Eppm Theory and HIV Prevention

9 YEAR AIDS SURVIVOR AT GEORGE MASON UNIVERSITY

PHOTO: Virginia Nguyen STORY: Christina Mennella . (April 30, 2007). Beating the Odds: Struggling With AIDS While Balancing School. Broadside, p. G12.

EPPM THEORY AND HIV PREVENTION

COURSE WORK:

BIS 490 HEALTH COMUNICATION PROJECT

JACK TURNER, GEORGE MASON UNIVERSITY

MENTORS:Dr. Nithya Muthuswamy

Dr. Xiaoquan Zhoa

READER : Dr. Michael Hurley

STATISTICS: Dr. Michael Hurley

Hillary Mcshea, TA

COURSE WORK:

HEALTH SCIENCES AND

COMMUNICATION

Accurate, Clear Communication about Health Issues

Design Persuasive Health Messages

Test Health Promotion on a Target Audience

MAIN POINTS

Background

Undergraduate Perceptions about HIV / AIDS

Promoting HIV / AIDS prevention

The Extended Parallel Process Model (EPPM)

Project Description

Health Communication Experiment DesignPurposeParticipants Procedure

Results of the Experiment

Limitations and Implications

Undergraduate Perceptions about

HIV / AIDS

Eight studies,1995-2007(Cambell & Babrow, 2004; Davis et al., 2007; Desiderado &

Crawford, 1995; Gagnon & Gidon, 2000; Grello et al., 2006; Labrie et al., 2002; Lance, 1999; Rothman, 1999)

Statistics may be outdated (Hightow et al., 2005).

Promoting HIV / AIDS Prevention

“Even with successful treatment, HIV is a debilitating and fatal disease.”

(Masur, 2002, Yuan, L’Italien, Mukherjee, &Iloeje, 2006 )

Use condoms every timeDe Vincenzi, I. (1994 )

Witte’s Extended Parallel Process Model (EPPM)

Witte, K. (. Putting the fear back in fear appeals. Communication

Monographs 59, 1992.

Figure: Witte, K., (1992)

▲▬▬▬►

▬▬▬►

▼

▬▬▬▬▬►

PHOTOS: Googleimages.com

PROCESS

PERCEIVED EFFICACY

COGNITIVE / LOGICAL

PERCEIVED THREAT

CAN I DEAL WITH IT?

CAN IT HURT ME?

▬▬▬▬▬►

DANGER CONTROL PROCESS

CARTOONS: Calvin & Hobbes Copyright 1988 Bill Watterson

FEAR CONTROL PROCESS

MESSAGE

FEARMESSAGE REJECTION

MESSAGE ACCEPTANCE

OUTCOME▬▬▬▬▬▬▬▬▬►MESSAGE PROCESSING▬▬▬►

Figure: Turner, J. (2008)

Purpose: Test an HIV / AIDS Fear Appeal

Measure Undergraduates’ Response

Six variables: Perceived severity and susceptibility Perceived response efficacy and self – efficacy Perceived fear Condom use intentions

Participants

Procedure: Poster Design and Questionnaire

Participants

PHOTO: Googleimages.com

High Efficacy Poster

DEALING WITH EMBARRASSMENT: IT HELPS TO KNOW WHERE TO BUY CONDOMS AND WHAT THEY ARE LIKE TO HANDLE. BUY SOME WITH A FRIEND. MAKE IT A GAME. LAUGH

ACCORDING TO DE VINCENZI'S STUDY, CONDOMS WERE 100% EFFECTIVE AGAINST HIV TRANSMISSION FROM AN INFECTED PARTNER 1

1 20 MONTH STUDY, 124 COUPLES. DIVENZI STUDY,1994

YOU CAN PREVENT HIV/AIDS

FEMALE CONDOMS ALSO AVAILABLE. MALE CONDOM SHOWN

TIPS FOR TALKING ABOUT CONDOMS:

CONDOMS: SIMPLE EASY AND HIGHLY EFFECTIVE AGAINST HIV

WHEN USED EVERYTIME 1

MIRROR

"I don't know how to use one."

"I do. I want us both to be safe. No glove, no

YOU CAN SAY:IF YOUR PARTNER SAYS:

" I don't use condoms"

START BY ACKNOWLEDGING EMBARRASSMENT: "THIS IS DIFFICULT FOR ME TO TALK ABOUT, BUT I WANT TO BE PROTECTED AGAINST SEXUALLY TRANSMITTED DISEASES

FOR MORE INFO ABOUT USING CONDOMS AND TALKING ABOUT CONDOMS: USE SEARCH TERM "TALKING ABOUT C

"I don't have any condoms." "The drugstore is around the corner."I do. Let me put it on for you."

"I wouldn't give you a disease. Don't you trust me?" "Either one of us could have an STD and not know it. I'm trusting you to care about our health."

THESE TIPS CAN HELP YOU PLAN YOUR TALK ABOUT CONDOMS. MAKE IT CLEAR

THAT YOU WON'T HAVE SEXUAL INTERCOURSE WITH

Besides, you're not going to feel anything without a condom."

"I can't feel anything. There's no sensitivity.""There are new designs that provide more sensation. We can have fun trying different kinds.

Poster Design: Turner, J. (2008)

High Threat Poster

MIRROR

TO YOUNG TO DIE FROM AIDS? THINK AGAIN:

COLLEGE-AGE DEATHS FROM AIDS IN THE

U.S. IN ONE YEAR: 1,386 2

ONE MILLION AMERICANS HAVE HIV.

250,000 OF THEM DO NOT KNOW IT1

CRYPTOCOCCOSIS / AIDS WASTING SYNDROME /AIDS

THIS COULD HAPPEN TO YOU: MAYBE IT’S HAPPENING ALREADY

YOU CAN BE INFECTED WITH HIV, THE VIRUS THAT CAUSES AIDS,

AND NOT HAVE SYMPTOMS 1

2 Center for Disease Control, Basic Statistics, 2005

AIDS: ACQUIRED IMMUNODEFIENCY SYNDROME, A DISEASE

AIDS IS A DEBILITATING, FATAL DISEASE 1

COLLEGE-AGE HIV INFECTIONS IN THE U.S. IN ONE YEAR: 3, 876 2

HIV: HUMAN IMMUNODEFICIENCY VIRUS. HIV CAUSES AIDS1

THAT DESTROYS THE IMMUNE SYSTEM.1

SEXUAL INTERCOURSE (NOT USING A CONDOM).1HIV IS TRANSMITTED PRIMARILY BY UNPROTECTED

1 National Institute of Allergy and Infectious Diseases ,2007


Low Threat Poster

4 Gagnon and Gidon 2000 5 De Vincenzi Study,1994


FOR MORE INFORMATION ON HEALTHY LIVING, CONTACT OR VISIT GEORGE MASON'S STUDENT HEALTH SERVICES, SUB I, ROOM 214

CONDOMS ARE HIGHLY EFFECTIVE AGAINST HIV INFECTION,

WHEN USED PROPERLY AND EVERY TIME, ACCORDING TO DEVINCENZI RESEARCH. 5

COLLEGE STUDENTS USE CONDOMS FREQUENTLY, ACCORDING TO GAGNON AND GIDON STUDY

1 Gayle, H.D., (1990). The New England Journal of Medicine

Kotloff, K.L, . (1991). American Journal of Epidemiology

REPORTED BY THE NEW ENGLAND JOURNAL OF MEDICINE AND AMERICAN JOURNAL OF EPIDEMIOLOGY 1

COLLEGE STUDENTS ARE SEVEN TIMES LESS LIKELY TO BE INFECTED THAN THE REST OF THE U.S. POPULATION , ACCORDING TO THE

NATIONAL HEALTH AND NUTRITION EXAMINATION STUDY 2

2National Health and Nutrition Examination Study, 2002

Mirror

Medical Research New Quick Test Devices

LOW HIV INFECTION RATE IN COLLEGE STUDENTS


AIDS: ACQUIRED IMMUNODEFIENCY SYNDROME3


Fear Appeal

YOU CAN PREVENT HIV/AIDS

FEMALE CONDOMS ALSO AVAILABLE. MALE CONDOM SHOWN

TIPS FOR TALKING ABOUT CONDOMS:

CONDOMS: SIMPLE EASY AND HIGHLY EFFECTIVE AGAINST HIV

WHEN USED EVERYTIME 1

DEALING WITH EMBARRASSMENT: IT HELPS TO KNOW WHERE TO BUY CONDOMS AND WHAT THEY ARE LIKE TO HANDLE. BUY SOME WITH A FRIEND. MAKE IT A GAME. LAUGH

ACCORDING TO DE VINCENZI'S STUDY, CONDOMS WERE 100% EFFECTIVE AGAINST HIV TRANSMISSION FROM AN INFECTED PARTNER 1

1 20 MONTH STUDY, 124 COUPLES. DIVENZI STUDY,1994

MIRROR

FOR MORE INFO ABOUT USING CONDOMS AND TALKING ABOUT CONDOMS: USE SEARCH TERM "TALKING ABOUT C

"I don't have any condoms." "The drugstore is around the corner."I do. Let me put it on for you."

"I wouldn't give you a disease. Don't you trust me?" "Either one of us could have an STD and not know it. I'm trusting you to care about our health."

THESE TIPS CAN HELP YOU PLAN YOUR TALK ABOUT CONDOMS. MAKE IT CLEAR

THAT YOU WON'T HAVE SEXUAL INTERCOURSE WITH

Besides, you're not going to feel anything without a condom."

"I can't feel anything. There's no sensitivity.""There are new designs that provide more sensation. We can have fun trying different kinds.

"I don't know how to use one."

"I do. I want us both to be safe. No glove, no

YOU CAN SAY:IF YOUR PARTNER SAYS:

" I don't use condoms"

START BY ACKNOWLEDGING EMBARRASSMENT: "THIS IS DIFFICULT FOR ME TO TALK ABOUT, BUT I WANT TO BE PROTECTED AGAINST SEXUALLY TRANSMITTED DISEASES

MIRROR

2 Center for Disease Control, Basic Statistics, 2005

AIDS: ACQUIRED IMMUNODEFIENCY SYNDROME, A DISEASE

AIDS IS A DEBILITATING, FATAL DISEASE 1

COLLEGE-AGE HIV INFECTIONS IN THE U.S. IN ONE YEAR: 3, 876 2


THAT DESTROYS THE IMMUNE SYSTEM.1

SEXUAL INTERCOURSE (NOT USING A CONDOM).1HIV IS TRANSMITTED PRIMARILY BY UNPROTECTED


ONE MILLION AMERICANS HAVE HIV.

250,000 OF THEM DO NOT KNOW IT1

CRYPTOCOCCOSIS / AIDS WASTING SYNDROME /AIDS

THIS COULD HAPPEN TO YOU: MAYBE IT’S HAPPENING ALREADY

YOU CAN BE INFECTED WITH HIV, THE VIRUS THAT CAUSES AIDS,

AND NOT HAVE SYMPTOMS 1

TO YOUNG TO DIE FROM AIDS? THINK AGAIN:

COLLEGE-AGE DEATHS FROM AIDS IN THE

U.S. IN ONE YEAR: 1,386 2

High Efficacy High Threat

Sample EPPM Questions

Perceived Severity of ThreatI think AIDS is a fatal disease.

Perceived Response Efficacy

I am protected against HIV infection if I use a condom during sex

1 2 3 4 5 Strongly Disagree Neutral Agree Strongly Disagree Agree

Muthuswamy, N. (2006); Witte, K.,

Meyer, A., & Martell, A. (2001).

Results of the Experiment

No Statistically Significant DifferenceSix variables Means and Differences

Gender and HIV SusceptibilitySignificant differenceP<.011

Sample Statistic: Means

CHART: Turner, J. (2008)

High Threat / High Efficacy

3.31

4.39

2.15

4.22

3.95

3.65

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

1

Six Variables

Med

ian S

core

ss

Fear

Severity

Susceptibility

Response Efficacy

Self-efficacy

Condom Intentions

Low Threat / Low Efficacy

2.9

4.3

2.1

4.1

3.73.6

Implications Posters alone may have little effect

Gender and perceived susceptibilityFemales are at much higher risk(National Institute of Allergy and Infectious Diseases [NIAID],

2006).

Longer duration HIV / AIDS programs

Posters can play an important role

GMU sample compared to others High perception of the severity of HIV / AIDSPartners and sexual activity

Limitations

Expected low fear / low concern population

Convenience sample

Short duration exposure

Male to female ratio

CDC REPORT AUGUST 2008

Hall, H.I. et al. (2008)

REFERENCESCampbell, R.G, & Babrow, A.S. (2004). The role of empathy in responses to

persuasive risk communication: overcoming resistance to HIV prevention messages. Health Communication 16.2, 159-182.

Dahl, D. W., Frankenberger, K, & Manchanda, R (2003). Does it pay to shock? of Advertising Research. 43.3, 268-280.

Davis, C., Sloan, M., MacMaster, S., & Kilbourne, B. (2007). HIV/AIDS knowledge and sexual activity: an examination of racial differences in a college sample. Healthand social work 32.3, 211-218.

Desiderato, L.L., & Crawford, H. (1995). Risky sexual behavior in college students: Relationships between number of sexual partners, disclosure of previous risky behavior, and alcohol use. Journal of Youth and Adolescence 24.1, 55-68.

De Vincenzi, I. (1994). A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. New England Journal of Medicine 331.6, 341-346.

Gagnon, M., & Godin, G. (2000). The impact of new retroviral treatments on college students’ intention to use a condom with a new sexual partner. AIDS Education and Prevention 12.3, 239-251.

Gayle, H.D., Keeling, R.P., Garcia-Tunon, M., Kilbourne, B.W., Narkunas, J.P., Ingram, F.R., & Rogers, M.F., et al. (1990). Prevalence of the human immunodefeciency virus among university students. The New England Journal of Medicine 323.22, 1538-1541.

REFERENCESGrello, C., Welsh, ED., & Harper, M. (2006). No strings attached: The nature of

casual sex in college students. The Journal of Sex Research 43.3, 255-267.

Hall, H.I. et al. (2008). Estimation of HIV incidence in the United States. Journal of the American Medical Association (JAMA) 300.5, 520-529.

Hightow, L.B., Macdonald, P.D., Pilcher, C.D., Kaplan, A.H., Foust, E., & Nguyen, T.Q., et al. (2005). The unexpected movement of HIV epidemic in the Southeastern United States. Journal of Acquired Immune Deficiency Syndrome 38.5, 531-537.

Kotloff, K.L., Tacket, C.O., Clemens, J.D., Wasserman, S.S., Cowan, J.E., & Bridwell, M.W., et al. (1991). Assessment of the prevalence and risk factors for human immunodeficiency virus type 1 (HIV-1) infection among college students using three survey methods. American Journal of Epidemiology 133. 1, 2-8.

Lance, Larry (2001). HIV/AIDS perceptions and knowledge heterosexual college students within the context of sexual activity: suggestions for the future. College Student Journal 35, 401-409.

Masur,H. (2002). Acquired immunodeficency syndrome in the intensive care unit: Will human immunodefiency virus-related admissions continue to decline? American Journal of Respiratory Critical Care. 166, 258-261.

Mennella, C. (April 30, 2007). Beating the odds: Struggling with AIDS while balancing school. Broadside, p. G12.

REFERENCESMcQuillan, G., Kottiri, B., & Kruszon-Moran, D. (2002). The prevalence of HIV in the

United States household population: The national health and nutrition examination surveys, 1988 to 2002.12th Conference on Retroviruses and Opportunistic Infections. February 22-25, 2005. Boston, MA. Abstract no. 166.

National Institute of Allergy and Infectious Diseases (NIAID) (2006). HIV infection in women. NIAID Fact Sheet, May 2006. Retrieved from NAIAD database November 22, 2008.http://www.niaid.nih.gov/factsheets/womenhiv.htm

Rothman, A., Kelly, K., Weinstein, N., O’Leary, A. (1999). Increasing the salienceof risky sexual behavior: Promoting interest in HIV-antibodies among heterosexually active young adults. Journal of Applied Psychology 29.3, 531-555.

Turk. T., Ewing, T.M., & Newton, F.J. (2006). Using ambient media to promote HIV/AIDS protective behavior change. International Journal of Advertising 25.3333-359.

Witte, K. (1992, December). Putting the fear back into fear appeals: The extended parallel process model. Communication Monographs 59.

Witte, K. (1994). Fear control and danger control: A test of the extended parallel process model (EPPM): Communication Monographs. 61,113-134.

Witte, K., Meyer, A., & Martell, A. (2001). Effective health risk messages. Thousand Oaks, CA: Sage Publications, Inc.

Yuan, Y., L’Italian, G., Mukherjee, J., Iloeje, UH (2006, April). HIV Medicine 7.3, 156-162,

Eppm Theory and HIV Prevention

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