Stepping back from social norms campaigns: comparing normative influences to other predictors of health behaviors

Recent health campaigns on college campuses have used a social norms approach, which suggests that one's perceptions of others' attitudes and behaviors are the key components in attitude and behavior change. However, the efficacy of social norms campaigns has been mixed. This study was conducted to assess the relationships among sociodemographics, normative perceptions, and individual attitudes on 3 health behaviors. Students at 2 universities (N = 393) completed questionnaires assessing how these variables related to their consumption of alcohol, tobacco use, and exercise behaviors. Regressions indicated that each of these variables was associated with behavior, but varied independent variables emerged as the salient predictors among behaviors. In several conditions the effect of normative perceptions on behaviors was not significant, a finding in direct opposition to social norms marketing. In all 3 behavioral conditions, the variable accounting for the greatest variance was whether or not the individual liked participating in that particular behavior. Thus, although some social norms marketing may be meeting with success, it may be the case that predicted attitudinal and behavioral changes will not be found when applied across diverse health topics.     

HIV阳性者高危行为和影响因素的研究

部分HIV感染者得知感染状况后仍然发生危险行为,可能造成一代传播.一些调查研究显示艾滋病的知晓率、毒品和饮洒、社会支持、社会规范、社会地位、负面情绪及抗病毒治疗等因素对感染者高危行为的发牛有一定影响,所以应开展针对这些因素的预防和干预措施,降低感染者高危行为发生率,减少二代传播.此文对HIV阳性者高危行为的改变情况和改变因素等进行了综述.     

Using social marketing to create communities for our children and adolescents that do not model and encourage drinking

Our children and adolescents are growing up in environments that support, and even, encourage (excessive) drinking. Thus, if we are to address the problem of underage drinking our focus needs to move beyond eliciting behavior change among children and adolescents to changing underlying community attitudes, social norms, and the environment itself. This review sought to examine the evidence base surrounding ‘community-based’ interventions designed to address underage drinking; to determine the extent to which ‘community’ interventions have thus far targeted the broader community and gone beyond behavior-focused strategies and endeavored to change social and physical environments. The review found surprisingly few interventions that sought to comprehensively address social norms at a community level. We need to move (research and interventions) beyond narrowly-focused efforts targeting teens and their parents; it is only when we address alcohol consumption at a population level that we will be able to provide an environment for children and adolescents which does not model (excessive) drinking as a normative social behavior.     

SOMOS: evaluation of an HIV prevention intervention for Latino gay men

Latino gay men face multiple barriers to human immunodeficiency virus (HIV) prevention, in particular a lack of intervention programs that integrate prevention messages with cultural norms and address issues of social marginalization from multiple communities (gay community and Latino community), homophobia and racism. In order to address these specific issues, a multilayered HIV intervention was designed to incorporate and integrate psychosocial and community factors through multiple session groups, social marketing and community presentations. Participants learned strategies for effective community leadership and were encouraged to provide HIV education and address internalized homophobia in their communities. There were a total of 113 Latino gay male participants. Pretests and post-tests at 90-day follow-up were administered to measure knowledge, attitudes and behaviors related to HIV infection, self-efficacy, internalized homophobia and connectedness (i.e. gay community affiliation and social provisions); a risk index was calculated to measure level of behavioral risk for HIV infection. Participants demonstrated lower risk indices and a decrease in partners at 3 and 6 months after the intervention. There was also an increase in reported social support resources, along with an increase in group identification. Connectedness was a strong predictor of the number of sexual partners at the 90-day follow-up. This homegrown program represents a culturally responsive, highly needed and relevant intervention that should be subjected to further rigorous testing.     

Contextual determinants of drug use risk behavior: A theoretic framework

Over the past two decades, public health research has emphasized the role of individual risk behaviors, primarily injection and sexual risk behaviors, in the spread of HIV infection. Much less emphasis has been given to understanding the determinants of these risk behaviors. Although individual characteristics are partly responsible for risky injection and sexual behaviors, they do not explain all the interpersonal variability in risk behavior. Contextual factors associated with HIV risk behavior may include structural factors (e.g., availability of services), social norms and attitudes (e.g., social trust), disadvantage (e.g., neighborhood socioeconomic status), and features of the physical environment (e.g., housing quality). This article presents a conceptual framework that incorporates some of the key contextual domains that may affect drug use behavior. It also presents data from a study of street-recruited drug users as an example of the relations between social contextual factors and frequency of injecting drug use, and discusses some methodological challenges in the study of contextual determinants of drug use behavior.     

Implementing a community intervention program for health promotion

High rates of cardiovascular disease (CVD) among low income African American and Latinos are well documented. While health promotion interventions leading to personal behavior change are known to reduce CVD in white, middle class, more educated populations, these approaches have not been widely tested in poor, minority ethnic communities. This paper describes a community intervention program to reduce cardiovascular disease risk factors in East Harlem, a low income New York City community in Manhattan, whose population is 53% Latino and 39% African American. This primary prevention model seeks to change attitudes, norms and values regarding behaviors that contribute to chronic disease within a defined population through initiating changes in the social, educational, cultural and physical environment. Environmental and organizational conditions that predict successful outcomes for the model and strategies, methods and skills, borrowed from social work and other behavioral sciences to implement and institutionalize community wide lifestyle changes, are highlighted.     

Primary Prevention of Sexually Transmitted HIV Infections: Transferring Behavioral Research Technology to Community Programs

Behavioral research to prevent the spread of human immunodeficiency virus (HIV) infection has made significant progress over the past decade. Most importantly, studies have repeatedly shown that theory-based prevention interventions that build self-efficacy through self-management and communication skills training successfully reduce HIV risk behaviors. Simultaneously, communities have mobilized to develop programs that assist persons in reducing their risk for HIV infection. The degree to which behavioral sciences have contributed to community-based HIV prevention programming is examined in this paper through a systematic assessment of technology transfer in the area of sexual risk behavior reduction. We analyzed the content of twelve community-based HIV risk-reduction programs targeting gay and bisexual men developed by seven of the nation's largest AIDS service organizations. Telephone interviews were conducted with community program developers to determine the source of their programs and whether they had been influenced by behavioral sciences. Evidence was mixed with respect to the degree to which behavioral sciences have contributed to the development of community-based programs. Program elements often reflected research-based models but with questionable fidelity. Evidence for diffusion of research-based information occurred most often when community organizations received direct consultation from behavioral scientists. We suggest that technology transfer in HIV prevention requires behavioral scientists working in communities to serve as translators of theoretical constructs for practical applications. Preventing the spread of HIV could therefore be improved through partnerships between behavioral researchers and communities.     

Youth health outcomes from the Connect-to-Protect coalitions to prevent adolescent HIV infections

We assessed the relationships among HIV-related social and behavioral outcomes resulting from an adolescent-focused HIV structural change initiative in eight urban sites operating Connect-to-Protect coalitions. Over a 4-year period, annual cross-sectional panels of adolescents (N = 2248) completed an audio-computer-assisted interview, providing data on satisfaction with their communities as adolescent-supportive environments, internalized HIV stigma, lifetime HIV-testing, lifetime sexual risk-taking and number of sexual partners in the prior year. We used structural equation modeling to estimate hypothesized links between time since coalition mobilization to our social and behavioral outcomes. Over the 4 years, adolescents perceived their communities to become more supportive (p < .05). Positive perceptions of community support were associated with lower lifetime HIV sexual risk (p < .05). The effect of time on risk behavior was mediated by perceptions of community support. Stigma was unchanged over time. Stigma had damaging effects on risk behavior, effects which were also mediated by perceptions of community support. Special efforts are needed to address the deleterious effect of HIV stigma on high-risk urban adolescents.     

Implementing a Community Intervention Program for Health Promotion

ABSTRACT

High rates of cardiovascular disease (CVD) among low income African American and Latinos are well documented. While health promotion interventions leading to personal behavior change are known to reduce CVD in white, middle class, more educated populations, these approaches have not been widely tested in poor, minority ethnic communities. This paper describes a community intervention program to reduce cardiovascular disease risk factors in East Harlem, a low income New York City community in Manhattan, whose population is 53% Latino and 39% African American. This primary prevention model seeks to change attitudes, norms and values regarding behaviors that contribute to chronic disease within a defined population through initiating changes in the social, educational, cultural and physical environment. Environmental and organizational conditions that predict successful outcomes for the model and strategies, methods and skills, borrowed from social work and other behavioral sciences to implement and institutionalize community wide lifestyle changes, are highlighted.     

The protective effects of community involvement for HIV risk behavior: a conceptual framework

This paper presents a conceptual framework of the protective effects of community involvement in HIV/AIDS-related groups and organizations for HIV sexual risk behavior among gay and bisexual men. The framework delineates hypotheses for future research, and provides a guide for prevention programs based on the active and direct involvement of participants, particularly communities of color. The framework (1) argues that community involvement moderates the association between three socio-structural risk factors (i.e. poverty, homophobia and racism) and sexual risk behavior; (2) posits that community involvement in HIV/AIDS reduces sexual risk behavior via its effects on four mediating factors (i.e. peer norms, self-efficacy, positive self-identity and alienation); (3) proposes five socio-cultural barriers to and facilitators of community involvement in HIV/AIDS (i.e. motives for participation, poverty, acculturation, stigma and perceived opportunities); and (4) addresses burnout as one potential negative consequence of community involvement in HIV/AIDS-related organizations and groups. The conceptual framework advances the understanding of HIV sexual risk behavior by integrating both its socio-structural risk and protective factors. It contributes to health education by specifying how interventions based on collective action (e.g. community involvement) for social change may be effective in generating healthy behaviors at individual and community levels.     

Collective Efficacy and HIV Prevention in South African Townships

South African townships have high HIV prevalence and a strong need for collective action to change normative sexual risk behaviors. This study investigated the relationship between perceptions of individuals about collective efficacy in the community’s ability to prevent HIV and their personal HIV risk behaviors. Men (n = 1,581) and women (n = 718) completed anonymous surveys within four Black African Townships in Cape Town, South Africa from June 2008 to December 2010. Measures included demographics, alcohol use, attitudinal and behavioral norms, sexual health communications, and sexual risk behaviors. In multivariate logistic regressions, men were more likely to endorse collective efficacy if they were married, drank less often in alcohol serving establishments, believed that fewer men approve of HIV risk behaviors, talk more with others about HIV/AIDS, and had more sex partners in the past month. Women were more likely to endorse collective efficacy if they drank alcohol less often, talked more with others about HIV/AIDS, had more sex partners in the past month, but reported fewer unprotected sex acts in the past month. Community level interventions that strengthen collective efficacy beliefs will have to consider both protective and risk behaviors associated with believing that the community is ready and capable of preventing HIV.     

Scoping review of the exclusion and inclusion of rural newcomers in community participation

Few studies have considered the impact of rural migration on rural community engagement. The objective of this research was to undertake a scoping review about the inclusion and exclusion of newcomers in rural community participation to inform design of inclusive participation processes. The scoping review used the six stages of Arksey and O'Malley's methodological framework. Narrative analysis of the articles was structured using three themes of inclusion and exclusion derived from the literature: interpersonal, socio‐cultural norms, and structural and organisational processes. Inclusion and exclusion at the interpersonal level is intricate and often represents broader social rules and tensions that newcomers must navigate in order to become involved. Social norms, such as fear of outsiders and difference, can exclude newcomers from participating in a rural community. Newcomer's awareness of these issues means they are mindful of how they contribute and give respect to the social position of existing residents. Despite this, resistance to change is experienced by newcomers when contributing in organisational contexts. Formal participation processes can harness the practice and value of rural hospitality that newcomers experience as inclusionary. Deliberately designing group processes and operational norms for inclusion can reduce tensions when change occurs and prevent group loss due to exclusionary practices.     

Social marketing as a tool to improve behavioral health services for underserved populations in transition countries

Human development efforts continue to change the world and improve quality of life for humans. Without the struggle and drive to contemplate new ideas to improve society, the global community would be in a constant state of oppression. Although cultures and norms change as international boundaries are crossed, the universal goal is to improve standards of living to include behavioral health services for underserved populations. In recent times, pioneers and community groups have used social marketing as an instrument to change public perceptions and behaviors within societies. These efforts have transformed nations in the acceptance and understanding of community health and rehabilitation, education, service, and human rights. This article examines the justification for utilization of the concepts and tools of social marketing to bring about proactive behavior modification among segments of underserved populations. A section of this article provides an overview of the basics of social marketing for the benefit of makers of health policy in transition countries. Finally, the case of 2 underserved population segments in the Republic of Slovakia, a new member of the European Union (former socialist block member), is examined for possible implementation.     

Community AIDS/HIV risk reduction: the effects of endorsements by popular people in three cities.

OBJECTIVES. It is critical to extend community-level acquired immunodeficiency syndrome (AIDS) prevention efforts beyond education alone and to develop models that better encourage behavioral changes. Gay men in small cities are vulnerable to human immunodeficiency virus (HIV) infection due to continued high rates of risk behavior. This research introduced an intervention that trained popular people to serve as behavioral change endorsers to peers sequentially across three different cities. METHODS. Populationwide surveys were conducted of all men patronizing gay clubs in each city to establish risk behavior base rates. After a small cadre of popular "trendsetters" were identified, they received training in approaches for peer education and then contracted to communicate risk reduction recommendations and endorsements to friends. Surveys were repeated at regular intervals in all cities, with the same intervention introduced in lagged fashion across each community. RESULTS. Intervention consistently produced systematic reductions in the population's high-risk behavior (unprotected anal intercourse) of 15% to 29% from baseline levels, with the same pattern of effects sequentially replicated in all three cities. CONCLUSIONS. This constitutes the first controlled, multiple-city test of an HIV prevention model targeting communities. The results support the utility of norm-changing approaches to reduce HIV risk behavior.     

AIDS prevention through school health education: some sensitive issues

AIDS education for young people 10-24 years old requires special attention given the prevalence of high-risk social and sexual behaviors in this age group. Schools represent neglected agents of behavioral change and vehicles for the dissemination of AIDS-related information. Sex education has been shown to lead to more responsible behavior in young people and reduces the exposure to HIV risk by delaying the initiation of sexual activity or increasing condom use. Although program goals may vary from school to school, the general goals of AIDS education are to reduce the risk of infection by imparting accurate information about HIV/AIDS, correct myths and misinformation, create an appropriate degree of concern and motivation for behavioral change, build skills needed to avoid high-risk situations, and eliminate fears and prejudiced attitudes toward people with AIDS. A clearly formulated policy that takes account of the moral, cultural, religious, and philosophical issues related to HIV/AIDS is essential to the success of school-based AIDS prevention. Also important is support from teachers, parents, and the community.     

Norms,social networks,and HIV-related risk behaviors among urban disadvantaged drug users

Altering norms may be an important approach to introducing and sustaining health protective behavior change. This study sought to examine the relationship between condom use, condom norms, and social network characteristics among a sample of economically impoverished individuals at risk for acquiring and transmitting HIV. Participants were 1051 individuals from a drug-using community in the USA. Eighty percent were current drug users; 17% were HIV seropositive. Reported condom use was strongly associated with peer norms about condom use (friends talking about condoms, encouraging condom use, and using condoms). Women were less likely than men to report that their friends used condoms. Injection drug use was negatively associated with peer norms about condom use, while church attendance and network characteristics were positively associated with condom-promoting norms. The size of the health advice and the financial support networks was most positively related to condom norms. Network methodology may aid in the identification of specific ties that promote condom use norms in a population. The findings of this study may have implications for norm change interventions among disadvantaged communities at high risk for HIV/AIDS.     

Communication,Reasoning, and Planned Behaviors: Unveiling the Effect of Interactive Communication in an Anti-Smoking Social Media Campaign

This study examines direct and indirect effects of interactive communication in an antismoking social media campaign. To that end, we pose a multitheoretical framework that integrates communication mediation models and the Theory of Planned Behavior. To test the theorized model, we conducted an experiment using a two-group pretest–posttest design. Participants (N = 201) were randomly assigned into two experimental conditions: “campaign message reception only” as a control group and “message reception and social interaction” as a treatment group, in which the participants contributed to the antismoking campaign by posting their own campaign ideas and information they found through mediated and interpersonal communication. The findings show that interactive communication catalyzes the participants’ information searching behaviors through diverse communication channels. In turn, increased media use plays a crucial role in changing their attitudes and perceived social norms about smoking behaviors, and eventually reducing smoking intention. This study affirms that the theory of planned behavior is effective in predicting behavioral intention and demonstrates the usefulness of a multitheoretical approach in interactive campaign research on social media.     

Forms of Safety and Their Impact on Health: An Exploration of HIV/AIDS-Related Risk and Resilience Among Trans Women in Lebanon

Using minority stress theory, the authors investigated risk behaviors of transgender women (trans women) in Lebanon. Using semistructured interviews, the authors explored six areas: relationships with family and friends; openness about gender and sexuality; experiences with stigma; sexual behavior; attitudes and behaviors regarding HIV testing; and perceived HIV-related norms among transgender peers. Participants voiced the importance of different forms of safety: social/emotional, physical, sexual, and financial. Strategies for obtaining safety were negotiated differently depending on social, behavioral, and structural factors in the environment. In this article, we provide study findings from the perspectives of trans women, their exposure to stigma, and the necessary navigation of environments characterized by transphobia.     

Effectiveness of an HIV prevention intervention in prison among African Americans, Hispanics, and Caucasians.

Prisons and prison inmates present important targets for HIV/AIDS prevention interventions. Inmates often have histories of high-risk behavior that place them in danger of contracting HIV/AIDS, and rates of HIV/AIDS tend to be much higher in this population. The goal of this study was to assess the effectiveness of a prison-based HIV/AIDS intervention to change attitudes toward HIV prevention, norms supporting HIV prevention, perceived behavioral control (i.e., self-efficacy) for HIV prevention behaviors, and intentions to engage in HIV prevention behaviors postrelease. The intervention also had the goal of encouraging inmates to become HIV/AIDS peer educators. The intervention appeared most successful at influencing beliefs and behaviors related to peer education and somewhat successful at influencing beliefs and intentions related to condom use. Analyses also showed some significant differences in effectiveness by race/ethnicity. Results are discussed from the perspectives of both research and practice with regard to prison-based HIV prevention efforts.