Beyond Access: Communication Beyond Access: Communication - PowerPoint PPT Presentation

Beyond Access: Communication Beyond Access: Communication Inequality and its Implications for Inequality and its Implications for Health Disparities Health Disparities K. “ “Vish Vish” ” Viswanath Viswanath K. Harvard School of Public Health Harvard School of Public Health Dana- Dana - Farber Cancer Institute Farber Cancer Institute

Abundance of health information Abundance of health information 80 70 60 # of Stories (in thousands) 50 40 30 20 10 0 1990-4 1980-4 1985-9 1995-9 2000-4 FIGURE: Print news Years coverage of health Tobacco/Smoking Heart Disease Obesity HIV/AIDS issues.

Health- -related news stories related news stories Health increasing increasing 7 6 # of Stories (in thousands) 5 4 3 2 1 0 1980-4 1985-9 1990-4 1995-9 2000-4 Years FIGURE: Ethnic print Heart Disease Tobacco/Smoking Obesity HIV/AIDS coverage of leading health issues.

Figure 1. National TV News Coverage of Leading Health Issues 160 140 120 100 # of Stories 80 60 40 20 0 1980-4 1985-9 1990-4 1995-9 2000-4 Years Heart Disease Tobacco/Smoking Obesity HIV/AIDS

Differential Disease Burden Differential Disease Burden in the Population in the Population � Higher incidence rates: Higher incidence rates: � � Black males more likely to develop Black males more likely to develop � any type of cancer than White any type of cancer than White males males � Higher death rates: Higher death rates: � � Black women are more likely to Black women are more likely to � die from breast cancer than White die from breast cancer than White women. women. � Cardiovascular disease Cardiovascular disease � � SES disparities in smoking SES disparities in smoking �

Cigarette Smoking Among Adults Cigarette Smoking Among Adults by Education 1980- -2004 2004 by Education 1980 less than 12 12 13-15 16 or more 40 35 30 25 Percent 20 15 10 5 0 1980 1985 1990 1995 2000 2004 Year Source: National Health Interview Surveys: 1980, 1985, 1990, 1995, 2000, 2004.

Estimated Prevalence of Diabetes in Adults Estimated Prevalence of Diabetes in Adults (> >20yrs.) by Race/Ethnicity 20yrs.) by Race/Ethnicity ( 2002 and 2005 2002 and 2005 16 14 12 White 10 African American Percent 8 American I ndian 6 Hispanic 4 2 0 2002 Year 2005 Source: American Diabetes Association available at http://www.diabetes.org/diabetes-statistics/prevalence.jsp

Obesity Prevalence by Obesity Prevalence by Education Level 1991- -2001 2001 Education Level 1991 Less than HS HS Some College College 30 25 20 Percent 15 10 5 0 1991 1998 2000 2001 Year Source: CDC, BRFSS, 1991-2001

Why do these disparities exist? Why do these disparities exist? � Social determinants: Social determinants: � � Social cohesion Social cohesion � � Social stratification Social stratification � � Social Class Social Class � � SES SES � � SEP SEP � � Social networks Social networks � � Neighborhood conditions Neighborhood conditions � � Social policies Social policies �

Multilevel approach to Multilevel approach to epidemiology epidemiology Figure: Adopted from Kaplan (2004).

What links social determinants What links social determinants with health outcomes? with health outcomes? Communication one potential Communication one potential thread linking proximal to thread linking proximal to distant factors and their distant factors and their outcomes to health outcomes to health

Multilevel approach to Multilevel approach to epidemiology epidemiology Figure: Adopted from Kaplan (2004).

Functions of Communication in Functions of Communication in Health Health Informational: acquire acquire � Informational: � knowledge knowledge Instrumental: enables action enables action � Instrumental: � Social control: defines social defines social � Social control: � norms norms Communal: access to social access to social � Communal: � capital capital

e s Structural Influence Model of Structural Influence Model of Communication (SIM) Communication (SIM) Social Mediating/ Health Health Determinants Moderating Communication Outcomes Conditions Outcomes Socioeconomic Socio- • Health Media • Knowledge Position Demographics • Health Beliefs • Education • Age Use & Exposure • Information • Comprehension • Income • Gender • Capacity for • Employment • Race/Ethnicity seeking • Attention • Occupation action • Information • Incidence Social Networks • Health Behaviors • Social Capital Processing Place • Prevention • Neighborhood • Screening • Urban versus Social Networks • Treatment • Resources rural • Survivorship • End-of-life care Communication may play a role in linking SES, resources and health outcomes. H e a

Communication Inequality Communication Inequality Differences among social classes in the generation, manipulation, and distribution of information at the group level and differences in access to and ability to take advantage of information at the individual level.

Dimensions of communication Dimensions of communication inequality inequality � At the societal level At the societal level � � Differences in the generation, Differences in the generation, � manipulation and distribution of manipulation and distribution of information among social information among social groups. groups. � Capacity to act on information Capacity to act on information �

Dimensions of communication Dimensions of communication inequality inequality � At the individual level Differences in: � Access to and use of information channels � Attention to health content � Seeking Information � Recall, knowledge and comprehension � Capacity to act on information

Recent Work Recent Work SES, Race and Ethnicity are associated with � subscription to cable or satellite TV and the Internet � daily readership of newspapers � Attention to health content in different media � Differential time with different media � Knowledge gaps in health (Viswanath, 2005; Viswanath, In Press; Viswanath et al., In Press; Ramanadhan & Viswanath, In Press)

Figure 6. Days Read Newspaper in Last Week, by Race 60 P e rc e n t (% ) 40 20 0 Never 1-3 4+ Days White African-American

Figure 4. Days Read Newspaper in Last Week, by Education 60 P e r c e n t (% ) 40 20 0 Never 1-3 4+ Days HS or Less Some College Plus

Figure 5. Days Read Newspaper in Last Week, by Income 60 50 P e r c e n t (% ) 40 30 20 10 0 Never 1-3 4+ Days <$24,999 $25,000 - $49,999 $50,000+

Access to Information Services among Different SES and Racial Ethnic Groups Percent Report Access to Percent Report Access to Cable/Satellite % Cable/Satellite % Internet % Internet % Education (n=6,149) Education (n=6,149) HS or Less HS or Less 77.17 77.17 38.17 38.17 Some College Plus 83.25 80.64 Some College Plus 83.25 80.64 Income (n=6,149) Income (n=6,149) <$24,999 70.91 35.52 <$24,999 70.91 35.52 $25,000 - - $49,999 $49,999 79.20 62.69 $25,000 79.20 62.69 $50,000+ $50,000+ 89.53 89.53 87.64 87.64 Employment Status (n=6,131) Employment Status (n=6,131) Employed Employed 82.03 82.03 73.52 73.52 Not Employed Not Employed 78.70 78.70 47.36 47.36 Race (n=5,666) Race (n=5,666) White 82.56 66.02 White 82.56 66.02 African- -American American 77.30 55.81 African 77.30 55.81 Ethnicity (n=5,666) Ethnicity (n=5,666) Non- Non -Hispanic Hispanic 81.72 81.72 66.42 66.42 Hispanic Hispanic 77.08 77.08 44.94 44.94 Note: For all ethnicity assessments, multi-racial persons were excluded from the analysis. Data from HINTS.