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Article

Audience Segmentation Techniques  

Rachel A. Smith

A premise in health promotion and disease prevention is that exposure to and consequences of illness and injury can be minimized through people’s actions. Health campaigns, broadly defined as communication strategies intentionally designed to encourage people to engage in the actions that prevent illness and injury and promote wellbeing, typically try to inspire more than one person to change. No two people are exactly alike with respect to their risk for illness and injury or their reactions to a campaign attempting to lower their risk. These variations between people are important for health messaging. Effective campaigns provide a target audience with the right persuasive strategy to inspire change based on their initial state and psychosocial predictors for change. It is often financially and logistically unreasonable to create campaigns for each individual within a population; it is even unnecessary to the extent to which people exist in similar states and share psychosocial predictors for change. A challenging problem for health campaigns is to define those who need to be reached, and then intelligently group people based on a complex set of variables in order to identify groups with similar needs who will respond similarly to a particular persuasive strategy. The premise of this chapter is that segmentation at its best is a systematic and explicit process of research to make informed decisions about how many audiences to consider, why the audience is doing what they are doing, and how to reach that audience effectively.

Article

Transtheoretical Model and Stages of Change in Health and Risk Messaging  

Seth M. Noar

The Transtheoretical Model (TTM) is an integrative health behavior change theory that describes the process of how people change their behavior. The central organizing construct in the theory is stages of change, which are five distinct stages of readiness to change behavior, ranging from not ready to change (precontemplation), thinking about change (contemplation), preparing to change (preparation), changing (action), and maintaining the change (maintenance). Movement through the stages may be nonlinear, and cycling and recycling through the stages is viewed as a natural part of the change process. Other model constructs explain what drives individuals forward through the stages of change. Decisional balance involves a weighing of pros and cons of changing behavior, while self-efficacy involves situation-specific confidence that one can change. Increases in pros, deceases in cons, and increases in self-efficacy propel people forward through the stages of change. The processes of change are experiential and behavioral strategies that people use to change their behavior. In early stages of change, people use experiential strategies while they use behaviorally oriented strategies in later stages of change. The TTM holds significant implications for message design. Most notably, messages should be targeted and tailored to stages of change, and where possible, to other model variables as well. Studies indicate that the TTM has been successfully applied to health communication campaigns, and to a larger extent, to computer-tailored interventions to change health behavior. Meta-analyses indicate that scores of computer-tailored interventions have been efficacious, including many based upon the TTM and stages of change. New applications of the model include a focus on novel health behaviors, multiple behavior change, and advancing an understanding of message design in the context of the TTM in combination with other theoretical approaches.

Article

Big Data’s Role in Health and Risk Messaging  

Bradford William Hesse

The presence of large-scale data systems can be felt, consciously or not, in almost every facet of modern life, whether through the simple act of selecting travel options online, purchasing products from online retailers, or navigating through the streets of an unfamiliar neighborhood using global positioning system (GPS) mapping. These systems operate through the momentum of big data, a term introduced by data scientists to describe a data-rich environment enabled by a superconvergence of advanced computer-processing speeds and storage capacities; advanced connectivity between people and devices through the Internet; the ubiquity of smart, mobile devices and wireless sensors; and the creation of accelerated data flows among systems in the global economy. Some researchers have suggested that big data represents the so-called fourth paradigm in science, wherein the first paradigm was marked by the evolution of the experimental method, the second was brought about by the maturation of theory, the third was marked by an evolution of statistical methodology as enabled by computational technology, while the fourth extended the benefits of the first three, but also enabled the application of novel machine-learning approaches to an evidence stream that exists in high volume, high velocity, high variety, and differing levels of veracity. In public health and medicine, the emergence of big data capabilities has followed naturally from the expansion of data streams from genome sequencing, protein identification, environmental surveillance, and passive patient sensing. In 2001, the National Committee on Vital and Health Statistics published a road map for connecting these evidence streams to each other through a national health information infrastructure. Since then, the road map has spurred national investments in electronic health records (EHRs) and motivated the integration of public surveillance data into analytic platforms for health situational awareness. More recently, the boom in consumer-oriented mobile applications and wireless medical sensing devices has opened up the possibility for mining new data flows directly from altruistic patients. In the broader public communication sphere, the ability to mine the digital traces of conversation on social media presents an opportunity to apply advanced machine learning algorithms as a way of tracking the diffusion of risk communication messages. In addition to utilizing big data for improving the scientific knowledge base in risk communication, there will be a need for health communication scientists and practitioners to work as part of interdisciplinary teams to improve the interfaces to these data for professionals and the public. Too much data, presented in disorganized ways, can lead to what some have referred to as “data smog.” Much work will be needed for understanding how to turn big data into knowledge, and just as important, how to turn data-informed knowledge into action.

Article

Cultural Fusion in Physician–Patient Communication and Decision Making in Japan  

Miho Iwakuma and Daisuke Son

The term “cinemeducation” was coined by Matthew Alexander in 2002, and according to P. Ravi Shankar, it refers to the use of clips from movies and videos to educate medical students and residents on the psychosocial aspects of medicine. As a counterbalance to the biomedicine-centric medical curricula, cinemeducation deals with the psychosocial aspects of medicine and sensitive topics in healthcare, including but not limited to depression, family and marital counseling, doctor–patient relationships, family systems, addiction, mental illness, cultural competency, and foreign patients and their healthcare beliefs. Cinemeducation is particularly useful when the viewing is followed by a discussion, which engages students in active learning of clinically relevant concepts such as informed consent (IC), palliative care, and patient-centeredness. In other words, cinemeducation provides students in the healthcare fields with opportunities to learn about the humanistic aspects of medicine by watching movies or clips that provide insight into human experiences and challenges in medicine. A famous Japanese medical TV series, Shiroi Kyoto (The Great White Tower) will be examined to discuss the cultural fusion that has occurred in Japan, specifically with regard to clinical communication. Based on a novel authored by Toyoko Yamazaki in the 1960s, this series is of interest because the novel was made into a drama twice, first in the 1970s and again in 2003. Accordingly, several significant changes in health communication are noticeable between the first and second versions. Social changes in paternalism in medicine, palliative care, and IC that were adapted from the West and localized in Japan, as cultural fusion are evident in several noteworthy scenes.

Article

Communication and Recruitment to Clinical Research Studies  

Janice L. Krieger and Jordan M. Neil

Strategic communication is an essential component in the science and practice of recruiting participants to clinical research studies. Unfortunately, many clinical research studies do not consider the role of communication in the recruitment process until efforts to enroll patients in a timely manner have failed. The field of communication is rich with theory and research that can inform the development of an effective recruitment plan from the inception of a clinical research study through informed consent. The recruitment context is distinct from many other health contexts in that there is often not a behavioral response that can be universally promoted to patients. The appropriateness of a clinical research study for an individual is based on a number of medical, psychological, and contextual factors, making it impossible to recommend that everyone who is eligible for a clinical research study enroll. Instead, clinical research study recruitment efforts must utilize strategic communication principles to ensure that messages promote awareness of clinical research, maximize personal relevance, minimize information overload, and facilitate informed choice. This can be accomplished through careful consideration of various aspects of the communication context described in this chapter, including audience segmentation, message content, message channels, and formative, process, and outcome evaluation, as well as the enrollment encounter.

Article

Cross-Cultural Adaptation  

Young Yun Kim

Countless immigrants, refugees, and temporary sojourners, as well as domestic migrants, leave the familiar surroundings of their home culture and resettle in a new cultural environment for varying lengths of time. Although unique in individual circumstances, all new arrivals find themselves in need of establishing and maintaining a relatively stable working relationship with the host environment. The process of adapting to an unfamiliar culture unfolds through the stress-adaptation-growth dynamic, a process that is deeply rooted in the natural human tendency to achieve an internal equilibrium in the face of adversarial environmental conditions. The adaptation process typically begins with the psychological and physiological experiences of dislocation and duress commonly known as symptoms of culture shock. Over time, through continuous activities of new cultural learning, most people are able to attain increasing levels of functional and psychological efficacy vis-a-vis the host environment. Underpinning the cross-cultural adaptation process are the two interrelated experiences of deculturation of some of the original cultural habits, on the one hand, and acculturation of new ones, on the other. The cumulative outcome of the acculturation and deculturation experiences is an internal transformation in the direction of assimilation into the mainstream culture. Long-term residents and immigrants are also likely to undergo an identity transformation, a subtle and largely unconscious shift from a largely monocultural to an increasingly intercultural self-other orientation, in which conventional, ascription-based cultural categories diminish in relevance while individuality and common humanity play an increasingly significant role in one’s daily existence. Central to this adaptation process are one’s ability to communicate in accordance to the norms and practices of the host culture and continuous and active engagement in the interpersonal and mass communication activities of the host society.

Article

Online Talk About Mental Health  

Joyce Lamerichs and Wyke Stommel

There is a need to focus on research conducted on online talk about mental health in the domains of ethnomethodology, Conversation Analysis (CA), Discursive Psychology (DP), and Membership Categorization Analysis (MCA). We use the notion of “talk” in this article, as opposed to what could be considered a more common term such as “discourse,” to highlight that we approach computer-mediated discourse as inherently interactional. It is recipient designed and unfolds sequentially, responding to messages that have come before and building a context for messages that are constructed next. We will refer to the above domains that all share this view as CA(-related) approaches. A characterizing feature of interactional approaches to online mental health talk is their focus on in-depth analyses of relatively small amounts of data. With this focus at the center of their attention, they sit in the wider field of Discourse Analysis (DA), or Computer-Mediated Discourse Analysis (CMDA) who use language as their lens to understand human interaction. DA and CMDA research include a much wider set of both micro- and macro-analytic language-focused approaches to capture online discourse. Of all the CA(-related) work on online materials, a disproportionally large number of studies appear to deal with (mental) health talk. We aim to answer the question what the field of research on online mental health talk has yielded in terms of findings and methodologies. Centrally, CA (-related) studies of online mental health talk have aimed to grasp the actions people accomplish and the identities they invoke when they address their health concerns. Examples of actions in online mental health talk in particular are presenting oneself, describing a problem, or offering advice. Relevant questions for the above approaches that consider language-as-social-action are how these different actions are brought off and how they are received, by closely examining contributions such as e-mail and chat postings and their subsequent responses. With a focus on talk about mental health, this article will cover studies of online support groups (OSGs, also called online communities), and interaction in online counseling programs, mainly via online chat sessions. This article is organized as follows. In the historiography, we present an overview of CA(-related) work on online mental health talk. We discuss findings from studies of online support groups (OSGs) first and then move to results from studies on online counseling. The start of our historiography section, however, sets out to briefly highlight how the Internet may offer several particularly attractive features for those with mental health problems or a mental illness. After the historiography, we discuss what an interactional approach of online mental health talk looks like and focuses on. We offer examples of empirical studies to illustrate how written contributions to a forum, and e-mails or chat posts that are part of online counseling sessions are examined as interaction and which types of findings this results in. We conclude with a review of methodological issues that pertain to the field, address the most important ethical considerations that come into play when examining online mental health talk, and will lastly highlight some areas for future research.

Article

Risk Perceptions and Risk Characteristics  

Hye-Jin Paek and Thomas Hove

Risk perception refers to people’s subjective judgments about the likelihood of negative occurrences such as injury, illness, disease, and death. Risk perception is important in health and risk communication because it determines which hazards people care about and how they deal with them. Risk perception has two main dimensions: the cognitive dimension, which relates to how much people know about and understand risks, and the emotional dimension, which relates to how they feel about them. Several theoretical models have been developed to explain how people perceive risks, how they process risk information, and how they make decisions about them: the psychometric paradigm, the risk perception model, the mental noise model, the negative dominance model, the trust determination model, and the social amplification of risk framework. Laypeople have been found to evaluate risks mostly according to subjective perceptions, intuitive judgments, and inferences made from media coverage and limited information. Experts try to base their risk perceptions more on research findings and statistical evidence. Risk perceptions are important precursors to health-related behaviors and other behaviors that experts recommend for either dealing with or preventing risks. Models of behavior change that incorporate the concept of risk perception include the Health Belief Model, Protection Motivation Theory, the Extended Parallel Process Model, and the Risk Perception Attitude framework. Public awareness and perceptions of a risk can be influenced by how the media cover it. A variety of media factors have been found to affect the public’s risk perceptions, including the following: (1) amount of media coverage; (2) frames used for describing risks; (3) valence and tone of media coverage; (4) media sources and their perceived trustworthiness; (5) formats in which risks are presented; and (6) media channels and types. For all of these media factors, albeit to varying degrees, there is theoretical and empirical support for their relevance to risk perceptions. Particularly related to media channels and genres, two hypotheses have emerged that specify different kinds of media influences. The impersonal impact hypothesis predicts that news media mainly influence how people see risks as affecting other individuals, groups, nations, or the world population in general (societal-level risk perceptions). By contrast, the differential impact hypothesis predicts that, while news media influence people’s societal-level risk perceptions, entertainment media have stronger effects on how people see risks as affecting themselves (personal-level risk perceptions). As the media environment become increasingly diverse and fragmented, future research on risk perception needs to examine more of the influences that various media, including social media, have on risk perception. Also, the accounts of how those influences work need to be further refined. Finally, since people’s risk perceptions lead them to either adopt or reject recommended health behaviors, more research needs to examine how risk perceptions are jointly affected by media, audience characteristics, and risk characteristics.

Article

Disasters and Communication about Health  

Rebecca Cline and Andrea Meluch

Health consequences and key communication processes that emerge during disasters vary by type of disaster. The types of disasters that researchers have most investigated are rapid-onset natural disasters and slowly-evolving human-caused disasters. Three types of communication processes occur in disasters that have implications for health. The first set of communication processes involves the social dynamics of affected communities. Communities that experience natural disasters tend to exhibit an emergent altruistic community; community members join together to support each other in the immediate aftermath of the disaster. In contrast, community conflict is the hallmark of slowly-evolving environmental disasters. That conflict triggers a cascade of social dynamics that infests close personal relationships with interpersonal conflict, stigmatization of victims and advocates, and pressures to avoid open communication (i.e., social constraints) regarding the disaster and its traumatic effects. These dynamics contribute to elevated mental health problems. The second set of communication processes focuses specifically on social support. Supportive communication processes and networks are important resources for coping with ongoing disasters and for mitigating their longer-term mental health effects. Due to differences in community-level social dynamics, patterns of social support evolve differently in natural versus human-caused disasters. Natural disasters are typified by immediate intra-community social support. Community members support each other in the immediate aftermath of the disaster. Ultimately this social support is overwhelmed by the disaster’s needs and deteriorates. As a result, communities are largely dependent on internal and external institutional sources to meet community members’ needs. In contrast, slowly-evolving human-caused disasters tend to exhibit the emergence of corrosive communities. In these communities, those most affected by the disasters (those whose health is harmed or who claim other harmful or potentially harmful effects, and those who function as advocates) tend to experience failed or diminished social support. Whereas the community may previously have been altruistic, mutual help either fails to emerge or is withdrawn in the disaster context. Failed social support contributes to the relatively worse mental health consequences of slowly-evolving human-caused disasters when compared to natural disasters. The third set of communication processes relate to institutional responses in disasters. In natural disasters, institutional communication is driven largely by widely disseminated and applied models that are intended to prevent harm and to provide resources to address harm and to reduce further negative consequences to health and well-being. Institutions and their agencies provide resources immediately following the disaster to meet basic human needs and, thereafter, to restore normalcy to the community and thereby protect community members’ physical and mental health. These efforts assume that natural disasters unfold in predictable stages (i.e., preparedness, warning, post-disaster, recovery) and that institutions’ responses should vary according to the stage of the disaster. In contrast, no such response models exist for slowly-evolving human-caused disasters. Moreover, community members experiencing such disasters often encounter what they perceive as institutional failures by both community-based and external responding institutions. Often community institutions (e.g., business, government) are perceived as causing the disaster and/or minimizing it, if not denying its existence or covering it up. As a result, communities experiencing this class of disasters tend to develop substantial distrust for local and responding institutions.

Article

Cancer Communication Science: Intergroup Perspectives  

Lisa Sparks and Gary L. Kreps

At the heart of cancer communication research is an effort both to increase knowledge and to identify practical strategies for improving cancer communication and for improving prevention and control of cancer, as well as for addressing cancer care issues from theoretical and applied communication perspectives across the continuum of cancer care. One important theoretical approach to consider in cancer communication science is taking an intergroup approach to cancer care. The challenge moving forward is to develop cancer communication research programs that combine important theoretical and applied perspectives, focusing on prevention strategies that can help reduce cancer risk, incidence, morbidity, and mortality, and to promote the highest quality of life for people of every age and every background.

Article

Death and Dying: An Intergroup Communication Approach  

Chien-Yu Chen

Death is inevitable: We witness the death of others and eventually face our own. However, people in general view death as taboo and tend to avoid discussing their own or others’ mortality. A cultural shift has been taking place in the developed world so that dying has become an increasingly medicalized process, where death is viewed as something to be stopped or delayed instead of accepted as part of a natural life cycle. As family members are less responsible for the dying process, communication about death and dying becomes a sensitive topic and is often ignored or avoided. Lack of this meaningful communication can lead to stereotypes about the dying person, conflict among family members, and fear of death. Talking about death and dying, if done correctly, can have a positive impact on health-care delivery and the bereavement process. Incorporating knowledge of intergroup communication with a lifespan approach can deepen communication effectiveness about death and dying. People’s group identities can play important roles in the conversation about death and dying. As children and adolescents, people can encounter the death of older family members (e.g., grandparents) and the communication here can be intergenerational. Due to age differences, younger adults may feel uncomfortable to react to older adults’ painful disclosure of death and the bereavement process. During adulthood, people deal with the death uncertainty for themselves and their loved ones. The communication in this period can be intergenerational and inter-occupational, especially when there are third parties involved (e.g., medical providers or legal authorities). Death and dying communication tend to happen mostly, albeit not always, during the later lifespan, as time of death approaches, among older adults, family members, and medical providers. These conversations include advanced care planning (i.e., arrangements and plans about the dying process and after death), medical decision making, palliative care, and final talks. Increasing the awareness of death and dying can help to normalize the dying process.

Article

Grounded Theory Methodology  

Paul Sebastian Ruppel and Günter Mey

Grounded theory methodology is one of the most widely used approaches to collect and analyze data within qualitative research. It can be characterized as a framework for study design, data collection, and analysis, which aims at the development of middle-range theories. The final result of such a study is called a “grounded theory,” and it consists of categories that are related to each other. Health and risk message design researchers working with grounded theory methodology are explicitly invited to use any kind of data they consider suitable for a particular project. Grounded theory methodology studies were originally based on intense fieldwork data, but in the meantime, interviews have become the most widely used type of data. In addition, there is a growing interest in using visual data such as pictures or film. Grounded theory methodology originated from sociology, but has since been applied in many different disciplines. This widened application went along with modifications, new developments, and innovations, and led to several current variants of grounded theory methodology. Basic features of grounded theory methodology include theoretical sampling, specific coding procedures with a comparative approach to analysis, and memo writing. The strategy of theoretical sampling requires that theoretical insights gained from the analysis of initially collected data guide subsequent data collection. Hence, during the research process data collection and analysis alternate and interact. For data analysis, different ways of coding enable the researcher to develop increasingly abstract conceptual ideas and reflections, first embodied in codes, later in categories. This analytical process allows for a step-by-step development of categories that are grounded in data. Category development entails comparisons at all stages, for example, of different cases during sampling, of different data pieces, and of different codes and categories during analysis. As a result, grounded theory methodology is also known as the constant comparative method. Throughout the research process the researcher writes memos and keeps track of the development of conceptual ideas, methodological reflections, and practical to-dos. Today, many researchers use software specifically developed to assist the process of qualitative data analysis.

Article

Media Literacy as a Consideration in Health and Risk Message Design  

Yvonnes Chen and Joseph Erba

Media literacy describes the ability to access, analyze, evaluate, and produce media messages. As media messages can influence audiences’ attitudes and behaviors toward various topics, such as attitudes toward others and risky behaviors, media literacy can counter potential negative media effects, a crucial task in today’s oversaturated media environment. Media literacy in the context of health promotion is addressed by analyzing the characteristics of 54 media literacy programs conducted in the United States and abroad that have successfully influenced audiences’ attitudes and behaviors toward six health topics: prevention of alcohol use, prevention of tobacco use, eating disorders and body image, sex education, nutrition education, and violent behavior. Because media literacy can change how audiences perceive the media industry and critique media messages, it could also reduce the potential harmful effects media can have on audiences’ health decision-making process. The majority of the interventions have focused on youth, likely because children’s and adolescents’ lack of cognitive sophistication may make them more vulnerable to potentially harmful media effects. The design of these health-related media literacy programs varied. Many studies’ interventions consisted of a one-course lesson, while others were multi-month, multi-lesson interventions. The majority of these programs’ content was developed and administered by a team of researchers affiliated with local universities and schools, and was focused on three main areas: reduction of media consumption, media analysis and evaluations, and media production and activism. Media literacy study designs almost always included a control group that did not take part in the intervention to confirm that potential changes in health and risk attitudes and behaviors among participants could be attributed to the intervention. Most programs were also designed to include at least one pre-intervention test and one post-intervention test, with the latter usually administered immediately following the intervention. Demographic variables, such as gender, age or grade level, and prior behavior pertaining to the health topic under study, were found to affect participants’ responses to media literacy interventions. In these 54 studies, a number of key media literacy components were clearly absent from the field. First, adults—especially those from historically underserved communities—were noticeably missing from these interventions. Second, media literacy interventions were often designed with a top-down approach, with little to no involvement from or collaboration with members of the target population. Third, the creation of counter media messages tailored to individuals’ needs and circumstances was rarely the focus of these interventions. Finally, these studies paid little attention to evaluating the development, process, and outcomes of media literacy interventions with participants’ sociodemographic characteristics in mind. Based on these findings, it is recommended that health-related media literacy programs fully engage community members at all steps, including in the critical analysis of current media messages and the production and dissemination of counter media messages. Health-related media literacy programs should also impart participants and community members with tools to advocate for their own causes and health behaviors.

Article

keepin’ It REAL”: A Case History of a Drug Prevention Intervention  

Michael L. Hecht and Michelle Miller-Day

Adolescent substance use and abuse has long been the target of public health prevention messages. These messages have adopted a variety of communication strategies, including fear appeals, information campaigns, and social marketing/branding strategies. A case history of keepin’ it REAL, a narrative-based substance abuse prevention intervention that exemplifies a translational research approach, involves theory development testing, formative and evaluation research, dissemination, and assessment of how the intervention is being used in the field by practitioners. The project, which started as an attempt to test the notion that the performance of personal narratives was an effective intervention strategy, has since produced two theories, an approach to implementation science that focused on communication processes, and, of course, a school-based curriculum that is now the most widely disseminated drug prevention program in the world. At the core of the keepin’ it REAL program are the narratives that tell the story of how young people manage their health successfully through core skills or competencies, such as decision-making, risk assessment, communication, and relationship skills. Narrative forms not only the content of curriculum (e.g., what is taught) but also the pedagogy (e.g., how it is taught). This has enabled the developers to step inside the social worlds of youth from early childhood through young adulthood to describe how young people manage problematic health situations, such as drug offers. This knowledge was motivated by the need to create curricula that recount stories rather than preaching or scaring, that re-story health decisions and behaviors by providing skills that enable people to live healthy, safe, and responsible lives. Spin-offs from the main study have led to investigations of other problematic health situations, such as vaccination decisions and sexual pressure, in order to address crucial public health issues, such as cancer prevention and sex education, through community partnerships with organizations like D.A.R.E. America, 4-H clubs, and Planned Parenthood.

Article

The ACT2 Program and Eliminating Racial and Ethnic Disparities in HIV and AIDS Clinical Trials: A Case Study in Health and Risk Messaging  

Marya Gwadz and Amanda S. Ritchie

It is well documented that African American/Black and Hispanic individuals are underrepresented in biomedical research in the United States (U.S.), and leaders in the field have called for the proportional representation of varied populations in biomedical studies as a matter of social justice, economics, and science. Yet achieving appropriate representation is particularly challenging for health conditions that are highly stigmatized such as HIV/AIDS. African American/Black, and Hispanic individuals, referred to here as “people of color,” are greatly overrepresented among the 1.2 million persons living with HIV/AIDS in the United States. Despite this, people of color are substantially underrepresented in AIDS clinical trials. AIDS clinical trials are research studies to evaluate the safety and effectiveness of promising new treatments for HIV and AIDS and for the complications of HIV/AIDS, among human volunteers. As such, AIDS clinical trials are critical to the development of new medications and treatment regimens. The underrepresentation of people of color in AIDS clinical trials has been criticized on a number of levels. Of primary concern, underrepresentation may limit the generalizability of research findings to the populations most affected by HIV/AIDS. This has led to serious concerns about the precision of estimates of clinical efficacy and adverse effects of many treatments for HIV/AIDS among these populations. The reasons for the underrepresentation of people of color are complex and multifaceted. First, people of color experience serious emotional and attitudinal barriers to AIDS clinical trials such as fear and distrust of medical research. These experiences of fear and distrust are grounded largely in the well-known history of abuse of individuals of color by medical research institutions, and are complicated by current experiences of exclusion and discrimination in health care settings and the larger society, often referred to as structural racism or structural violence. In addition, people of color experience barriers to AIDS clinical trials at the level of social networks, such as social norms that do not support engagement in medical research and preferences for alternative therapies. People of color living with HIV/AIDS experience a number of structural barriers to clinical trials, such as difficulty accessing and navigating the trials system, which is often unfamiliar and daunting. Further, most health care providers are not well positioned to help people of color overcome these serious barriers to AIDS clinical trials in the context of a short medical appointment, and therefore are less likely to refer them to trials compared to their White peers. Last, some studies suggest that the trials’ inclusion and exclusion criteria exclude a greater proportion of people of color than White participants. Social/behavioral interventions that directly address the historical and contextual factors underlying the underrepresentation of people of color in AIDS clinical trials, build motivation and capability to access trials, and offer repeated access to screening for trials, hold promise for eliminating this racial/ethnic disparity. Further, modifications to study inclusion criteria will be needed to increase the proportion of people of color who enroll in AIDS clinical trials.

Article

Communication, Aging, and Culture  

Robert M. McCann

Research into age and culture strongly suggests that people of different adult generations, regardless of culture, typically regard others and act in ways that display bias in favor of one’s own age group. While people across cultures share some basic patterns of aging perceptions, there is considerable variance in views on older people from one country to the next. Over the past two decades, the tenor of communication and aging research has shifted dramatically. Traditional research into aging across cultures painted a picture of Asia as a sort of communicative oasis for elders, who were revered and communicated to by the younger generations in a respectful and mutually pleasing manner. Compelling evidence now suggests the opposite, which is that (interregion variability in results notwithstanding) elder denigration may be more pronounced in Eastern than Western cultures. Accelerated population aging, rural-to-urban shifts in migration, new technologies, rapid industrialization, and the erosion of cultural traditions such as filial piety, may partially account for these results. Additionally, there are well-established links between communication and the mental health of older people. Specifically, communication accommodation in all of its forms (e.g., over accommodation, nonaccommodation, accommodation) holds great promise as a core predictor of a range of mental health outcomes for older people across cultures.