摘要：Objectives. After conducting a media campaign focusing on the importance of oral and pharyngeal cancer (OPC) examinations, we assessed mechanisms of behavior change among individuals receiving an OPC examination for the first time. Methods. We used data from 2 waves of telephone surveys of individuals residing in 36 rural census tracts in northern Florida (n = 806). The second survey occurred after our media intervention. We developed media messages and modes of message delivery with community members via focus groups and intercept interviews. We performed a mediation analysis to examine behavior change mechanisms. Results. Greater exposure to media messages corresponded with heightened concern about OPC. Heightened concern, in turn, predicted receipt of a first-time OPC examination, but only among men. Conclusions. We extended earlier studies by measuring an outcome behavior (receipt of an OPC examination) and demonstrating that the putative mechanism of action (concern about the disease) explained the link between a media intervention and engaging in the target behavior. Improving the quality of media campaigns by engaging community stakeholders in selecting messages and delivery methods is an effective strategy in building public health interventions aimed at changing behaviors. Racial and gender disparities in disease-specific mortality from oral and pharyngeal cancer (OPC) are not new, 1–5 but recent data show that these inequities are widening. 6 According to data from the Surveillance, Epidemiology, and End Results Program, Black men are most at risk for dying from OPC, with a 36.0% 5-year relative survival rate (as compared with rates of 66.6% among White men, 68.0% among White women, and 59.7% among Black women). 7 Moreover, a downward trend in survival rate has been observed among Black men, with the rate decreasing from 48.5% to 36.0% between 2004 and 2006. Although other explanations are plausible, 1 disparities in OPC survival are largely attributed to inequities in stage of diagnosis. 8 Late-stage diagnosis is associated with low survival rates. 8 Blacks are more likely than Whites to be diagnosed at the regional and distant stages, 6,9 when the outcome of the disease is most devastating and costly. 10–12 One explanation for this late-stage diagnosis may be lower rates of OPC examinations (sometimes called OPC screenings) among those who self-identify as Black. 13,14 OPC examination rates are low for a number of reasons, including a lack of overall public awareness of risk factors, signs, and symptoms. 15 These low examination rates are believed to place certain groups, such as men, Blacks, and rural people of lower socioeconomic status, at increased risk for late-stage diagnosis of OPC. Overall, cancer mortality rates are higher among rural residents than urban residents, and rural cancer survivors are more likely than urban cancer survivors to report fair or poor health and health-related unemployment. 16 Thus, it is important to aid rural residents in undergoing examinations for cancer. 16,17 Limited access to health care, especially in rural areas, is one reason why health inequities exist, but access to information and knowledge is also a key factor in health inequalities. 14,18 To date, there is little evidence of the effectiveness of population-wide public health campaigns, 19,20 but there is growing evidence that these campaigns should be carefully and sensitively designed for specific groups and geographic regions. 18,21–23 It seems reasonable that when an individual deems health information relevant, he or she is more likely to pay attention to the message. Viswanath and Emmons have suggested that “framing” messages to target a specific population’s concerns increases attention and salience, leading to behavior change and ultimately improved outcomes. 18 Appropriately reaching different sectors of the public by framing relevant messages according to their health literacy level is a crucial first step in improving overall population health. 24,25 To address Black–White disparities in OPC stage of diagnosis, we propose that messages must be designed to garner the attention of Blacks, must be salient to Blacks, and must contain a call to action. Using these salient messages to increase OPC examinations (and to promote earlier examinations) may have a profound effect on reducing disparities in OPC stage of diagnosis. We designed a small media campaign targeting rural residents (particularly Black residents) to promote OPC examinations. We used images and facts characterizing the disease and disease threat among Blacks. 26 The campaign consisted of posters, brochures, car magnets, and handheld fans placed in different areas of the study communities. Our rationale was that exposure to multiple message delivery modes would be more influential than exposure to a single delivery modality. We were also interested in understanding why our messages might increase OPC examinations. In an earlier study, we found that concern about OPC partially mediated the relationship between message exposure and intention to undergo a free OPC examination. 26 When concern about a health behavior is high, it follows that people are more likely to engage in relevant actions (as predicted by several theories of attitude, persuasion, and behavior change 27–32 ) such as undergoing a cancer examination. Because many people are not aware of OPC and especially its deadly consequences, 14,15 we predicted that our media campaign would raise concern about the disease, which would in turn lead to more first-time OPC examinations among our participants. In our earlier work, we found that there were race and gender effects related to whether participants had heard about and undergone examinations, as well as race and gender effects related to knowledge and concern about OPC. 13,15 These results led us to predict that gender and race would moderate our effects ( Figure 1 ). We hypothesized that our use of multiple messages delivered through multiple modalities designed to be noticeable and important to Blacks 33 would lead to higher OPC concern among Blacks and, ultimately, more first-time OPC examinations among Blacks than among Whites. 18,34 Open in a separate window FIGURE 1— The conceptual study model. Note . OPC = oral and pharyngeal cancer.
