior (TNSB) and thereby proposing guidelines for further expanding the purview of the TNSB; discussing the attribute-centered approach as a framework for focusing on behavioral characteristics; and highlighting areas for further inquiry into social norms.

This study was designed to evaluate the impact of an interactive computer program developed to empower prenatal communication among women with restricted literacy skills. A total of 83 women seeing 17 clinicians were randomized to a computer-based communication activation intervention (Healthy Babies Healthy Moms [HBHM]) or prenatal education (Baby Basics [BB]) prior to their prenatal visit. Visit communication was coded with the Roter Interaction Analysis System, and postvisit satisfaction was reported. Participants were on average 24 years of age and 25 weeks pregnant; 80% were African American. Two thirds scored ≤8th grade on a literacy screener. Women with literacy deficits were more verbally active, disclosed more medical and psychosocial/lifestyle information, and were rated as more dominant by coders in the HBHM group relative to their counterparts in the BB group (all ps < .05). Clinicians were less verbally dominant and more patient centered with literate HBHM relative to BB group women (p < .05); there was a similar, nonsignificant trend (p < .1) for lower literate women. Clinicians communicated less medical information and made fewer reassurance statements to lower literate women in the HBHM relative to the BB group (p < .05). There was a trend toward lower visit satisfaction for women with restricted literacy in the HBHM relative to the BB group (p < .1); no difference in satisfaction was evident for more literate women. The HBHM intervention empowered communication of all women and facilitated verbal engagement and relevant disclosure of medical and psychosocial information of women with literacy deficits. Satisfaction, however, tended to be lower for these women.

We document how social contexts serve to refract media effects. We theorized the relationship between media use and individual-level knowledge (and attitude) would be stronger when community-level knowledge (and attitude) was low than when it was high. Data come from a national survey (N = 12,608 women and 1,237 men) conducted in Nepal. Knowledge and stigma toward people living with HIV were the 2 dependent variables. Hypotheses were tested 12 times: across the use of 3 media (newspaper, radio, television) × 2 study outcomes (knowledge and attitudes) × 2 genders. Predicted interactions were supported in 9 of the 12 tests. Findings point to the need to take into account the role of community factors in theorizing about media effects

Individuals' behaviors are influenced by those of others in their social environment (i.e., descriptive norms), as well as by how individuals perceive they should behave in that environment (e.g., injunctive norms). Although social norms are thought to play an important role in hepatitis B virus (HBV) screening, limited theoretical or empirical guidance exists on how the underlying process works. In addition, norms are social phenomena that are spread through family discussion about the importance of getting HBV screening. Using the theory of normative social behavior (TNSB), this study examined the roles of injunctive norms (IN), descriptive norms (DN), and family discussion in HBV screening behavior among Asian Americans. Data from a survey of Asian Americans in the Baltimore Washington metropolitan area (N=877) were used to test underlying theoretical propositions. DN and family discussion emerged as key factors in HBV screening behavior among all Asian Americans. IN were associated with HBV screening among Chinese and Korean Americans, but not for Vietnamese Americans. Family discussion moderated the influence of DN on behavior among Chinese and Vietnamese Americans. However, the main effect of DN on screening behavior was not modified by IN (no interactions between DN and IN). The results indicate that family discussion and social norms are integral in enabling Asian Americans to undergo HBV screening and warrant sensitivity in the design and implementation of a liver cancer prevention program in this high-risk group of Asian Americans.

Asian immigrants have higher breast cancer rates compared to counterparts in their native countries. Little is known about psychosocial factors pertaining to their breast health. We sought to understand how acculturation moderates the relationship between anxiety and breast cancer-related outcomes among immigrant Asian Indian women. Surveys and in-person interviews were conducted among a sample of immigrant Indian women. Acculturation was a significant predictor of information seeking, frequency of mammograms, and clinical breast exams. There was also a significant Anxiety×Acculturation interaction effect on information seeking. The relationship between anxiety and information seeking was particularly acute for high, as compared to average, level of acculturation. When designing interventions for immigrants, it is important for health communication campaigns to take into account two critical factors: acculturation and anxiety of the audience. Anxiety among highly acculturated women appears to suppress inf...

Conceptualizing disparities as comprising both psychosocial and structural components, we hypothesized that interpersonal communication would moderate the effects of disparities on knowledge and HIV prevention behaviors. Using data (N = 3,843) from the Malawi BRIDGE Project, we examined the effects of project exposure on knowledge, HIV testing, condom use, and condom use intentions. Controlling for known predictors, exposure to the intervention was associated with knowledge and HIV testing but not with condom use or intention. The effect of campaign exposure on knowledge and HIV testing was heightened by interpersonal discussion. Interpersonal communication also heightened the effect of community norms on condom use, suggesting that interventions can garner greater effects and reduce disparities if they promote interpersonal discussion.

Underage drinking is a serious public health problem in the United States, and youth exposure to alcohol advertising has been indicated as a possible contributing factor. Although a number of studies have identified advertising content features that youth find appealing, a key limitation of this research is the absence of a broader tool to examine those features, especially those used by alcohol brands that are popular with underage drinkers. We created an index of content elements found in the research literature to be appealing to youth, and then used this index in a content analysis to identify the degree to which youth-appealing content appeared in a sample of alcohol ads that aired on television shows popular among youth. Finally, using bivariate analysis, we tested the relationship between alcohol brands' use of this content and the popularity of those brands among youth. We found that many of the ads featured youth-appealing content, and that the ads for the alcohol brands most popular among youth had more youth-appealing content than the less popular brands.

The theory of normative social behavior (TNSB) suggests that injunctive norms, group identity, outcome expectations, and peer communication moderate this relation between descriptive norms and behavioral intentions. This article extends the TNSB by conceptualizing parental influences (parental monitoring and disapproval) as important moderators in the relationship between descriptive norms and Korean mid-adolescents’ prior drinking behaviors as well as their drinking intentions. A study was conducted among Korean high school students ( N = 538) to assess their normative perceptions, parental monitoring, parental disapproval of drinking, drinking intentions, and past alcohol use. The current study found a significant association between parental monitoring and disapproval, on the one hand, and drinking and intentions, on the other, after controlling for descriptive norms. The results revealed that the harmful effects of adolescents’ perceptions about the prevalence of alcohol consumption among their peers may be mitigated through active parental involvement. When adolescents believed that their parents closely monitored and expressed disapproval of their drinking, they were less likely to be influenced by the high-risk behaviors practiced by their peers.

This journal has played a critical role in promoting norms-based scholarship. Publication of the first issue of Health Communication in 1989 coincided with the publication of the second edition of ...

In the literature, perceived risk is conceptualized as perceptions of both susceptibility and severity. Optimistic bias, the belief that one is less vulnerable than others to various diseases, is based primarily on assessments of personal susceptibility. In this article, the authors ask how perceptions of relative severity/susceptibility differ as a function of perceived similarity between oneself and a referent. Based on predictions from the optimistic bias literature, Study 1 (N = 67) manipulated similarity and measured both susceptibility and severity. As anticipated, ratings of susceptibility were negatively correlated with similarity. Ratings of severity, however, were unexpected in that they were highest for a similar referent. The uniqueness of personal threat hypothesis was proposed as an explanation for this finding, and this hypothesis was tested in Study 2 (N = 121). Results were mostly supportive. Findings indicated that individuals strategically use susceptibility and severity ratings to modulate their assessment of overall risk and personal identity.

Despite the importance of health information seeking not all people engage in such behaviors especially when thinking about the disease is distressing. The focus of this paper is to examine the antecedents of information seeking and retention. Based on individuals risk perception and efficacy beliefs the risk perception attitude framework is used to formulate four groups: responsive (high risk high efficacy) avoidance (high risk low efficacy) proactive (low risk high efficacy) and indifference (low risk low efficacy). In Study 1 a 2 (risk) x 2 (efficacy) between-subjects experiment participants perceived risk to skin cancer and skin cancer-related efficacy beliefs were induced to determine their information seeking retention and intentions to engage in future seeking. The responsive group as predicted was associated with the most information-seeking behaviors and information-seeking intentions. The avoidance group however sought information but exhibited the lowest retention scores. These results were used to derive two predictions - the incredulity hypothesis and the anxiety-reduction hypothesis - that were then tested in Study 2. Study 2 also a 2 (risk) x 2 (efficacy) between-subjects experiment dealing with diabetes found support for the anxiety-reduction hypothesis which argues that the high-risk low-efficacy group experiences more anxiety which leads to high motivations to seek but lower ability to retain information. (authors)

In recent years we have witnessed a resurgence of interest in the study of normative influences. The multitude of scholars who approach the topic from a variety of disciplinary perspectives widely share the convention backed by strong empirical evidence that social norms exert a great deal of influence on human behavior and that processes of normative influence exist in a variety of contexts and situations that people encounter in their everyday lives. Still despite several efforts to link norms to behavior more explicitly much about the actual mechanisms and processes through which normative influence is exerted remains unclear. Much more work also needs to be done in specifying the role that human communication processes play in how norms are understood and disseminated in a social group. (excerpt)

Normative restructuring strategies currently under way to combat alcohol-related problems among U.S. college students are based on the idea that students harbor inflated perceptions about the prevalence of drinking on campus and that if these misperceptions can be corrected, then alcohol consumption will decrease. Evidence for the effectiveness of these strategies is lacking, and there is little discussion in the literature about how or why people’s normative beliefs exert influence on their behaviors. The theory of normative social behavior that is proposed in this article includes three mechanisms—injunctive norms, outcome expectations, and group identity—that are hypothesized to moderate the influence of descriptive norms on behavior. This theory is tested through a survey (N = 1,352) conducted among incoming college students. Although all normative mechanisms predicted behavioral intention, four of the six variables also interacted with descriptive norms to influence intention, with relatively smaller effects. Overall, the model was able to predict 63% of the variance in intention to consume alcohol. Implications for health campaigns are discussed.

This article identifies four factors for consideration in norms-based research to enhance the predictive ability of theoretical models. First, it makes the distinction between perceived and collective norms and between descriptive and injunctive norms. Second, the article addresses the role of important moderators in the relationship between descriptive norms and behaviors, including outcome expectations, group identity, and ego involvement. Third, it discusses the role of both interpersonal and mass communication in normative influences. Lastly, it outlines behavioral attributes that determine susceptibility to normative influences, including behavioral ambiguity and the public or private nature of the behavior. The study of norms is of particular importance to communication scholarship because, by definition, norms are social phenomena, and they are propagated among group members through communication (Kincaid, 2004). Communication plays a part not only in formulating perceptions about norms (as when people use the preponderance of a behavior depicted in the media to form their perceptions about the prevalence of the behavior), but also in acting as a conduit of influence (when people base their decisions to act in a situation on the support for their actions that is communicated to them). This article is based on the premise that, given the centrality of communicative processes in propagating information about norms, its inclusion would enhance the explanatory power of theories of normative influences. The purpose of this article is to explore the intersection between social norms and communication by specifying the meaning of norms, delineating the moderators in the relationship between norms and behavior, and highlighting some of the attributes of behaviors that determine their susceptibility to normative influences.

Evidence of a direct correlation between risk perception and self-protective behavior is ambiguous at best. Witte's (1992, 1994) extended parallel process model (EPPM) explains many contradictory findings by pointing out the moderating role played by efficacy beliefs. Working from the EPPM, this article introduces the risk perception attitude (RPA) framework that categorizes individuals into one of four attitudinal groups: responsive (high risk, high efficacy), avoidance (high risk, low efficacy), proactive (low risk, high efficacy), and indifference (low risk, low efficacy). We conducted two studies to test our hypotheses that these groups differ in their self-protective motivation, intention to seek information, behavioral intention, knowledge acquisition, and time spent seeking information. Results, though not entirely consistent, suggest that, when risk and efficacy are made salient (Study 1), people's risk perception guides most of their subsequent actions, but in a natural context (Study 2), risk and efficacy jointly affect subsequent action.

Although a number of studies demonstrate the impact of perceived norms on human behavior we know little about how this relation works. Extant norms-based campaigns to reduce alcohol consumption among U.S. college students fail to distinguish between descriptive and injunctive norms. In this article we make this distinction and we develop a model of normative influences that also includes the impact of group identity and communication patterns of students alcohol consumption. Based on a survey of college students (N = 353) we found that descriptive and injunctive norms were different in terms of their impact on behavior. Furthermore the inclusion of group identity and communication patterns significantly added to the explanatory power of our model. Overall we were able to explain roughly 53% of the variance in consumption. (authors)

Using Witte's (1992) extended parallel process model, this study identifies 4 groups of individuals according to their perceived risk and self-efficacy: responsive (high perceived risk, high efficacy), proactive (low perceived risk, high efficacy), avoidance (high perceived risk, low efficacy), and indifference (low perceived risk, low efficacy). Membership in these groups is hypothesized to influence motivation to think about cardiovascular diseases (CVD), use of CVD-related information, and knowledge acquisition. In the cross-sectional data waves, there was a significant interaction between risk perception and self-efficacy on individuals' (a) motivation to think about CVD issues, (b) use of health information, and (c) knowledge acquisition. This study also found similar results longitudinally over a 2-year and a 6-year period.

Three cross-sectional data waves spanning 10 years (N = 2,055; 2,026; and 2,068) and 2 longitudinal data waves spanning 4 years (N = 1,384 and 1,151) from the Stanford Five-City Project (see Farquhar, Fortmann, Maccoby, & Haskell, 1985, for a full description of the project) were analyzed to determine whether diet self-efficacy mediated the relation between diet knowledge and behavior. In the cross-sectional data waves, knowledge-behavior correlations were greater among those with high (compared to low) self-efficacy. In the longitudinal data waves, knowledge-behavior correlations increased among those who increased their self-efficacy and decreased among those who decreased their self-efficacy. Recommendations are made for public health campaigns designed to improve individuals' health behaviors.

Public health campaign success is conceptualized in terms of improvements in three cardiovascular disease-related behaviors (diet, exercise, and smoking) and their precursors, including knowledge and self-efficacy. Two cross-sectional data waves (baseline and sixth year, N = 4,214) from the Stanford Five-City Project (FCP) are analyzed to test a model of campaign influences. Exposure to FCP campaign messages is correlated with health information seeking and interpersonal communication, which in turn are correlated with health behaviors. The central premise of the model is then tested on a longitudinal sample (N = 1,225) over a 3-year period with similar results. An overall health orientation index is introduced and recommendations are made for enhancing public health campaign effectiveness.

Using both cross-sectional and longitudinal data spanning a decade, this article analyzes how dietary behavior of household children and adults (N = 576 households) was affected by the Stanford Five-City Project (FCP). Tests of a three-part, cumulative model of bidirectional influences within the family, which conceptualizes household members as sources of influence on each other and subject to influence by an external agent, were supported. Children and adults were influenced by both each other and the FCP campaign in changing and maintaining health behaviors. This article demonstrates that public health campaigns can be made more effective if they conceptualize both children and adults as potential sources of influence. The long-term effectiveness of such efforts can be enhanced by encouraging families, as opposed to individuals, to change health behaviors.

This article provides a detailed analysis of message and production values used by government health agencies and television networks in 33 countries to create HIV AIDSrelated Public Service Announcements (PSAs). Although the first half of the article examines message factors in 317 PSAs, the second half presents a correlational analysis linking message factors to country characteristics such as level of social vulnerability, gross national product, human freedom, and female status.

Moving away from source-oriented models of communication, this article proposes that we reframe our understanding of the patient as an active citizen involved in individual and collective decision making. Citizens' health-related decisions in their physical, social, and mediated environments are examined. The role of the health communication researcher in each of these environments is to increase citizens' decision-making competencies, a task that requires adopting (a) a multilevel concep- tualization of health and (b) a definition of communication that involves the exchange of shared meaning.

Evaluation of effects of mass media-based health interventions requires accurate assessments of exposure, which can be difficult to obtain when young children are the primary audience. Alam Simsim, the Egyptian version of Sesame Street, aired nationally in Egypt to teach preschoolers about numeracy, literacy, and gender-equitable attitudes. The purpose of this article was to assess the effect of the program through a first-of-its-kind household-level survey that interviewed caretakers (n = 426) and preschoolers (n = 486). The authors introduced and tested the efficacy of a parsimonious measure of exposure: children's recognition of the primary characters of the program. Overall, the authors' models explained as much as 53% of the variance in children's learning; exposure to the program was significantly associated with learning. Furthermore, the parsimonious measure of exposure was as effective as a more elaborate child-reported measure. Relative to these two measures of exposure, caretakers' report of children's viewing was not as good a predictor of learning.

Global climate change is likely to have significant impacts on public health. Effective communication is critical to informing public decision making and behavior to mitigate climate change. An effective method of audience segmentation, the risk perception attitude (RPA) framework has been previously tested with other health behaviors and classifies people into 4 groups on the basis of their perceptions of risk and beliefs about personal efficacy. The 4 groups – indifference (low risk, weak efficacy), proactive (low risk, strong efficacy), avoidance (high risk, weak efficacy), and responsive (high risk, strong efficacy) – are hypothesized to differ in their self-protective behaviors and in their motivations to seek information. In this paper, we extend the RPA framework in two ways. First, we use it at the household level to determine whether parental classifications into the 4 groups are associated with their teenage children’s classification into the same 4 groups. Second, we predict adolescent information-seeking behaviors on the basis of their and their parents’ membership in the 4 RPA groups. Results (N = 523 parent-adolescent pairs) indicated that parental membership in the 4 RPA groups was significantly associated with children’s membership in the same 4 groups. Furthermore, the RPA framework was a significant predictor of adolescent information-seeking: those in the responsive and avoidance groups sought more information on climate change than the indifference group. Family communication on global warming was positively associated with adolescents’ information-seeking. Implications for interventions are discussed.

The purpose of this study was to test the effect of computer-generated, tailored feedback on the quality of chronic disease management for type 2 diabetes when provided to a patient prior to a scheduled physician visit. A stand-alone computer application was developed to provide tailored feedback aimed at empowering patients to engage more actively in their diabetes management. Adults with type 2 diabetes (n = 203) were randomly assigned to groups receiving either efficacy (positive) messages (n = 68), risk (negative) messages (n = 67), or to a delayed treatment control group (n = 68). The intervention was delivered prior to a patient's visit with his or her physician so that patients would have the opportunity to discuss the messages at the clinical appointment. Although there were no significant differences in the percentage of participants who received intensified care or routine tests between the control and intervention groups, we learned that more directive messaging may be needed to help patients effectively manage their diabetes. Patients may benefit from directive feedback, providing them with specific questions to ask their physician that can lead to improved care, rather than receiving general and educational informational messages.

The risk perception attitude (RPA) framework posits that efficacy beliefs moderate the relationship between risk perception and health outcomes. To extend the purview of the theory, this central hypothesis was tested in the context of HIV/AIDS-prevention behaviors. Data (N = 890) were collected from 8 districts in Malawi in southern Africa as part of a baseline research effort to obtain benchmark measures on key behavior-change indicators. Results pertaining to 2 behaviors, use of condoms and remaining monogamous, are reported in this study. Relationships between risk perception and behavioral intentions were not significant, but those between efficacy beliefs and behavioral intentions were. Furthermore, efficacy beliefs were found to moderate the relationship between risk perception and intentions to remain monogamous, but not between risk perceptions and intentions to use condoms. The model was able to explain approximately 40% of the variance in intentions to use condoms, and 19% of the variance in intentions to remain monogamous. Implications for health campaigns, particularly the need to strengthen efficacy beliefs and the need to be careful in enhancing risk perceptions without simultaneously strengthening efficacy beliefs, are also discussed.

Informed by the theory of normative social behavior, this article sought to determine the underlying mediating and moderating factors in the relationship between descriptive norms and behavioral intentions. Furthermore, the theory was extended by asking whether and what role behavioral identity played in normative influences. Simulating the central message of norms-based interventions to reduce college students' alcohol consumption, in this field experiment, descriptive norms were manipulated by informing half of the students (n = 665) that their peers consumed less alcohol than they might believe. Others (n = 672) were not provided any norms information. students' injunctive norms, outcome expectations, group identity, behavioral identity, and behavioral intention surrounding alcohol consumption were then measured. Exposure to the low-norms information resulted in a significant drop in estimates of the prevalence of consumption. Injunctive norms and outcome expectations partially mediated and also moderated the relationship between descriptive norms and behavioral intentions. Group identity and behavioral identity also moderated the relationship between descriptive norms and behavioral intentions, but the effect size was relatively small for group identity. Implications for health campaigns are also discussed.

Social norms have been shown to impact behaviors, but with mixed results. The theory of normative social behavior delineates factors that moderate the relationship between descriptive norms and behaviors, and it addresses the attributes of behaviors that make them susceptible to normative influence. This study tests whether group orientation moderates the impact of descriptive norms on water conservation attitudes and behavioral intentions. Findings indicate a consistent pattern of interactions for descriptive norms and group orientation on both attitudes and behavioral intent. Implications for normative theory and campaign design are addressed.

In recent years researchers have focused attention on understanding the role of normative factors in influencing behaviors. Although there is some evidence to support the idea that restructuring normative beliefs can result in behavior change, the norms literature is largely silent about how or why this influence occurs. The theory of normative social behavior describes the moderators of the descriptive norm-behavior relationship. Through a 2 (descriptive norms: high or low)×2 (perceived benefits: high or low)×2 (similarity: high or low) between-subjects experiment(N = 174), we tested whether these cognitive mechanisms moderated the norms-behavior link. Results indicated that descriptive norms do not exert a direct influence on behavior. Rather, perceived benefits moderated the relationship between descriptive norms and behavioral intention and perceived similarity moderated the relation between descriptive norms and self-efficacy.

This study investigates whether, and to what extent, community organizations can serve as viable channels of health information. We use Putnam's (2000) findings on social capital to argue that organizations can serve two major functions in health campaigns: instrumental (e.g., providing material support) and affinity (social support). Through a secondary analysis of data from the Stanford Five-City Project, we find significant support for our predictions about who joins community organizations. Membership in community organizations explains greater variance in health outcomes than that explained by general media use, demographic indicators, and health-specific media use. Implications for health campaigns are discussed.

A model of household dietary behaviors based on adults’ and children’s intrapersonal, interpersonal, and communicative factors is introduced and tested. To the extent that children’s health behaviors are influenced by adults’ health behaviors, it is hypothesized that children’s behavioral determinants, including self-efficacy, knowledge, and use of health information, will be affected by household adults’ behavioral determinants. Household communication is expected to affect the behaviors and the behavioral determinants of adults and children. Data come from the Stanford Five-City Project. Structural equation models revealed that adults’ dietary behavior was influenced by their self-efficacy, knowledge, and discussion between adults and children. Children’s dietary behavior was influenced by their self-efficacy, knowledge, and use of health information. Adults’ intrapersonal determinants of dietary behavior predicted corresponding children’s measures. Implications for health education efforts directed at children include encouraging household discussion about health and focusing on adults as agents of change as an integral campaign strategy.

Background Although social norms are thought to play an important role in couples’ reproductive decisions, only limited theoretical or empirical guidance exists on how the underlying process works. Using the theory of normative social behavior (TNSB), through a mixed-method design, we investigated the role played by injunctive norms and interpersonal discussion in the relationship between descriptive norms and use of modern contraceptive methods among the urban poor in India. Methods Data from a household survey (N = 11,811) were used to test the underlying theoretical propositions, and focus group interviews among men and women were then conducted to obtain more in-depth knowledge about decision-making processes related to modern contraceptive use. Results Spousal influence and interpersonal communication emerged as key factors in decision-making, waning in the later years of marriage, and they also moderated the influence of descriptive norms on behaviors. Norms around contraceptive use, which varied by parity, are rapidly changing with the country’s urbanization and increased access to health information. Conclusion Open interpersonal discussion, community norms, and perspectives are integral in enabling women and couples to use modern family planning to meet their current fertility desires and warrant sensitivity in the design of family planning policy and programs.