Prevention and Communication Research
Health communication for the
promotion of healthy lifestyles

(January 25, 2002) How might we best use health communication to more effectively translate our cancer prevention knowledge into lasting behavior changes? The Harvard Center for Cancer Prevention and the Health Communication Core and Risk Reduction Program of the Dana-Farber/Harvard Cancer Center recently co-sponsored a workshop to specifically address this question.

The workshop's first speaker was Dr. Robert Hornik, Professor of Communication and Health Policy in the Annenberg School for Communication at the University of Pennsylvania. Hornik began by noting that some public health programs have failed to yield positive results in behavior change, while others (several of which were not as strong in their evaluation designs) were more successful. For example, in COMMIT, a comprehensive trial aimed at reducing tobacco use, there was little difference in the cessation rates of heavy smokers between treatment and control groups. However, in a smaller campaign to reduce drug use in Kentucky, researchers saw marked declines in marijuana use. Hornik argued that the differing success of the two programs might have resulted from differences in the amount of exposure in each program. In COMMIT, the treatment and control groups received similar levels of exposure to anti-tobacco messages, whereas in the Kentucky trial, subjects got considerably greater exposure to anti-marijuana messages during intervention periods than control periods.

According to Hornik, the implications of his argument are two-fold. First, a program needs to provide exposure through multiple channels repeatedly over time; such exposure can be achieved by "buying it, begging for it, advocating for it, or making news." Second, large communication programs need to be evaluated in ways that respect the complex nature of the diffusion processes responsible for behavior change. For instance, although randomized controlled trials are considered the "ideal" evaluation design, they are often not appropriate for eva luating large-scale communication efforts where multiple sources and channels interact to produce behavior change. Alternative evaluation designs then need to be considered.

Following Dr. Hornik's presentation, Dr. K. Viswanath, Senior Health Communication Scientist at the National Cancer Institute, spoke on mass communication and secular trends in health and communication disparities. He started by commenting that health behavior change is possible, and that communication is playing an increasingly important role in promoting such change. However, the positive effects of communication efforts are not uniform across the population, and unless carefully planned and targeted, these efforts could actually exacerbate existing inequalities between social groups. For example, by increasing the flow of health information through mass media campaigns and Web sites, we will likely reach only higher socioeconomic groups, since they have greater resources available to them and also prior knowledge of many health topics. In this way, mass communication efforts can inadvertently widen the health knowledge gap between socioeconomic groups. To prevent this from happening, public health practitioners need to be aware of existing knowledge gaps and to frame health information appropriately in the media. After these remarks, a panel of representatives from the media, clinical, research, and public health communities provided their perspectives.

The panel included Robin Herman, Director of Communications at the Harvard School of Public Health; Dr. Larissa Nekhlyudov, General Internist at Harvard Vanguard Medical Associates; Dr. Glorian Sorensen, Director of the Center for Community-Based Research at Dana-Farber Cancer Institute; and Martha Wood, Director of Cancer Prevention and Control at the Massachusetts Department of Public Health. Some of their remarks included an underscoring of the media's power to potentially "set the public health agenda" and the importance of defining audiences and knowing the best channels to reach them.

The workshop concluded with a discussion on how health communication research, policy, and practice might be integrated to promote sustained healthy lifestyles. In summarizing these discussions, Dr. Norman Anderson, Professor of Health and Social Behavior at the Harvard School of Public Health, outlined several practical steps, including the formation of coalitions between scientists, community groups, and health communicators; the development of best practices databases for health communicators; and the creation and expansion of interdisciplinary training among journalists, public health practitioners, and scientists.

written by Daniel Kim