Evaluation of a mass-media-led campaign to increase Pap smear screening. Increase of vaccination coverage by mass media and individual approach: intensified measles, mumps, and rubella prevention program in Finland. Returned-medicines campaign in Birmingham, 1977. 911 and emergency department use for chest pain: results of a media campaign. Effect of information campaign by the mass media on hysterectomy rates. Further experience of public education for the early diagnosis of malignant melanoma in Leicestershire. [Campaign of early detection of melanoma in the Provence-Alpes-Côte-d'Azur area 1989. Lessons of an experience]. Immediate effects of a public education campaign on prognostic features of melanoma. Effects of professional and media warnings about the association between aspirin use in children and Reye's syndrome. Harnessing the heightened public awareness of celebrity HIV disclosures: "Magic" and "Cookie" Johnson and HIV testing. HIV testing in Glasgow Genito-Urinary Medicine Clinics 1985-1987. The planning, implementation and evaluation of an immunization promotion campaign in South Australia. Influences of educational interventions and adverse news about calcium-channel blockers on first-line prescribing of antihypertensive drugs to elderly people in British Columbia. General practitioner and patient response during a public education program to encourage skin examinations. Effect of Nancy Reagan's mastectomy on choice of surgery for breast cancer by US women. Do public media campaigns designed to increase skin cancer awareness result in increased skin excision rates? [An awareness campaign on the diagnosis and prevention of colon and rectal cancer. Planning and evaluation of its results]. Cutaneous malignant melanoma. Publicity, screening clinics and survival--the Edinburgh experience 1982-90. A media campaign aiming at reducing delay times and increasing the use of ambulance in AMI. HIV testing: changing trends.
A health education campaign designed to encourage women between the ages of 18 and 70, especially 'older' women (defined as those 50 and over), to have a Pap smear took place in New South Wales (NSW), Australia in early 1988. The campaign involved the mass media, some related community activities and mailing of an educational package to all General Practitioners. According to a sample survey the media campaign was recalled by just over 40% of its target audience. Outcome evaluation was based on the analysis of Pap smear records for a representative 10% sample (N = 338 000) of women registered with the Australian universal health insurance scheme in NSW and three control States. From logistic regression models we estimate that, for women over 50 years and older in NSW, there was a 30% increase overall in Pap smears during the 4 months following the campaign and a 50% increase amongst those who had not had a smear in the previous 2 years. Smaller increases were observed in some other States. Increases of 13-20% were observed among the younger age groups in NSW. Although the campaign appears to have prompted short-term increases in screening rates, the effect is too small to make a substantial impact on the size of the under-screened population. In the 1970s, mass vaccination projects were started in various parts of the world against measles and congenital rubella, with eradication as the final goal. In many developing and industrial countries, including Finland, the elimination of measles failed because of low vaccination coverage. In Finland, a combined measles, mumps, and rubella (Virivac) vaccination program was started in 1982. Computerized recording of the vaccinated children was considered necessary and was integrated with the population registry to identify the hard-to-reach families. Several interventions improved compliance: a mass media campaign and notification of nonvaccinated children to local health professionals and parents. All successive campaigns increased vaccination coverage significantly, with the notification of parents about their nonvaccinated child being especially effective. A vaccination coverage of over 96% was achieved, which theoretically prevents measles, mumps, and rubella transmission. In a returned-medicines campaign lasting 3 weeks 362000 tablets and capsules were returned in 11400 containers from a population of 1.05 million. This yield was considered low. A comparison of hospital admission figures for childhood poisoning before, during, and immediately after the campaign suggests that the publicity and the destruction of unwanted medicines had little preventive value. The quantities of different medicines returned were roughly proportional to the quantities prescribed. We evaluated the effects of a community public education campaign that encouraged patients to quickly call 911 after the onset of acute myocardial infarction (AMI) symptoms.
                The media campaign focused on residents 50 years of age or older in King County, Washington, which has a population of 1.5 million (1990 census).
                We determined 911 responses for chest pain, emergency department visits for AMI symptoms, the number of patients admitted to a CCU with an admitting diagnosis of rule-out MI, and the number of confirmed AMIs before and after the campaign.
                The number of emergency medical services (EMS) responses (911 runs) for patients 50 years of age or older experiencing AMI symptoms increased significantly during the media campaign. ED visits for chest pain also increased significantly during the campaign, as did the number of patients 50 years of age or older admitted to a King County CCU with an admitting diagnosis of rule-out MI. Each of the above increases tapered--with time after the media campaign but remained above baseline.
                An intense public education campaign can significantly increase EMS use, ED visits, and CCU admissions for AMI symptoms. However, these effects taper off with time after the campaign. The annual frequency of hysterectomy was monitored in the Canton Ticino, Switzerland, from 1977 to 1986. From February to October, 1984, there was a public information campaign in the mass media about rates of and need for hysterectomy. After the start of the campaign and during the following year the annual rate of operations per 100,000 women of all ages dropped by 25.8%, whereas in the reference area (Canton Bern), where no information was given to the public, hysterectomy rates increased by 1%. In the same period the hysterectomy rate per 100,000 women aged 35-49 declined by 33.2%, and the number of hysterectomies performed annually per gynaecologist decreased by 33.3%. In Canton Bern these rates were unchanged. The decline began 2 months after the start of the information campaign. The reduction in the number of hysterectomies was greater (p less than 0.001) in non-teaching hospitals (31.9%) than in teaching hospitals (18.1%). Information on regional rates and on the need for hysterectomy given through the mass media to the general population can change professional practices. Publicity campaigns alerting the public to the need for early attention to malignant melanoma (MM) were conducted in Leicestershire, England during the summers of 1987, 1988 and 1989. There was a marked, and statistically significant, rise in the number of referrals with good prognosis MMs in the period immediately after the first campaign. In the 2 subsequent years, despite further publicity campaigns, the number of MMs diagnosed per week remained lower than the postpublicity peak of 1986/87. The postpublicity rise was less marked in 1987/88 and 1988/89. In the next year (1989/90), in which there was no publicity campaign, the total number of MMs seen was higher than in 1988/89. Numbers of MMs seen per week remained relatively steady throughout the year. There was again no publicity in 1990/91, and the total number of MMs diagnosed was about the same as in the previous year. There was a rise in the number of MMs seen per week in what would have been the postpublicity period of this year. The initial results would be consistent with the initial postpublicity rise in numbers of MMs seen being made up of lesions seen 'early', that is, in 1986/87 and 1987/88. Since these lesions were seen earlier than they would have been had there been no publicity, the number of MMs seen in 1988/89 was lower than it would otherwise have been and the publicity effort appeared to have less effect. By 1989/90 and 1990/91 this effect seems to have been wearing off. It may be that, at least in low MM incidence areas like the UK, it is better to pulse public education for the early diagnosis of melanoma rather than to use annual or continuous campaigns. However, longer-term experience, and the pooling of data between centres will be necessary to test this conclusion. The prognosis of melanoma is closely related to tumor thickness at the time of surgical excision. Thickness depends on the duration of disease before diagnosis. This underlines the importance of information campaigns to promote early diagnosis of melanoma. The purpose of this study was to estimate the cost and effectiveness of a media campaign for the early screening of malignant melanoma (MM) at national level. This trial, the first of its kind in France, was conducted in the spring of 1989 in the Provence-Alpes-Côte d'Azur-Corse region. The campaign combined an effort to inform and heighten awareness in the medical community and the broadcast of an information movie for the general population on a regional TV channel. Following the campaign, the number of MM diagnosed in a representative selection of pathology laboratories increased significantly compared with the same period of the previous year: + 108 p. 100 over the 10 first weeks, + 47.6 p. 100 over 6 months. This increase was mostly for MM of low thickness (less than 1 mm) which have a good prognosis: + 74 p. 100 over 6 months. However MM distribution by thickness was not significantly different from one year to the next. Although the number of added cost generated by this campaign could not be precisely determined, these positive initial results argue for a national prevention campaign based on the lessons of this experience. nan The media played a central role in changing the use of aspirin among children with viral illness following reports of its association with a rare but deadly disease, Reye's syndrome (RS). It did so by alerting health professionals and parents about ways to prevent RS in children. Indeed, by the time aspirin product labeling was required by the FDA in 1986, most of the decline in RS incidence had already occurred. In the past, media-only health education campaigns have been relatively unsuccessful in achieving long-term changes in complex health behaviors. This article supports the theory that media warnings about the hazards of common products may successfully change consumer behaviors when the illness is devastating, the behavioral message is simple, acceptable and inexpensive alternatives are available, and the campaign is comprehensive, involving multiple professional groups to reinforce direct appeals to consumers. This article investigates the impact NBA basketball star Earvin ("Magic") Johnson's HIV disclosure had on changes in demand for HIV counseling and testing services in New York State's 61 Anonymous HIV Counseling and Testing sites. Interrupted time-series analyses were conducted on weekly data from over 34,000 clients seeking anonymous HIV counseling and testing services from January 1991 to June 1992, to determine whether demand for these services changed as a result of the disclosure. Results indicated that immediately following the HIV disclosure, there was a substantial increase in service demand, which transcended all sex, race, age, and most HIV risk-related boundaries. Seven months later, demand had not returned to pre-disclosure levels. The strong impact on females, coupled with additional data analyses in obstetrical settings, suggests that previous research has been too narrow in focus, and that the effect of Johnson's HIV disclosure has been enhanced, in part, by the publicity surrounding his wife and baby. The importance of harnessing the heightened public awareness of celebrity HIV disclosures is discussed. Between 1 March 1985 and 28 February 1987, 1659 patients attending Glasgow Genito-Urinary Medicine (GUM) Clinics were tested for antibodies to human immunodeficiency virus (HIV). Forty (2.4%) were positive. Thirty-seven of these were homosexual (36/37) or bisexual (1/37) males. The overall prevalence of antibodies to HIV in this group was 3.9% (37/940) and showed no significant increase over the two year period. Following the extensive media campaign in October 1986, the total numbers tested each month rose from an average of around 50, to 144 in December 1986. There was a further rise to 220 in March 1987 coinciding with AIDS week in March 1987. Since then the numbers have again declined. Before the October campaign, 70% of these tested (692/990) were homo/bisexual males. After the campaign the number of heterosexual males and females rose sharply, accounting for 68% of these tested. nan The way in which dissemination of evidence changes medical practice needs to be better understood. Controversy about calcium-channel blockers (CCB) in the past 3 years has provided a natural experiment, enabling assessment of the impact of media stories, a national warning letter, a teleconference, small group workshops, and newsletters on first-line prescribing of antihypertensive drugs.
                We included all physicians (4403) in British Columbia who prescribed a thiazide diuretic, beta-blocker, inhibitor of angiotensin-converting enzyme (ACE), or CCB as the first antihypertensive agent for 36,507 residents aged 66 years and over, with no previous or concurrent sign of underlying cardiovascular disease. We used a database covering all prescriptions to elderly people to measure the change in proportion of newly treated patients who received each class of drug as first-line therapy. We used a matched cohort design for assessment of the teleconference and workshops, a randomised community design for the newsletters, and time-series analysis for the media impacts.
                The proportion of patients who received a CCB as first-line therapy declined gradually from 22% in early 1994 to 15% in late 1996. This proportion was not affected by two waves of adverse news about CCBs in 1995, but fell by 5% for 5 months and by 3% for 1 month after two waves in 1996. The proportion of patients who received either a CCB or an ACE inhibitor as first-line therapy, contrary to guidelines, was still 42% overall in 1996. The workshops and newsletters were followed by shifts from first-line CCB to first-line thiazide prescribing.
                Changes in prescribing practices occur gradually with the accumulation of small impacts from educational interventions and lay media attention. To describe the response of general practitioners (GPs) and patients during the 1991 National Skin Cancer Awareness Week media campaign.
                Skin examinations in general practices in three representative regional towns in Queensland were monitored for five weeks around the time of the campaign and participating GPs were personally interviewed.
                Number and type of consultations in which the skin was examined for cancer before, during and after the campaign, and GPs' attitudes and beliefs about skin checks.
                The 46 GPs (47%) who participated, representing 60% of the practices, conducted 1805 consultations in which the skin was examined for cancer. The number of consultations in which skin examinations were conducted by each GP increased by 56% during the campaign. Skin checks were nearly always initiated by the patient (90%), and in only half of all cases was the examination given as the primary reason for the consultation. Sixty-two per cent of lesions were considered to be clinically benign.
                Public education programs may have an impact on the level of skin examinations requested in general practice consultations. Currently, patients are the principal initiators of such examinations during consultations--there is potential to increase the active role played by GPs in support of patient requests for the early detection of skin cancer. While the actions of popular figures are believed to influence the behavior of the general public, including health care decisions, little research has examined such an effect.
                To determine whether a temporal association exists between use of breast-conserving surgery (BCS) for treatment of breast cancer and Nancy Reagan's mastectomy in October 1987.
                Population-based observational cohort study.
                Two sources of data: (1) 82 230 women aged 30 years and older who were included in the Surveillance, Epidemiology, and End Results tumor registry because of a diagnosis of local or regional breast cancer from 1983 to 1990; and (2) 80057 female Medicare beneficiaries aged 65 to 79 years who received inpatient surgery for local or regional breast cancer in 1987 or 1988.
                Percentage of use of BCS vs mastectomy over time.
                Compared with women undergoing surgery for breast cancer in the third quarter of 1987 (just prior to Mrs Reagan's mastectomy), women were 25% less likely to undergo BCS in the fourth quarter of 1987 (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.66-0.85) and in the first quarter of 1988 (OR, 0.76; 95% CI, 0.67-0.86). In subsequent quarters, the rate returned to the baseline. In multivariate analyses, the decline was significant among white but not nonwhite women. It was most prominent among women aged 50 to 79 years in the central and southern regions of the country, and most sustained among women living in areas with lower levels of income and education.
                Celebrity role models can influence decisions about medical care. The influence appears strongest among persons who demographically resemble the celebrity, and those of lower income and educational status. We report on an observational study of one city in Queensland over a 30-month period to evaluate the effects of two public skin cancer campaigns on the excision rates of melanocytic skin lesions. The numbers of melanomas, the numbers of potentially malignant melanocytic lesions (Hutchinson's melanotic freckles and dysplastic naevi) whose excision might have benefited the patient, and the total number of melanocytic skin lesions submitted to pathology services were recorded. A total of 3221 melanocytic skin lesions were excised. More lesions were excised during summer than non-summer periods (rate ratio 1.22, 95% CI 1.06, 1.40) and, independently, during campaign periods than non-campaign periods (rate ratio 1.24, 95% CI 1.11, 1.37). There were 145 melanomas (4%), of which 116 were < 0.76 mm thick, and an additional 53 (2%) other potentially malignant lesions. During campaigns, proportions of neither type increased significantly, nor was there a significant reduction in excised melanoma thickness. Doctors reported more often that the reason for excision was to exclude malignancy during the campaigns, although they felt themselves to be under less pressure from patients to excise lesions. There may be considerable cost associated with primary prevention campaigns in the form of increased excision of benign skin lesions, which should be addressed in future skin cancer public awareness campaigns. Colorectal cancer is very frequent in Argentina. It is the third most frequent cancer, after skin and breast tumor in the city of Rosario. Our population usually ignores the symptoms of colonic cancer and early diagnosis are infrequent. The Societies of Gastroenterology, Oncology and Colonoproctology organizes a public awareness campaign during july, august and september 1985 in Rosario and its surrounding (population 1,300,000) by means of newspaper, radio and specially by television, describing the symptoms were present, as well as insisting of the possibility of prevention by endoscopy diagnosis and removal of polyps. Literature and pamphlets were distributed, and information letters were send to all the physicians in Rosario. An International update meeting on colon and rectal took place. The results of this campaign were evaluated through the Tumor Registry of Rosario. Since september 1984 still february 1986, the monthly incidence of polyps and cancer of the colon and rectum was recorded. The monthly average incidence of polyps was 18.9. Previous to the campaign, the monthly average of diagnosed polyps was 17.5; during the campaign, 27.5; and after it, 13.8. The monthly average of colorectal cancer was 39, before the campaign, 41; during the campaign, 49, and 26 afterwards. These results were statistically studies by the parametric test of Mann and Whitney. During the campaign a significant (p = 0.05) increase of diagnosed polyps and cancers, was found. Our conclusion is that the awareness was successful, but we think that it is necessary to insist with periodic and longer campaigns. The incidence of cutaneous malignant melanoma has increased considerably in south-east Scotland over recent years. In 1987 the Cancer Research Campaign launched a project to aid the early detection, diagnosis and treatment of malignant melanoma. Edinburgh, chosen as one of seven centres in the U.K. to participate in the study, was provided with funding for a direct access pigmented lesion clinic from 1987 to 1989. The changes in the pattern of cutaneous malignant melanoma before, during and after the publicity campaign have been examined; between 1982 and 1990. The incidence of malignant melanoma doubled from 5.7 to 11.4/100,000 per annum. The percentage of thin tumours (Breslow thickness < or = 1.5 mm) increased steadily and significantly (from 43% in 1982 to 68% in 1990), but the number of thick tumours (Breslow thickness > 3.0 mm) remained constant over the same period (22 +/- 3.8). The influence of publicity was assessed using a questionnaire. Those who were influenced by publicity were significantly younger and had more thin tumours (Breslow < or = 1.5 mm) than those who were uninfluenced by publicity. Five-year survival has significantly increased from 70% in the 1982-84 cohort to 84% in the 1987-89 cohort. The effect of the publicity campaign has been beneficial, but the impact on mortality cannot yet be assessed. To improve the prognosis in patients with acute myocardial infarction (AMI) if treatment by early instituting treatment, we initiated a media campaign during 1 year with the intention to reduce delay times and increase ambulance use in patients with acute chest pain. This article describes the outcome during 3 years after the campaign was finished. The median delay time in patients with AMI was reduced from 3 hours 0 min before the campaign to 2 hours 20 minutes during the year of the campaign (P < .001). The median delay time remained at a similar level (2 hours 20 min) during the 3 years after the campaign. Ambulance use was not affected during or after the campaign. It can be concluded that a media campaign resulted in a reduction of delay times not only during the campaign, but also during 3 years after its performance, whereas ambulance use was not affected. nan
Despite the limited information about key aspects of mass media interventions and the poor quality of the available primary research there is evidence that these channels of communication may have an important role in influencing the use of health care interventions. Although the findings of this review may be affected by publication bias, those engaged in promoting better uptake of research information in clinical practice should consider mass media as one of the tools that may encourage the use of effective services and discourage those of unproven effectiveness.